#IDgrandrounds #3
1/4
51/M, receiving vancomycin & cefepime for osteomyelitis, developed diffuse bullous lesions (trunk, extremities, buttocks)
Dx: vancomycin-induced linear IgA bullous dermatosis (LABD)
2/4
Vancomyin-induced LABD
-- most common drug a/w LABD (others: lithium, phenytoin, TMP/SMX, furosemide, atorvastatin, dicolfenac)
-- severity NOT correlated w/ serum vanc level
-- onset: 2-21 days after start
-- Tx: D/c vancomycin --> time to resolution 2 d to 4 wks
3/4
Vancomycin-induced LABD
-- characterized by Ig A deposition in the dermoepidermal junction --> bullae is TENSE
-- tense bullae distinguishes it from drug-induced SJS/TEN (intraepidermal pathology ▶️ flaccid bullae ▶️ +Nikolsky's sign)
4/4
Nikolsky's sign: dislodging of epidermis w/ finger pressure; SJS/TEN, Staph scald skin sx, pemphigus
Asboe-Hansen (variation of Lutz) sign: extension of tense blister to adjacent skin w/ finger pressure at the center of blister
4/4 extra
Vancomycin induced LABD
Note the tense bullae, negative Nikolsky sign.
ncbi.nlm.nih.gov/pubmed/27303171
Share this Scrolly Tale with your friends.
A Scrolly Tale is a new way to read Twitter threads with a more visually immersive experience.
Discover more beautiful Scrolly Tales like this.