title: Vancomycin-induced Henoch-Schönlein purpura: a case report.
abstract: BACKGROUND
  Henoch-Schönlein purpura is a small-vessel systemic vasculitis. Although its exact pathophysiology remains unknown, Henoch-Schönlein purpura has been reported in association with various medical conditions including hypersensitivity. We report the case of a patient with vancomycin-induced Henoch-Schönlein purpura.
  
  
  METHODS
  A 42-year-old Caucasian man who had previously undergone a heart transplant was diagnosed as having an intra-abdominal abscess after he underwent a Hartmann procedure. At 15 days after initiation of antibiotic therapy including vancomycin, he developed a purpuric rash of the lower limbs, arthralgia, and macroscopic hematuria. At that time, our patient was already on hemodialysis for end-stage renal disease. Henoch-Schönlein purpura was diagnosed. After a second 15-day course of vancomycin, a second flare of Henoch-Schönlein purpura occurred. Skin biopsies showed leucocytoclastic vasculitis with IgA deposits and eosinophils in the peri-capillary inflammatory infiltrate, suggesting an allergic mechanism. After vancomycin was stopped, we did not observe any further flares. Only five cases of isolated cutaneous vasculitis, one case of lupus-like syndrome and one case of Henoch-Schönlein purpura after vancomycin treatment have been described to date in the literature.
  
  
  CONCLUSIONS
  Clinicians should be aware that systemic vasculitis can be induced by some treatments. Vancomycin is a widely prescribed antibiotic. Occurrence of rare but serious Henoch-Schönlein purpura associated with vancomycin requires its prompt discontinuation.
authors.affiliation: Centre de Néphrologie et Transplantation rénale, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, 147 Boulevard Baille, 13005 Marseille, Université Aix-Marseille II, France. stanislas.bataille@ap-hm.fr.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Bataille
authors.forename: Aurélie
authors.initials: A
authors.lastname: Daumas
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Tasei
authors.forename: Noémie
authors.initials: N
authors.lastname: Jourde-Chiche
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dussol
authors.forename: Stéphane
authors.initials: S
authors.lastname: Burtey
authors.forename: Solène
authors.initials: S
authors.lastname: Taugourdeau
authors.forename: Yvon
authors.initials: Y
authors.lastname: Berland
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche