Vancomycin-induced linear IgA bullous disease presenting as toxic epidermal necrolysis.
Linear IgA bullous dermatosis (LABD) is a rare autoimmune vesiculobullous disorder characterized by variable clinical presentations that may mimic bullous pemphigoid, dermatitis herpetiformis, cicatricial pemphigoid and erythema multiforme. A few cases of drug-induced LABD that clinically resembled toxic epidermal necrolysis (TEN) have been reported. A subset of patients with LABD have been found to be drug-induced; the most common drug being vancomycin. The diagnosis of LABD is confirmed by the presence of a linear band of IgA along the basement membrane zone on direct immunofluorescence microscopy. We report a case of a 77-year-old man who presented to us with vancomycin-induced LABD that presented clinically as TEN. He had a complete recovery over a 3-week period following discontinuation of the vancomycin and the addition of oral dapsone therapy. It is important to be aware that drug-induced LABD can mimic TEN.
Waldman
M A
MA
Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, USA.
Black
D R
DR
Callen
J P
JP
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000175:diagnosis; D003937:Diagnosis, Differential; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D008297:Male; D012872:Skin Diseases, Vesiculobullous / Q000139:chemically induced* / Q000175:diagnosis; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000209:etiology*; D014640:Vancomycin / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D007070:Immunoglobulin A; D014640:Vancomycin