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Bullous Drug Eruption Treated With Amputation: A Challenging Case of Vancomycin-Induced Linear IgA Disease

Bullous Drug Eruption Treated With Amputation: A Challenging Case of Vancomycin-Induced Linear... Abstract REPORT OF A CASE The inpatient consultation service was asked to evaluate a 55-year-old woman with a bullous eruption of acute onset. The patient had been admitted to the hospital for cellulitis surrounding a chronic left lower extremity ulcer. Her history included diabetes mellitus type I for 45 years, hypertension, and severe peripheral vascular disease. She had undergone balloon angioplasty in the past but required a left femoral-peroneal bypass procedure several months prior to admission because of vessel reocclusion.On admission, the patient's physical examination revealed a ragged, necrotic ulcer overlying the left first metacarpophalangeal joint with purulent exudate and surrounding dusky erythema. Pulses were absent in both ankles. Bacterial culture of the ulcer and bone biopsy culture of the underlying unexposed bone both yielded methicillin sodium—resistant Staphylococcus aureus and Streptococcus viridans. A magnetic resonance imaging scan of the foot demonstrated osteomyelitis of the bone underlying the ulcer.The patient References 1. Baden LA, Apovian C, Imber MJ, Dover JS. Vancomycin-induced linear IgA bullous dermatosis . Arch Dermatol. 1988;124:1186-1188.Crossref 2. Carpenter S, Berg D, Sidhu-Malik N, Hall RP III, Rico MJ. Vancomycinassociated linear IgA dermatosis . J Am Acad Dermatol. 1992;26:45-48.Crossref 3. Kuechle M, Stegemeir E, Maynard B, Gibson LE, Leiferman KM, Peters MS. Drug-induced linear IgA bullous dermatosis: report of six cases and review of the literature . J Am Acad Dermatol. 1994;30:187-192.Crossref 4. Piketty C, Meeus F, Nochy D, Poux JM, Jacquot C, Bariety J. Linear IgA dermatosis related to vancomycin . Br J Dermatol. 1994;130:130-131.Crossref 5. Geissmann C, Beylot-Barry M, Doutre MS, Beylot C. Drug-induced linear IgA bullous dermatosis . J Am Acad Dermatol. 1995;32:296.Crossref 6. Richards S, Hall S, Yokel B, Whitmore SE. A bullous eruption in an elderly woman: vancomycin-associated linear IgA dermatosis . Arch Dermatol. 1995; 131:1447-1452.Crossref 7. Klein LE, Shmunes E, Carter JB, et al. Linear IgA bullous dermatosis related to captopril treatment . Cutis. 1989;44:393-396. 8. McWhirter JD, Hashimoto K, Fayne S, Ito K. Linear IgA bullous dermatosis related to lithium carbonate . Arch Dermatol. 1987;123:1120-1122.Crossref 9. Gabrielsen T, Staerfelt F, Thune PO. Drug-induced bullous dermatosis with linear IgA deposits along the basement membrane . Acta Derm Venereol. 1981;61: 439-441. 10. Argenyi ZB, Bergfeld WF, Valenzuela R, McMahon JT, Taylor JS. Adult linear IgA disease associated with an erythema multiforme-like drug reaction . Cleve Clin J Med. 1987;54:445-450.Crossref 11. Primka EJ III, Liranzo MO, Bergfeld W, Dijkstra JW. Amiodarone-induced linear IgA disease . J Am Acad Dermatol. 1994;31:809-811.Crossref 12. Wojnarowska F, Collier PM, Allen J, Millard PR. The localization of the target antigens and antibodies in linear IgA disease is heterogeneous, and dependent on the methods used . Br J Dermatol. 1995;132:750-757.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Bullous Drug Eruption Treated With Amputation: A Challenging Case of Vancomycin-Induced Linear IgA Disease

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1996.03890350027004
Publisher site
See Article on Publisher Site

Abstract

Abstract REPORT OF A CASE The inpatient consultation service was asked to evaluate a 55-year-old woman with a bullous eruption of acute onset. The patient had been admitted to the hospital for cellulitis surrounding a chronic left lower extremity ulcer. Her history included diabetes mellitus type I for 45 years, hypertension, and severe peripheral vascular disease. She had undergone balloon angioplasty in the past but required a left femoral-peroneal bypass procedure several months prior to admission because of vessel reocclusion.On admission, the patient's physical examination revealed a ragged, necrotic ulcer overlying the left first metacarpophalangeal joint with purulent exudate and surrounding dusky erythema. Pulses were absent in both ankles. Bacterial culture of the ulcer and bone biopsy culture of the underlying unexposed bone both yielded methicillin sodium—resistant Staphylococcus aureus and Streptococcus viridans. A magnetic resonance imaging scan of the foot demonstrated osteomyelitis of the bone underlying the ulcer.The patient References 1. Baden LA, Apovian C, Imber MJ, Dover JS. Vancomycin-induced linear IgA bullous dermatosis . Arch Dermatol. 1988;124:1186-1188.Crossref 2. Carpenter S, Berg D, Sidhu-Malik N, Hall RP III, Rico MJ. Vancomycinassociated linear IgA dermatosis . J Am Acad Dermatol. 1992;26:45-48.Crossref 3. Kuechle M, Stegemeir E, Maynard B, Gibson LE, Leiferman KM, Peters MS. Drug-induced linear IgA bullous dermatosis: report of six cases and review of the literature . J Am Acad Dermatol. 1994;30:187-192.Crossref 4. Piketty C, Meeus F, Nochy D, Poux JM, Jacquot C, Bariety J. Linear IgA dermatosis related to vancomycin . Br J Dermatol. 1994;130:130-131.Crossref 5. Geissmann C, Beylot-Barry M, Doutre MS, Beylot C. Drug-induced linear IgA bullous dermatosis . J Am Acad Dermatol. 1995;32:296.Crossref 6. Richards S, Hall S, Yokel B, Whitmore SE. A bullous eruption in an elderly woman: vancomycin-associated linear IgA dermatosis . Arch Dermatol. 1995; 131:1447-1452.Crossref 7. Klein LE, Shmunes E, Carter JB, et al. Linear IgA bullous dermatosis related to captopril treatment . Cutis. 1989;44:393-396. 8. McWhirter JD, Hashimoto K, Fayne S, Ito K. Linear IgA bullous dermatosis related to lithium carbonate . Arch Dermatol. 1987;123:1120-1122.Crossref 9. Gabrielsen T, Staerfelt F, Thune PO. Drug-induced bullous dermatosis with linear IgA deposits along the basement membrane . Acta Derm Venereol. 1981;61: 439-441. 10. Argenyi ZB, Bergfeld WF, Valenzuela R, McMahon JT, Taylor JS. Adult linear IgA disease associated with an erythema multiforme-like drug reaction . Cleve Clin J Med. 1987;54:445-450.Crossref 11. Primka EJ III, Liranzo MO, Bergfeld W, Dijkstra JW. Amiodarone-induced linear IgA disease . J Am Acad Dermatol. 1994;31:809-811.Crossref 12. Wojnarowska F, Collier PM, Allen J, Millard PR. The localization of the target antigens and antibodies in linear IgA disease is heterogeneous, and dependent on the methods used . Br J Dermatol. 1995;132:750-757.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1996

References