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Emily Shao

Emily Shao

The Prince Charles Hospital
Australia

Title: Vancomycin induced Panniculitis: a rare drug reaction

Biography

Biography: Emily Shao

Abstract

Introduction: Panniculitis is an uncommon condition that typically presents as a non-specific area of erythema, with deep-seated nodules and plaques. There are a number of aetiologies the cause panniculitis, including infection, auto-immune, traumatic, and drug-induced. To our knowledge there has been no published cases of vancomycin-induced panniculitis.

Case Study: An 57-year-old Indigenous-Australian woman presented with a 1-month history of painful subcutaneous nodules. This coincided with commencement of vancomycin for treatment of bacteremia secondary to osteomyelitis. There were no other new medications started. On examination there were tender, firm subcutaneous nodules to the left anterior chest, bilateral flank, and back, with widespread eczematous plaques to the back. She reported a similar episode onset of development of a subcutaneous nodule 2 years ago, also after starting vancomycin. Histopathology showed eosinophilic panniculitis with dermal reaction containing frequent eosinophils. There was no histological support for either lupus or infective causes.

She had a complex medical background, including type two diabetes, obesity, chronic obstructive pulmonary disease, ischemic heart disease, dyslipidaemia, osteoarthritis, pseudoseizures, atrial fibrillation, rheumatic heart disease and subsequent infectious endocarditis, requiring a mitral valve replacement.

Discussion: This is the first case of panniculitis associated with vancomycin that we have found in the literature. Medications that have been associated with panniculitis include but is not limited to leukotriene modifying agents (1), interferon beta therapy (2), potassium bromide (3), protease inhibitors (4), glatiramir acetate(5, 6), and corticosteroid withdrawal (7).  

Conclusion: Panniculitis is associated with a wide range of aetiologies. Drug induced panniculitis and the mechanisms behind it are poorly understood, and features are often indistinguishable from other causes. In patients who present with panniculitis, clinicians should maintain a degree of suspicion for an adverse drug reaction, as there is a wide range of medications that can cause panniculitis.