2006 Volume 116 Issue 14 Pages 2285-2290
An 82-year-old man with bladder cancer underwent total cystectomy and urinary diversion. Because his postoperative course was complicated by sepsis due to methicillin-resistant Staphylococcus aureus, intravenous vancomycin hydrochloride was started. Fourteen days after the initiation of the vancomycin therapy, the patient developed diffuse erythema on his trunk and extremities. Two days later, multiple tense bullae arising from erythematous lesions which ranged in diameter from 0.5 to 1.5 cm were also present. His palms and soles were partially involved, but the mucosae were spared. A biopsy specimen revealed a subepidermal blister with inflammatory infiltrates composed mainly of neutrophils and eosinophils in the underlying dermis. Direct immunofluorescence technique demonstrated linear IgA deposition along the basement membrane zone that was consistent with linear IgA bullous dermatosis. Vancomycin hydrochloride was suspected as the causative agent and was discontinued, an anti-allergic agent and topical steroid were initiated. Within a few days, new lesions no longer appeared, and two weeks later, skin lesions had almost completely resolved. Based on the clinical course and histopathological findings, the diagnosis was determined to be vancomycin hydrochloride-induced linear IgA bullous dermatosis.
