Red man syndrome caused by vancomycin powder

J Clin Neurosci. 2018 Apr;50:149-150. doi: 10.1016/j.jocn.2018.01.044. Epub 2018 Feb 2.


Red man syndrome (RMS) is a well-known hypersensitivity reaction caused by intravenous administration of vancomycin, with symptoms ranging from flushing, erythematous rash, pruritus, mild to profound hypotension, and even cardiac arrest. RMS has not previously been described from local application of vancomycin powder in a surgical wound, a technique increasingly utilized for infection prophylaxis in many surgical disciplines including neurosurgery. We describe the first reported case of RMS as a result of local intra-wound application of vancomycin powder for infection prophylaxis. A 73-year-old male with a history of Parkinson's disease underwent 2-stage deep brain stimulation implantation surgeries. Vancomycin powder was applied locally in the surgical wounds for infection prophylaxis during both of the surgeries. The patient developed a well-demarcated, geometric erythematous pruritic rash following the second surgery that was clinically diagnosed as RMS and resolved without sequelae.

Keywords: Anaphylactoid reaction; Complication; Infection prophylaxis; Perioperative antibiotic; Red man syndrome; Vancomycin powder.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Antibiotic Prophylaxis / adverse effects*
  • Antibiotic Prophylaxis / methods*
  • Deep Brain Stimulation
  • Drug Eruptions / etiology*
  • Humans
  • Male
  • Neurosurgical Procedures
  • Powders / therapeutic use
  • Surgical Wound Infection / prevention & control
  • Syndrome
  • Vancomycin / administration & dosage
  • Vancomycin / adverse effects*


  • Anti-Bacterial Agents
  • Powders
  • Vancomycin