Red Man Syndrome

 

Background

This week while on rounds at work, one of the differential diagnoses that was mentioned for a patient on our list, was Red Man Syndrome. The patient had Stevens-Johnson syndrome, which I had learned about in respiratory school, but I had never heard of Red Man syndrome before. Being curious, here’s what I learned when I inquired further about red man syndrome.

Introduction

Vancomycin is an antibiotic that is commonly used to fight various infections. However, like all

medications, vancomycin administration is not without risk. Vancomycin can cause two types of hypersensitivity reactions:

• red man syndrome
• anaphalyxis reaction

Signs

Some of the signs associated with red man syndrome include the following:

• puritis
• erythematosus  rash on the face and neck
• some less frequently seen signs are

o   hypotension

o   angioedema

Symptoms

• patient c/o diffuse burning and itching
•  discomfort
• dizzy
• agitated
• headache
• chills and fever
• parasthesia around the mouth
• in severe reactions:

o   chest pain

o   difficulty breathing

Timing of Signs and Symptoms
signs and symptoms typically present 4-10 minutes after infusion of Vancomycin or soon after completion of the medication infusion typically associated with rapid I.V. infusion (< 1 hour) after first infusion of Vancomycin. To help avoid such potentially harmful reactions associated with Vancomycin, most hospitals has as their protocol, to infuse at 60 min. as a minimum. Any rate of infusion faster than that, places patients at risk for reaction

Links

Red man syndrome has also been linked to administration of Vancomycin when given via intra-peritoneal route or orally. In years past, red man syndrome was thought to be caused by the impurities seen in Vancomycin preparations and earned its name, “Mississippi Mud”.

Reaction mechanism

• mast cell degranulation
•  IgE and complement involvement

Summary

• Vancomycin should be given over at least one hour interval.  Longer infusion times should be used if giving larger doses  (Vancomycin > 1 gram)
• Vancomycin better tolerated when given in smaller, frequent doses
• If unable to give over prolonged infusion times, pretreatment with antihistamines combined with H₂ antagonist can be protective

Reference:

1. Sivagnanam, S., Deleu, D. Red man syndrome. Crit Care 2003, 7: 119-120.