One Case of Red Man Syndrome Caused by Locally-Used Low-Dose Vancomycin

doi:10.19803/j.1672-8629.20240547

Abstract

Abstract: Objective To analyze the clinical characteristics and sensitization mechanisms of red man syndrome (RMS) induced by locally-used low-dose vancomycin, warn of associated risks and provide a reference for pharmacovigilance. Methods One case of RMS caused by low dose vancomycin locally used for prevention of surgical site infections (SSIs) was reported. The mechanism was studied based on ADR monitoring and a literature review while related pharmaceutical care was traced. Results According to the correlation evaluation of ADR, the score of Naranjo^'s scale and an analysis of sensitization mechanisms, vancomycin was considered to have caused RMS, so clinical pharmacists initiated adverse reaction monitoring and pharmaceutical care, and the symptoms of RMS were improved and disappeared. Conclusion Even locally-used low-dose vancomycin can potentially induce RMS, which is why pharmacovigilance is recommended.

Key words: Vancomycin, Red Man Syndrome(RMS), Surgical Site Infections (SSIL), Low-dose, Local Use, Adverse Drug Reaction

CLC Number:

LI Xiaobo, ZHOU Guojian, HUANG Yuling, LI Haiqiao, CHEN Tingting. One Case of Red Man Syndrome Caused by Locally-Used Low-Dose Vancomycin[J]. Chinese Journal of Pharmacovigilance, 2025, 22(2): 217-220.

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https://zgywjj.magtechjournal.com/EN/Y2025/V22/I2/217

