2019 Volume 45 Issue 11 Pages 633-637
Anaphylaxis associated with teicoplanin, a glycopeptide antibiotic, which has a safety profile, has rarely been reported. In addition, the cause of teicoplanin anaphylaxis remains unclear. We report teicoplanin-associated anaphylaxis despite no symptom when receiving vancomycin. A 60s-years-old man who received repeated partial pneumonectomy developed lung cancer. Under therapeutic drug monitoring, vancomycin was administered for methicillin resistant Staphylococcus aureus infection from hospitalization Day 5 day. Despite a vancomycin plasma trough level lower than 20 μg/mL, since acute kidney injury developed at hospitalization Day 13, the antimicrobial agent was replaced from vancomycin to teicoplanin. After subsequent first teicoplanin administration, he developed shivering in combination with tachycardia and peripheral cyanosis. Based upon a comprehensive assessment of the overall clinical course, we examined the likelihood and certainty of allergic anaphylaxis. According to the criteria of Savic et al, this symptom was considered as an indeterminate event due to only three criteria including within 15 minutes, ≥ 2 features of anaphylaxis present and alternative diagnosis excluded. In contrast, that was judged as a probable teicoplanin-associated adverse event, where the total of scores was 6, by criteria adopted from the Naranjo probability scale. In this context, while this case could not provide a definitive conclusion regarding anaphylaxis, it may be considered a as teicoplanin-associated adverse event. Clinicians should be aware that the responsiveness to allergy among glycopeptide antimicrobial agents may be different.
