Fatal Toxic Epidermal Necrolysis: A Complication of Vancomycin Treatment for an Infected Hip Arthroplasty

The incidence of MRSA or MRSE type infections involving hip prostheses is increasing. Treatment often involves removal of the prosthesis followed by a defined period of antibiotic treatment, prior to insertion of a second prosthesis. Vancomycin is often used in this setting. We report a fatal case of toxic epidermal necrolysis (TEN) in a patient receiving vancomycin following a first stage revision hip replacement. With the increasing use of vancomycin in revision arthroplasty cases, knowledge of this rare but commonly fatal side effect is important so that if it occurs, rapid and appropriate treatment may be commenced.