History:

Elderly cancer patient who developed pneumonia unresponsive to conventional community-based oral therapy. Was given vancomycin upon hospital admission, and with the first infusion developed bright red, confluent macular eruption, primarily on face and abdomen. Also had back spasms and hypotension, but no angioedema or worsening dyspnea. This is a nice example of "The Red Man Syndrome" associated with vancomycin, most commonly with a rapid infusion (1g over 30 minutes or >33mg/min). Treatment consists of discontinuing the infusion and administration of oral or IV antihistamines until the eruption resolves. This is not to be confused with true IgE-mediated anaphylaxis, and the patient can resume vancomycin treatment at a slower infusion rate or via continuous infusion in most cases.