Abstract
Elderly lady underwent right eye surgery for vitreous clot removal. 72 hours later, she complained of pain, redness and swelling in operated eye. Endophthalmitis was diagnosed. She was started on piperacillin/ tazobactam and vancomycin. Evisceration was required. Coagulase negative Staphylococci were isolated and vancomycin was continued postoperatively. She was discharged on home intravenous vancomycin therapy. Admitted one week later with painful oral ulcers, fever and diffuse erythmatous body rash. Vancomycin and other medications were stopped. Investigations revealed elevated double-stranded deoxyribonucleic acid and anti histone antibodies. Skin biopsy was suggestive of lupus rash. She was started on 60 mg of oral prednisone, improved dramatically and discharged to home.
Highlights
One week after discharge, she complained of weakness, dizziness and fever of 101 F at home
She was started on piperacillin/ tazobactam and vancomycin
Vancomycin is a potent antibiotic used in various life threatening infections
Summary
It is active against Staphylococci, including Staphylococcus aureus and Staphylococcus epidermidis (including heterogeneous methicillin-resistant strains) and Streptococci. Common adverse effects include nephrotoxcity, ototoxicity, neutropenia, Most common cutaneous side effect is red man syndrome [2]. It is characterized by flushing and itching in upper torso with hypotension in severe cases and is caused by histamine release from the mast cells. Others include Steven Johnson syndrome, vasculitic rash. The probability of piperacillin as the offending agent remains low
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