Vancomycin-cement reactions cause Red Man Syndrome and other life-threatening hypersensitivity reactions; the challenge of managing periprosthetic joint infection

Abstract

AbstractPeriprosthetic joint infections (PJI) are commonly treated with antibiotic-impregnated bone cement (AIBC). We described a 62-year-old female, who showed After 18 hours of surgery, symptoms of Red Man Syndrome (RMS) and other hypersensitivities were caused by a spacer containing vancomycin. Vancomycin can cause a variety of hypersensitivity reactions, including RMS and anaphylaxis. It can be challenging for physicians to manage emergency RMS features and life-threatening reactions such as anaphylaxis shock after using vancomycin-loaded bone cement following PJI. The patient received immediate emergency healthcare, intravenous fluid therapy, epinephrine, corticosteroids, and antihistamines in response to serious side effects, including flushing, erythema, agitation, urticaria, tachycardia, pruritus on the trunk and buttocks, severe itching, hypovolemia, macular rashes, and exfoliative dermatitis. Delayed surgery to remove antibiotic-loaded bone cement has been suggested as a successful treatment for periprosthetic joint infections (PJI).