Abstract

Background:
Vancomycin, a glycopeptide antibiotic, is primarily indicated for resistant Gram-positive infections, particularly methicillin-resistant Staphylococcus aureus (MRSA). While infusion-related reactions such as “Red Man Syndrome” are well recognized, delayed cutaneous hypersensitivity reactions, though uncommon, may present diagnostic and therapeutic challenges in pediatric patients. Awareness of such reactions is essential to prevent unnecessary morbidity and ensure safe therapeutic continuation.

Case Description:
A child on intravenous vancomycin therapy developed erythematous maculopapular rashes localized to the face on the 5th day of treatment. There was no mucosal or systemic involvement, and hematological and biochemical parameters were normal. The rash subsided promptly after substitution of the initial vancomycin brand with an alternative formulation, along with supportive care using antihistamines and emollients. Causality assessment using the World Health Organization–Uppsala Monitoring Centre (WHO-UMC) criteria categorized the event as “probable”.

Conclusion:
This case underscores the importance of recognizing formulation-specific reactions as a possible, though rare, cause of vancomycin-induced cutaneous ADRs. Thorough pharmacovigilance reporting and post-marketing surveillance are essential to validate such observations.

Key words: Vancomycin; Adverse drug reaction; Maculopapular rash; Pharmacovigilance; Pediatrics.