Drug-induced linear IgA bullous dermatosis in a patient with a vancomycin-impregnated cement spacer

Kelsie Riemenschneider; Daren A Diiorio; John A Zic; Matthew R Livingood; Jo-David Fine; Jennifer G Powers; Jeffrey P Zwerner; Eric Tkaczyk

Drug-induced linear IgA bullous dermatosis in a patient with a vancomycin-impregnated cement spacer

Journal article

Peer reviewed

Drug-induced linear IgA bullous dermatosis in a patient with a vancomycin-impregnated cement spacer

Kelsie Riemenschneider, Daren A Diiorio, John A Zic, Matthew R Livingood, Jo-David Fine, Jennifer G Powers, Jeffrey P Zwerner and Eric Tkaczyk

Cutis (New York, N.Y.), Vol.101(4), pp.293-296

04/2018

PMCID: PMC10183100

PMID: 29763476

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Abstract

Linear IgA bullous dermatosis (LABD) is an autoimmune blistering rash caused by IgA autoantibodies against the epidermal basement membrane zone. It commonly is drug induced, often in association with systemic vancomycin. We report a case of a previously healthy 77-year-old man who developed a diffuse macular rash and hemorrhagic bullae on the left leg 10 days after placement of a vancomycin-impregnated cement spacer (VICS) during a revision knee arthroplasty and initiation of postoperative treatment with intravenous (IV) vancomycin. The lesions initially were limited to the leg in which the hardware was placed, but the patient later developed painful palmoplantar and oropharyngeal blisters as well as edematous, erythematous plaques on the back and buttocks. A punch biopsy from a lesion on the left thigh revealed neutrophil-rich subepidermal bullae, and immunofluorescence revealed linear IgA and C deposition along the dermoepidermal junction, confirming a diagnosis of LABD. This report illustrates the importance of considering antibiotic-impregnated cement spacers, which frequently are used to manage prosthetic joint infections, as potential culprits in patients with cutaneous eruptions.

Aged

Anti-Bacterial Agents - administration & dosage

Anti-Bacterial Agents - adverse effects

Bone Cements

Humans

Knee Prosthesis - adverse effects

Linear IgA Bullous Dermatosis - chemically induced

Male

Vancomycin - administration & dosage

Vancomycin - adverse effects

Details

Title: Subtitle: Drug-induced linear IgA bullous dermatosis in a patient with a vancomycin-impregnated cement spacer
Creators: Kelsie Riemenschneider - Vanderbilt University School of Medicine
Daren A Diiorio - Medical College of Wisconsin
John A Zic - Vanderbilt University Medical Center
Matthew R Livingood - Private practice, Washington, District of Columbia, USA
Jo-David Fine - Vanderbilt University Medical Center
Jennifer G Powers - University of Iowa
Jeffrey P Zwerner - Vanderbilt University Medical Center
Eric Tkaczyk - Vanderbilt University Medical Center
Resource Type: Journal article
Publication Details: Cutis (New York, N.Y.), Vol.101(4), pp.293-296
PMID: 29763476
PMCID: PMC10183100
NLM abbreviation: Cutis
ISSN: 0011-4162
eISSN: 2326-6929
Language: English
Date published: 04/2018
Academic Unit: Dermatology
Record Identifier: 9984368078602771

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