Literature case analysis on vancomycin-associated drug-induced hypersensitivity syndrome in children
10.3760/cma.j.cn114015-20200706-00744
- VernacularTitle:万古霉素致儿童药物超敏反应综合征文献病例分析
- Author:
Xiaole LI
1
;
Wei GUO
1
;
Yongsheng XU
1
Author Information
1. 天津市儿童医院呼吸科，天津 300134
- Publication Type:Journal Article
- Keywords:
Vancomycin;
Drug hypersensitivity;
Case reports;
Child
- From:
Adverse Drug Reactions Journal
2021;23(1):10-14
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the clinical features of vancomycin-associated drug-induced hypersensitivity syndrome (DIHS) in children.Methods:Case reports on vancomycin-associated DIHS in children were collected by searching the relevant databases home and abroad up to May 31, 2020. Patients′ relevant information (sex, age, primary disease, time from medication to onset of DIHS, main symptoms, organs and systems involved, hematological changes, RegiSCAR score, treatment and outcome) was extracted and descriptively analyzed.Results:A total of 12 children with DIHS caused by vancomycin were enrolled in the study, including 10 males and 2 females. Their ages ranged from 22 months to 17 years, with a median age of 14 years. The median time from vancomycin exposure to occurrence of DIHS was 17 days, ranging from 5 to 35 days. The main clinical features were fever (12 patients, 100.0%), rash (12 patients, 100.0%), lymphadenopathy (8 patients, 66.7%), and mucosal injury (5 patients, 41.7%). Among the 12 children, 9 (75.0%) had liver injury, 4 (33.3%) had kidney injury, 2 (16.7%) had lung injury, 1 (8.3%) had spleen injury, and 1 (8.3%) had myocardial injury. Blood routine examination showed increased eosinophilia in the 11 children (91.7%) and increased atypical lymphocytosis in 5 children (41.7%). After the diagnosis of DIHS, vancomycin was discon-tinued in all the 12 children. After treatments with glucocorticoids, antihistamines, gammaglobulins, etc. (1 patient underwent liver transplantation), 11 children (91.7%) were improved and 1 (8.3%) died.Conclusions:The clinical manifestations of DIHS caused by vancomycin in children are typical, mainly manifested by fever, rash, lymphadenopathy, etc. The damaged organs are mainly the liver, followed by the kidneys. Most of the children have a good prognosis, and a few may have severe organ damage leading to death.
