Red man syndrome following the use of vancomycin-loaded bone cement in the primary total knee replacement: A case report

Medicine (Baltimore). 2018 Dec;97(51):e13371. doi: 10.1097/MD.0000000000013371.

Abstract

Rationale: Red man syndrome (RMS) is the most common allergic reaction to vancomycin. It generally occurs during rapid infusion of vancomycin; only few cases have been reported as results of local vancomycin administration. We hereby report a rare case where RMS developed after insertion of vancomycin-loaded bone cement in a primary total knee replacement (TKR).

Patient concerns: A 74-year-old woman was admitted for a left TKR due to severe osteoarthritis. Erythematous changes over face, trunk, and extremities developed after the use of vancomycin-loaded bone cement.

Diagnoses: According to the clinical manifestations, the patient was diagnosed with vancomycin-induced RMS.

Interventions: She was treated with fluid challenge and intravenous ephedrine, followed by intravenous diphenhydramine and hydrocortisone.

Outcomes: The patient's symptoms and signs relieved within 1 h after treatment.

Lessons: Vancomycin-induced RMS may occur after the routine use of vancomycin-loaded bone cement in the primary TKR replacement.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee*
  • Bone Cements / adverse effects*
  • Diagnosis, Differential
  • Erythema / diagnosis
  • Erythema / etiology*
  • Erythema / therapy
  • Female
  • Humans
  • Hypersensitivity / diagnosis
  • Hypersensitivity / etiology*
  • Hypersensitivity / therapy
  • Osteoarthritis / surgery
  • Syndrome
  • Vancomycin / administration & dosage
  • Vancomycin / adverse effects*

Substances

  • Bone Cements
  • Vancomycin