Ye QF, Wang GF, Wang YX, Lu GP, Li ZP. Vancomycin-related convulsion in a pediatric patient with neuroblastoma: A case report and review of the literature. World J Clin Cases 2021; 9(13): 3070-3078 [PMID: 33969093 DOI: 10.12998/wjcc.v9.i13.3070]
Corresponding Author of This Article
Zhi-Ping Li, PhD, Chief Pharmacist, Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Shanghai 201102, China. zpli@fudan.edu.cn
Research Domain of This Article
Pediatrics
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 Clin Cases. May 6, 2021; 9(13): 3070-3078 Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3070
Vancomycin-related convulsion in a pediatric patient with neuroblastoma: A case report and review of the literature
Qiao-Feng Ye, Guang-Fei Wang, Yi-Xue Wang, Guo-Ping Lu, Zhi-Ping Li
Qiao-Feng Ye, Guang-Fei Wang, Zhi-Ping Li, Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China
Yi-Xue Wang, Guo-Ping Lu, Department of Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China
Author contributions: Ye QF and Wang GF visualized the data, reviewed the literature and drafted the manuscript; Wang YX and Lu GP contributed to the treatment of this patient and provided the patient’s medical data; Li ZP reviewed the literature and revised the manuscript; All authors issued final approval for the version to be submitted; Ye QF and Wang GF are co-first authors of this work.
Supported byNational Natural Science Foundation of China, No. 81874325; Key Innovative Team of Shanghai Top-Level University Capacity Building in Clinical Pharmacy and Regulatory Science at Shanghai Medical College, Fudan University, No. HJW-R-2019-66-19; Science and Technology Commission of Shanghai Municipality, No. 18DZ1910604, No. 19DZ1910703 and No. 19XD1400900.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying data.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Ping Li, PhD, Chief Pharmacist, Department of Clinical Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Shanghai 201102, China. zpli@fudan.edu.cn
Received: October 20, 2020 Peer-review started: October 20, 2020 First decision: January 7, 2021 Revised: January 11, 2021 Accepted: February 22, 2021 Article in press: February 22, 2021 Published online: May 6, 2021 Processing time: 178 Days and 9.3 Hours
Abstract
BACKGROUND
Vancomycin is often used as an anti-infective drug in patients receiving anti-tumor chemotherapy. There are concerns about its adverse drug reactions during treatment, such as nephrotoxicity, ototoxicity, hypersensitivity reactions, etc. However, potential convulsion related to high plasma concentrations of vancomycin in children receiving chemotherapy has not been reported.
CASE SUMMARY
A 3.9-year-old pediatric patient with neuroblastoma receiving vancomycin to treat post-chemotherapy infection developed an unexpected convulsion. No other potential disease conditions could explain the occurrence of the convulsion. The subsequently measured overly high plasma concentrations of vancomycin could possibly provide a clue to the occurrence of this convulsion. The peak and trough plasma concentrations of vancomycin were 59.5 mg/L and 38.6 mg/L, respectively, which were much higher than the safe range. Simulation with the Bayesian approach using MwPharm software showed that the area under the concentration-time curve over 24 h was 1086.6 mg· h/L. Therefore, vancomycin was immediately stopped and teicoplanin was administered instead combined with meropenem and fluconazole as the anti-infective treatment strategy.
CONCLUSION
Unexpected convulsion occurring in a patient after chemotherapy is probably due to toxicity caused by abnormal pharmacokinetics of vancomycin. Overall evaluation and close therapeutic drug monitoring should be conducted to determine the underlying etiology and to take the necessary action as soon as possible.
Core Tip: Vancomycin is often used as an anti-infective drug in patients receiving anti-tumor chemotherapy. We present a rare case of sudden onset of convulsion related to vancomycin treatment in a pediatric patient with neuroblastoma. This case demonstrates that unexpected convulsion occurring in patients after chemotherapy is probably due to the toxicity caused by abnormal pharmacokinetics of vancomycin. Close therapeutic drug monitoring is recommended to ensure the plasma concentration of vancomycin is within the normal range. A model-based Bayesian estimation tool could be used to estimate the area under the concentration-time curve and help health care practitioners create an individualized dosing plan.
