Case history

Case history

A 73-year-old woman was given intravenous vancomycin to treat Staphylococcus aureus osteomyelitis; 20 days into treatment she developed a generalised maculopapular exanthem with intense pruritus, malaise, and fever.[12] Blood biochemistry showed transaminitis. Vancomycin was withdrawn and prednisolone was prescribed. Her condition improved and resolved over 12 days.

Other presentations

There are a wide variety of clinical presentations due to adverse drug reactions (non-allergic reactions), including, for example: brown discoloration of the nails, particularly affecting the thumbs, caused by a 15-day course of doxycycline;[13] and a blue-grey discoloration of the face and other exposed areas, caused by amiodarone taken for 3 years. In the latter case study, protected areas, such as the forehead by a broad-brimmed hat and the skin under a wrist watch, were not affected.[14]

A high incidence of rashes in patients with cancers has been reported in those taking tyrosine kinase inhibitors including erlotinib, nilotinib, and vandetanib, and an increased risk of hand-foot skin reaction (palmar-plantar erythrodysaesthesia) has been reported in patients taking vascular endothelial growth factor receptor inhibitors including sorafenib, sunitinib, pazopanib, and axitinib.[15][16][17][18][19] The risk of rash is also high in HER2-positive metastatic breast cancer patients taking the HER2/neu receptor antagonist pertuzumab, and for ipilimumab, which is used for melanoma.[20][21] Psoriasis, either de novo or worsened, can occur paradoxically with beta-blockers and TNF-alpha inhibitors.[22] Acne-like rashes have been reported in patients receiving epidermal growth factor receptor antagonists, such as cetuximab.[23]

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