title: Bullous skin disease: an unusual allergic reaction to vancomycin.
abstract: Severe reactions due to vancomycin are uncommon. We describe a case of vancomycin-induced linear immunoglobulin A bullous disease and review the literature pertinent to this entity. This is a rare subepidermal blistering disorder, with a heterogenous clinical presentation. It is characterized by IgA deposition in a linear pattern along the basement membrane zone. It seems to be autoantibody-mediated and is not dose-dependent. Spontaneous and complete skin healing follows vancomycin withdrawal; rechallenge reproduces the disease with a more rapid and severe onset. Because vancomycin is almost never suspected to be the cause of such manifestations, awareness of this rare autoimmune reaction is crucial. Early diagnosis through direct immunofluorescence of the perilesional skin would avoid unnecessary laboratory investigations and therapeutic measures and would shorten significantly the pain and suffering of these patients.
authors.affiliation: Division of Infectious Diseases, University of Rochester Medical Center, New York 14642, USA. mcbni@pol.net
authors.forename: Bogdan I
authors.initials: BI
authors.lastname: Neughebauer
authors.forename: Gerardo
authors.initials: G
authors.lastname: Negron
authors.forename: Stephen
authors.initials: S
authors.lastname: Pelton
authors.forename: Richard W
authors.initials: RW
authors.lastname: Plunkett
authors.forename: Ernst H
authors.initials: EH
authors.lastname: Beutner
authors.forename: Richard
authors.initials: R
authors.lastname: Magnussen
mesh_terms: D001485:Basement Membrane / Q000276:immunology; D003875:Drug Eruptions / Q000209:etiology* / Q000276:immunology; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D008875:Middle Aged; D012867:Skin / Q000276:immunology; D012872:Skin Diseases, Vesiculobullous / Q000139:chemically induced* / Q000276:immunology; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D007070:Immunoglobulin A; D014640:Vancomycin