Vancomycin-induced linear IgA bullous dermatosis: associations

Abstract

Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering disease. LABD is consideredmostly idiopathic, butsome cases have been reported to be drug-induced, mainly associated with vancomycin (VCM).We present two cases of LABD possibly associated with VCM used for cardiac surgery prophylaxis; inthe presented cases, the eruptions occurred only after VCM withdrawal, therefore leaving a questionabout the relationship between VCM and LABD in these cases.We reviewed previous reports of VCM-induced LABD and analyzed the following parameters: gender,age, recent medical history, concurrent medication, latency period, progression after withdrawal,time to resolution, treatment, and rechallenge. The causal relationship between VCM and LABD was often unclear; patients frequently hadconcurrent medication and symptoms frequently began and/or progressed after VCM withdrawal. Amongthe 46 reviewed patients in addition to our two cases (n=48), 20 (42%) had recent history ofcardiac procedure, cardiac infection, congestive heart failure, or aortic aneurism. Further investigation is needed to ascertain the association between LABD, VCM, andheart disease.