Immunoglobulin E-mediated hypersensitivity reaction after intraperitoneal administration of vancomycin

Intraperitoneal (IP) vancomycin is widely used to treat Gram-positive peritonitis associated with peritoneal dialysis. There have been two cases of red man syndrome (RMS), a vancomycin-specific nonimmunologic reaction, associated with IP vancomycin. However, immune-mediated hypersensitivity reaction to IP vancomycin has not yet been reported. A 49 year old woman on continuous ambulatory peritoneal dialysis developed her first peritonitis episode. The patient was treated with IP vancomycin once/wk for 4 weeks. She experienced mild itching and flushing throughout her body for 1 day after the second treatment. Whenever vancomycin was administered, generalized urticaria and a prickling sensation developed, and the intensity increased gradually; however, these symptoms improved after vancomycin was discontinued. An allergic skin test was performed 6 weeks after the previous urticarial episode, and an intradermal skin test revealed a positive response to vancomycin. To our knowledge, this is the first case report of immunoglobulin E-mediated hypersensitivity reaction to IP vancomycin administration.

Prolonged hyperglycemia after intraperitoneal administration of triamcinolone acetonide in an end-stage ovarian cancer patient with refractory ascites

<b>Case</b>: A 71-year-old woman with diabetes mellitus was diagnosed as end-stage ovarian cancer. She was suffering from stomachache and anorexia because of massive ascites. Although we performed abdominal paracentesis for symptomatic palliation, ascites accumulated again in a few days. In order to control the refractory ascites, we administered intraperitoneal triamcinolone acetonide (10 mg/kg) after the fourth abdominal paracentesis; consequently, the interval between the consecutive abdominal paracentesis procedures was extended remarkably. However, prolonged hyperglycemia occurred despite the administration of a single dose of triamcinolone acetonide, and insulin therapy was required for eight days. <b>Conclusion</b>: To our knowledge, this is the first report of intraperitoneal administration of triamcinolone acetonide that caused prolonged hyperglycemia. Therefore, this drug should be administered with caution in such patients with diabetes mellitus.