Multiple bilateral branch retinal artery occlusions in a patient with sickle cell disease with vancomycin red man syndrome.

Abstract

To report a case of multiple bilateral branch retinal artery occlusions associated with vancomycin infusion in an African American patient in acute sickle crisis. Single case report. A 30-year-old man with complicated sickle cell disease presented with pain, fever, and hypoxia. During infusion of vancomycin, he became diaphoretic, hypotensive, and unresponsive, and exhibited respiratory distress and a disseminated red skin rash consistent with a severe allergic reaction referred to as the red man syndrome. When the patient regained consciousness within an hour, he complained of severe vision loss and demonstrated multiple bilateral branch retinal artery occlusions. Within 4 days, visual acuity recovered to 20/20 in the right eye but remained hand motions in the left eye. Retinal artery occlusion is a rare but potentially devastating complication of sickle cell disease. The potential for complications from vancomycin infusion during acute sickle crisis should be considered, although further study is warranted.