Al-Anii FM, Sadat-Ali M, Al-Tabash KW, AlMulhim AI, AlMousa SA, AlHawas AM. Vancomycin flushing syndrome in orthopaedic practice: A case report. World J Orthop 2023; 14(10): 771-775 [PMID: 37970623 DOI: 10.5312/wjo.v14.i10.771]
Corresponding Author of This Article
Mir Sadat-Ali, FRCS, FRCS (Gen Surg), MBBS, MS, Full Professor, Professor, Senior Scientist, Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, Pobox 40071, AlKhobar 31952, Saudi Arabia. drsadat@hotmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Oct 18, 2023; 14(10): 771-775 Published online Oct 18, 2023. doi: 10.5312/wjo.v14.i10.771
Vancomycin flushing syndrome in orthopaedic practice: A case report
Fawaz M Al-Anii, Mir Sadat-Ali, Khalid Waleed Al-Tabash, Ahmad I AlMulhim, Sulaiman A AlMousa, Abdulaziz M AlHawas
Fawaz M Al-Anii, Mir Sadat-Ali, Khalid Waleed Al-Tabash, Ahmad I AlMulhim, Sulaiman A AlMousa, Abdulaziz M AlHawas, Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, AlKhobar 31952, Saudi Arabia
Author contributions: Al-Anii FM, Sadat-Ali M, Al-Tabash KW, AlMulhim AI, AlMousa SA, and AlHawas AM participated in the study of the case, review of the literature, and the writing of the manuscript.
Informed consent statement: Informed consent was obtained from the patient to publish the photographs and the data.
Conflict-of-interest statement: All authors declare there are no conflicts of interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mir Sadat-Ali, FRCS, FRCS (Gen Surg), MBBS, MS, Full Professor, Professor, Senior Scientist, Orthopaedic Surgery, Imam AbdulRahman Bin Faisal University and King Fahd Hospital of the University, Pobox 40071, AlKhobar 31952, Saudi Arabia. drsadat@hotmail.com
Received: June 13, 2023 Peer-review started: June 13, 2023 First decision: August 16, 2023 Revised: August 16, 2023 Accepted: September 7, 2023 Article in press: September 7, 2023 Published online: October 18, 2023 Processing time: 124 Days and 17.9 Hours
Abstract
BACKGROUND
Vancomycin flushing syndrome (VFS), also known as red man syndrome, is an allergic reaction to vancomycin. It typically presents as a rash on the face, neck, and upper torso after intravenous administration of vancomycin. VFS is blamed on rapid intravenous infusion of vancomycin during management and rarely happens after local use. A review of the literature showed that in the last 23 years, 4 such cases have been reported. Here, we add another case of VFS developed after slow local absorption of vancomycin in cement beads.
CASE SUMMARY
A 44-year-old male with a known case of hypertension, no history of allergies to medications, and a history of chronic osteomyelitis of the right tibia with discharging sinus over the anterolateral aspect of the leg. The pus culture grew Staphylococcus aureus, which was sensitive to clindamycin and vancomycin. The patient underwent irrigation and debridement with the placement of vancomycin cement beads made from 4 g of vancomycin powder and 40 g of polymethyl methacrylate. Three hours postoperatively, the patient developed a pruritic, erythematous, macular rash predominantly on his face, neck, chest, and lower extremities and to a lesser extent his upper extremities. A diagnosis of VFS was made and was successfully treated with cetirizine (10 mg, oral) and methylprednisolone sodium succinate (125 mg, intravenous). The patient continued to have itching with a facial rash for 12 h with gradual improvement. A decision was made to not remove the beads as the patient continued to improve. Gradually, the rash disappeared after 96 h with no further sequela.
CONCLUSION
VFS can occur not only after rapid intravenous injection of vancomycin but also with local release, as in our case. As orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate in chronic osteomyelitis and revision arthroplasty, they should be aware of such a complication occurring.
Core Tip: Vancomycin-related allergic skin reactions are not uncommon and are typically reported to occur after rapid intravenous infusion. However, this complication can also occur when vancomycin is implanted for slow release. Since orthopaedic surgeons routinely use vancomycin with polymethyl methacrylate, they should be aware of this complication occurring despite its rarity.