References

[1] CHEN CT, NG KJ, LIN Y, et al.Red Man Syndrome Following the Use of Vancomycin-Loaded Bone Cement in the Primary Total Knee Replacement: a Case Report[J]. Medicine, 2018, 97(51): e13371.
[2] WANG CR.A Literature Review of 28 Cases of Vancomycin-Induced Red Man Syndrome both Domestically and Internationally[J]. Strait Pharmaceutical Journal(海峡药学), 2021, 33(9): 201-202.
[3] ZHAO CN, PEI H, ZHAO BH, et al.Literature Analysis of 95 Cases of Adverse Drug Reactions Induced by Vancomycin[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2018, 15(6): 354-358.
[4] YANG R, GAO YX, LI KS, et al.Experience in Diagnosis and Treatment of Red Man Syndrome Caused by Vancomycin after Cardiovascular Surgery[J]. Chinese Journal of Hospital Pharmacy(中国医院药学杂志), 2019, 44(3): 323-326.
[5] JU G, ZHANG Y, YE C, et al.Comparative Effectiveness and Safety of Six Antibiotics in Treating MRSA Infections: a Network Meta-Analysis[J]. International Journal of Infectious Diseases(国际传染病杂志), 2024, 146: 107109.
[6] PENG HY, YANG MS, ZHU J, et al.Advances in the Local Application of Vancomycin for Preventing Postoperative Surgical Site Infections in Spinal Surgeries[J]. International Journal of Orthopaedics(国际骨科学杂志), 2020, 41(4): 212-215.
[7] RYBAK MJ, LE J, LODISE TP, et al.Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcus Aureus infections: a Revised Consensus Guideline and Review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists[J]. American Journal of Health-System Pharmacy, 2020, 77(11): 835-864.
[8] WANG Q, CAO M, TAO H, et al.Evidence‐Based Guideline for the Prevention and Management of Perioperative Infection[J]. Journal of Evidence‐Based Medicine(循证医学杂志), 2023, 16(1): 50-67.
[9] BAILEY P, GRAY H.An Elderly Woman with Red Man Syndrome in Association with Oral Vancomycin Therapy: a Case Report[J]. Cases journal, 2008, 1(1): 1-3.
[10] ARROYO-MERCADO F, KHUDYAKOV A, CHAWLAG S, et al.Red Man Syndrome with Oral Vancomycin: a Case Report[J]. American Journal of Medical Case Reports, 2019, 7(1): 16-17.
[11] YADAV S, HASHMI MU, SHAH S, et al.Vancomycin Flushing Syndrome due to Oral Vancomycin in Chronic Kidney Disease Patients: a Case Report[J]. Cureus, 2022, 14(8): e28024.
[12] MOUSSA M, ABOU CHAKRA M, PAPATSORIS A, et al.Red Man Syndrome Caused by Intracavernous Irrigation with Vancomycin at the Time of Placing Penile Implants[J]. Archivio Italiano di Urologia EAndrologia, 2021, 93(1): 86-87.
[13] JUYAL A, KHURANA G, MAHESHWARI R.Red Man Syndrome: an Unusual Complication of Vancomycin Beads[J]. Bangladesh J Medl Sci, 2015, 14(3): 290.
[14] AL-ANII FM, SADATT-ALI M, AL-TABASH KW, et al.Vancomycin Flushing Syndrome in Orthopaedic Practice: a Case Report[J]. World Journal of Orthopedics, 2023, 14(10): 771-775.
[15] Ministry of Health. Provisions for Adverse Drug Reaction Reporting and Monitoring [EB/OL]. (2011-05-04) [2024-05-05]. https://www.nmpa.gov.cn/.
[16] O’TOOLE RV, JOSHI M, CARLINI AR, et al. Effect of Intrawound Vancomycin Powder in Operatively Treated High-Risk Tibia Fractures: a Randomized Clinical Trial[J]. JAMA Surg, 2021, 156(5): e207259-e207259.
[17] HAIMOTO S, SCHAR RT, NISHIMURA Y, et al.Reduction in Surgical Site Infection with Suprafascial Intrawound Application of Vancomycin Powder in Instrumented Posterior Spinal Fusion: a Retrospective Case-Control Study[J]. Journal of Neurosurgery: Spine, 2018, 29(2): 193-198.
[18] ZHANG YF, HU MW, GUO CC, et al.Clinical Efficacy of Intraarticular Vancomycin in Preventing Early Periprosthetic Joint Infection after Primary Knee Arthroplasty[J]. Chin J Surg(中华外科杂志) , 2024, 62(6): 591-597.
[19] ARTHUR JR, BINGHAM JS, CLARKE HD, et al.Intraosseous Regional Administration of Antibiotic Prophylaxis in Total Knee Arthroplasty[J]. JBJS Essential Surgical Techniques, 2020, 10(4): e20.
[20] KLASAN A, PATEL CK, YOUNG SW.Intraosseous Regional Administration of Vancomycin in Primary Total Knee Arthroplasty does not Increase the Risk of Vancomycin-Associated Complications[J]. The Journal of Arthroplasty, 2021, 36(5): 1633-1637.
[21] USHIROZAKO H, HASEGAWA T, YAMATO Y, et al.Impact of Intrawound Vancomycin Powder on Prevention of Surgical Site Infection after Posterior Spinal Surgery[J]. Journal of Neurosurgery: Spine, 2021, 34(4): 656-664.
[22] WONG MT, SRIDHARAN SS, DAVISON EM, et al.Can Topical Vancomycin Prevent Periprosthetic Joint Infection in Hip and Knee Arthroplasty: a Systematic Review[J]. Clinical Orthopaedics and Related Research, 2021, 479(8): 1655-1664.
[23] SERVITO M, KHANI-HANJANI A, SMITH KM, et al.Topical Vancomycin and Risk of Sternal Wound Infections: a Double-Blind Randomized Controlled Trial[J]. The Annals of Thoracic Surgery, 2022, 114(5): 1555-1561.
[24] CAO MN, WANG QY, TAO H, et al.Interpretation of Evidence-Based Guideline for the Prevention and Management of Perioperative lnfection[J]. Clinical Medication Journal(临床药物治疗杂志), 2023, 21(6): 19-25.
[25] Orthopaedic Expert Group of ERAS Profession Committee of National Health Commission, CRHA, Orthopaedic ERAS Profession Committee of China Association of Rehabilitation Technology Transformation and Promotion. Expert Consensus on Enhanced Recovery Management for the Prevention of Surgical Site Infection after Orthopaedic Selective Surgery[J]. Chinese Journal Bone and Joint Surgery(中华骨与关节外科杂志), 2022, 15(10): 746-753.
[26] Orthopaedic Expert Group of ERAS profession Committee of National Health Commission, CRHA, Orthopaedic ERAS profession Committee of China Association of Rehabilitation Technology Transformation and Promotion. Expert Consensus on Surgical Incision Operation and Prevention and Treatment of Complications in Orthopaedics in Enhanced Recovery after Surgery Program[J]. Chinese Journal Bone and Joint Surgery(中华骨与关节外科杂志), 2022, 15(10): 776-784.
[27] AMOLD PM, GHOGAWAL AZ, TAMERLER C. Vancomycin, Bone Growth,Wound Healing[J]. Journal of Neurosurgery: Spine, 2016, 25(2): 145-146.
[28] GOLDSCHMIDT E, RASMUSSEN J, CHABOT JD, et al.The Effect of Vancomycin Powder on Human Dural Fibroblast Culture and Its Implications for Dural Repair During Spine Surgery: Presented at the 2016 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves[J]. Journal of Neurosurgery: Spine, 2016, 25(5): 665-670.
[29] GHOBRIAL GM, CADOTTE DW, WILLIAMS K, et al.Complications from the Use of Intrawound Vancomycin in Lumbar Spinal Surgery: a Systematic Review[J]. Neurosurgical focus, 2015, 39(4): E11.
[30] WANG D, DONG D, TIAN CH.Course of Development of Pharmocovigilance Systems in China[J]. Chinese Journal of Pharmacovigilance(中国药物警戒), 2024, 21(7): 735-740.
[31] LING XJ, WEI JF, ZHU Y.Aiming to IgE: Drug Development in Allergic Diseases[J]. International Immunopharmacol(国际免疫药理学), 2023, 121: 110495.
[32] GRIMES J, DESAI S, CHARTER N W, et al.MrgX2 is a Promiscuous Receptor for Basic Peptides Causing Mast Cell Pseudo‐Allergic and Anaphylactoid Reactions[J]. Pharmacology Research & Perspectives, 2019, 7(6): e00547.
[33] ZANG T, LIU B, MA L, et al.A typical Case had Rare Immediate and Delayed Red Man Syndrome Multiple Times after Norvancomycin Injection: a Case Report[J]. Medicine, 2022, 101(47): e32047.
[34] EVANS T, PATEL S.Two Consecutive Preoperative Cardiac Arrests Involving Vancomycin in a Patient Presenting for Hip Disarticulation: a Case report[J]. A Case Rep, 2017, 9(9): 262-264.
[35] REUTER SE, STOCKER SL, ALFFENAAR JWC, et al.Optimal Practice for Vancomycin Therapeutic Drug Monitoring: Position Statement from the Anti-Infectives Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology[J]. Therapeutic Drug Monitoring, 2022, 44(1): 121-132.
[36] XU PG, TANG TT, ZHOU YG, et al.Clinical Pharmacy Inspection Service Standard for Inpatients in Medical Institutions[J]. Central South Pharmacy(中南药学), 2024, 22(1): 1-5.