title: A patient with penicillin-resistant viridans group streptococcal endocarditis and unusual reactions to vancomycin.
abstract: There is a paucity of data regarding the treatment of endocarditis caused by penicillin-resistant viridans group streptococci (PR-VGS). We report a 16-year-old girl who had native-valve endocarditis due to PR-VGS which was identified as Streptococcus mitis. She also had unusual reactions to vancomycin. Eighteen hours after initiation of 50 mg/kg/day vancomycin, she developed a maculopapular rash, then at 48 hours she developed an intermittent high fever and a progressive decrease in peripheral leukocytes and platelets. She developed hypotension on Day 8. Her serum C-reactive protein and procalcitonin levels were high. All reactions improved after vancomycin was discontinued and oral prednisolone was started. This unusual combination of reactions to vancomycin was likely caused by immune and nonimmune mechanisms. Her endocarditis was successfully treated with cefotaxime 200 mg/kg/ day for 4 weeks.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Nopporn
authors.initials: N
authors.lastname: Apiwattanakul
authors.forename: Suthep
authors.initials: S
authors.lastname: Wanitkun
authors.forename: Piriyaporn
authors.initials: P
authors.lastname: Chongtrakool
authors.forename: Sayomporn
authors.initials: S
authors.lastname: Sirinavin
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002439:Cefotaxime / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D010403:Penicillin Resistance; D011239:Prednisolone / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D034361:Streptococcus mitis / Q000302:isolation & purification*; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D014640:Vancomycin; D011239:Prednisolone; D002439:Cefotaxime