Thursday, June 27, 2013

Bug Juice

A patient with Staph endocarditis (not yet speciated) who has been receiving the antibiotic shown above for 3 days develops the rash shown below. Mucosal surfaces are spared. A dermatologist takes a biopsy and the pathologist notes linear IgA deposition at the dermal-epidermal junction of the basement membrane zone.

Challenge: Discontinuation of the drug leads to resolution of the rash - what drug is it?

First image is in the public domain. Second image shown under Fair Use.


sibogox said...

we would use vancomycin for the staph endocarditis. but pemphigoid like adverse reaction? hmm..

Anonymous said...

vancomycin-induced bullous pemphigoid

Craig Chen said...

close! this is a rare reaction, i've never actually seen it
Bug Juice

This is vancomycin-related linear IgA bullous dermatosis, a rare autoantibody-mediated skin reaction.

Sources: UpToDate; Wikipedia.