Linear IgA Bullous Dermatosis Associated with Vancomycin

Eric F. Bernstein; Mindy Schuster

doi:10.7326/0003-4819-129-6-199809150-00022

Letters |15 September 1998

Linear IgA Bullous Dermatosis Associated with Vancomycin

Eric F. Bernstein, MD; Mindy Schuster, MD

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TO THE EDITOR:

Linear IgA bullous dermatosis is an autoantibody-mediated subepidermal blistering disease that is rarely associated with drug exposure [1]. Clinical differentiation of this entity from more common blistering disorders such as bullous pemphigoid may not be possible on clinical grounds. It has been described in association with many medications [2-5], and vancomycin has been implicated in several patients [4, 5]. We describe two patients with severe linear IgA bullous dermatosis who received vancomycin within 2 weeks before the development of bullae.

A 60-year-old woman had surgical repair of an infected enterocutaneous fistula. Ten days after beginning postoperative intravenous antibiotic therapy with vancomycin, imipenim, and gentamicin, the patient developed widespread bullae (Figure 2, top). Histopathologic examination revealed a subepidermal blister with numerous neutrophils, and direct immunofluorescence revealed linear deposits of IgA along the dermal-epidermal junction; these findings were consistent with drug-induced LABD. Antibiotic therapy was discontinued; therapy with oral prednisone, 60 mg/d, was begun; and the blisters resolved.

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Letters |15 September 1998

Linear IgA Bullous Dermatosis Associated with Vancomycin

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Letters |15 September 1998

Linear IgA Bullous Dermatosis Associated with Vancomycin

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