Red Man Syndrome Due to Oral Vancomycin in Chronic Kidney Disease Patients: A Case Report

Abstract

The red man syndrome is a known complication of vancomycin. It is commonly seen with intravenous (IV) use but is also documented with oral use. We aim to describe a case of a chronic kidney disease (CKD) patient who developed red man syndrome secondary to oral vancomycin use. Our case is about an immunosuppressed 68-year-old man who received oral vancomycin for pseudomembranous colitis, which was caused by Clostridium difficile. On the eighth day of the treatment, the patient experienced pruritus and an erythematous rash, which was diagnosed as red man syndrome, and the oral vancomycin was immediately discontinued. Upon the discontinuation of the drug, the rash disappeared, thus confirming the diagnosis. The patient's status of chronic kidney disease stage four resulted in reduced clearance of the drug, thus causing the adverse effect. This case highlights the importance of prophylaxis to prevent red man syndrome in a chronic kidney disease patient. Red man syndrome is commonly seen after the initiation of vancomycin, ciprofloxacin, or amphotericin B. Prompt diagnosis and management are required to prevent the complications due to this condition.

Keywords: adr- adverse drug reactions; chronic kidney disease (ckd); clostridium difficle infection; infectious colitis; oral vancomycin.

Figure 1. Photograph of the patient's leg which shows erythematous rash caused due to vancomycin flushing syndrome

Figure 2. Photographs show the patient's hand: (a) erythematous rash due to vancomycin flushing syndrome; (b) after discontinuation of oral vancomycin