万古霉素引起过敏性紫癜病例讨论.pdfVIP

Bataille et al. Journal of Medical Case Reports 2012, 6:106 /content/6/1/106 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Vancomycin-induced Henoch-Schönlein purpura: a case report 1* 1 2 1 1 Stanislas Bataille , Aurélie Daumas , Anne-Marie Tasei , Noémie Jourde-Chiche , Bertrand Dussol , 1 3 1 4 Stéphane Burtey , Solène Taugourdeau , Yvon Berland and Laurent Chiche Abstract Introduction: Henoch-Schönlein purpura is a small-vessel systemic vasculitis. Although its exact pathophysiology remains unknown, Henoch-Schönlein purpura has been reported in association with various medical conditions including hypersensitivity. We report the case of a patient with vancomycin-induced Henoch-Schönlein purpura. Case presentation: A 42-year-old Caucasian man who had previously undergone a heart transplant was diagnosed as having an intra-abdominal abscess after he underwent a Hartmann procedure. At 15 days after initiation of antibiotic therapy including vancomycin, he developed a purpuric rash of the lower limbs, arthralgia, and macroscopic hematuria. At that time, our patient was already on hemodialysis for end-stage renal disease. Henoch-Schönlein purpura was diagnosed. After a second 15-day course of vancomycin, a second flare of Henoch- Schönlein purpura occurred. Skin biopsies showed leucocytoclastic vasculitis with IgA deposits and eosinophils in the peri-capillary inflammatory infiltrate, suggesting an allergic mechanism. After vancom