SUCCESSFUL VANCOMYCIN DESENSITIZATION IN A PATIENT WITH END-STAGE RENAL-DISEASE AND ANAPHYLACTIC SHOCK TO VANCOMYCIN

OBJECTIVE: TO report successful desensitization in a patient with a hi story of end-stage renal disease (ESRD) and anaphylactic shock after r eceiving vancomycin. CASE SUMMARY: A 47-year-old white woman with a hi story of ESRD was admitted to the hospital reporting persistent nausea , vomiting, and diffuse abdominal pain. She had developed anaphylactic shock after exposure to vancomycin 3 years prior to this hospitalizat ion. The patient's hospital course was complicated by septic shock and positive blood cultures for methicillin-resistant Staphylococcus epid ermidis. The patient tolerated vancomycin desensitization and received intravenous vancomycin 100 mg/d for 21 days. DISCUSSION: The desensit ization protocol used in this report allows for gradual increases in v ancomycin serum concentrations, avoiding peak and trough concentration s that occur with intravenous boluses. Maintaining the desensitized st ate is dependent on the continuous presence of the antigen with a retu rn of clinical sensitivity after drug discontinuation. The vancomycin desensitization protocol and subsequent dosing strategy was used to en sure the continuous presence of vancomycin at steady-state concentrati ons to prevent the return of anaphylactic sensitivity. CONCLUSIONS: De sensitization was successful in a patient with ESRD and history of ana phylactic shock to vancomycin.