Life-threatening reaction to vancomycin given for noninfectious fever

OBJECTIVE: TO report a case of vancomycin-induced anaphylaxis (or anaphylac toid reaction) in a patient with a fever of unrecognized noninfectious orig in. CASE SUMMARY: An 83-year-old white man, who was a patient of the Veterans A ffairs Medical Center, developed a serious anaphylactic (or anaphylactoid) reaction while receiving intravenous vancomycin as empiric therapy for a no socomial fever of unknown origin. The fever was subsequently proved to have been due to acute polyarticular gout rather than an infection. DISCUSSION: This patient developed respiratory distress and an increased se rum troponin concentration, suggestive of a myocardial enzymatic leak as a result of vancomycin therapy. Vancomycin was given before the noninfectious cause of his fever was recognized. CONCLUSIONS: Even with cautious slow infusion, intravenous vancomycin can p recipitate life-threatening infusion-related reactions in some patients. Be cause of this, and to reduce selective pressure for vancomycin resistance, sources of fever that do not require treatment with vancomycin should be di ligently investigated prior to the institution of empiric vancomycin therap y in febrile patients, particularly when the past medical history is sugges tive of an alternative diagnosis.