万古霉素相关血管炎文献病例分析

目的：分析万古霉素相关血管炎不良反应发生情况及其临床特点，为临床安全用药提供参考。方法：检索PubMed、Web of Science、Embase、EBSCO、Scopus、ScienceDirect数据库（检索时间为自建库至 2021 年4月），收集万古霉素相关血管炎的病例报道并进行汇总分析。结果：共收集到万古霉素相关血管炎患者14例，其中男性10例（71.4%），女性4例（28.6%）；所有患者中年龄最小的17岁，最大的83岁，中位年龄56.6岁。万古霉素暴露至发生血管炎的时间为1~27 d，多发生在7~15 d（9例）。14例患者均出现皮肤病变，表现为紫癜和（或）皮疹，其中累及四肢4例、下肢7例。13例进行了病变部位皮肤活检，12例示白细胞碎裂性血管炎，1例示狼疮样综合征。诊断血管炎后，14例患者均停用万古霉素，其中11例换用其他抗感染药物，4例接受糖皮质激素治疗，1例局部使用类固醇，14例患者均痊愈。结论：万古霉素相关血管炎多发生在用药后7~15 d，以男性患者居多，主要临床表现为紫癜和皮疹，多累及下肢，症状严重程度不同，及时停药均预后良好。

Literature case analysis of vancomycin-associated vasculitis

OBJECTIVE To explore the occurrences and clinical characteristics of vancomycin-associated vasculitis and provide references for clinical application.METHODS Case reports of vancomycin-associated vasculitis were searched from the databases of PubMed, Web of Science, Embase, EBSCO, Scopus and ScienceDirect(search time up to April 2021).RESULTS A total of 14 patients were collected, including 10 males(71.4%) and 4 females(28.6%).The median age was 56.6(17-83) years.Time from vancomycin dosing to the occurrence of vasculitis was 1-27 days.It was 7-15 days in 9 patients.There was an onset of purpura and/or rash.Skin lesions involved upper/lower(n=4) and lower extremities(n=7).And 13 patients underwent skin biopsy at lesion site.There were leukocytoclastic vasculitis(n=12) and lupus erythmatosus-like(n=1).Vancomycin was withdrawn after a definite diagnosis of vasculitis.Other antibiotics(n=11), glucocorticoids(n=4) and topical steroids(n=1) were prescribed.Finally all cases were cured.CONCLUSION Vancomycin-associated vasculitis usually occurs predominantly in males at Day 7-15 after an initial medication.Purpura and rash often appears at lower extremities.The severity of symptoms varies and the prognosis is decent when vancomycin is withdrawn timely.