A 42-year-old woman is admitted to the hospital after experiencing fever and chills following hemodialysis. The patient has a history of end-stage kidney disease caused by IgA nephropathy and has recently started intermittent dialysis via a tunneled catheter. She has a history of depression, for which she takes citalopram. The temperature is 38.4 C (101.1 F), the blood pressure is 130/80 mm Hg, and the pulse rate is 94 bpm. There is no erythema or tenderness at the catheter site, and the rest of the physical exam is normal. Blood cultures are taken, and an empiric course of vancomycin and ceftazidime is started. The patient reports a burning, itching sensation while receiving the intravenous vancomycin infusion. The vital signs remain unchanged, but a repeat examination reveals an erythematous rash on the face and neck. She reports no history of drug allergy but has never received these antibiotics. Which of the following is the most likely underlying cause of this patient's current condition?

Question

A 42-year-old woman is admitted to the hospital after experiencing fever and chills following hemodialysis. The patient has a history of end-stage kidney disease caused by IgA nephropathy and has recently started intermittent dialysis via a tunneled catheter. She has a history of depression, for which she takes citalopram. The temperature is 38.4 C (101.1 F), the blood pressure is 130/80 mm Hg, and the pulse rate is 94 bpm. There is no erythema or tenderness at the catheter site, and the rest of the physical exam is normal. Blood cultures are taken, and an empiric course of vancomycin and ceftazidime is started. The patient reports a burning, itching sensation while receiving the intravenous vancomycin infusion. The vital signs remain unchanged, but a repeat examination reveals an erythematous rash on the face and neck.   She reports no history of drug allergy but has never received these antibiotics. Which of the following is the most likely underlying cause of this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: The most common side effect of vancomycin is red man syndrome (RMS). It happens as a result of rapid vancomycin infusion, which causes direct activation of mast cells and subsequent release of vasoactive mediators. Within minutes of starting the medication, patients experience flushing, pruritus, and an erythematous rash on the upper torso, face, and neck. Because RMS is not a true allergic reaction (it is not mediated by IgE), vancomycin can be resumed at a slower rate of infusion once symptoms have resolved.

A 42-Year-Old Woman Is Admitted to the Hospital After Experiencing