Abstract | BACKGROUND: OBJECTIVE: To describe clinical, biochemical, and temporal characteristics of vancomycin-induced liver injury. METHODS: Cases of liver injury with recent exposure to vancomycin who were enrolled in the US Drug-induced Liver Injury Network between 2004 and 2020 were assessed. Sequencing of HLA alleles was performed on stored blood samples. RESULTS: Among 1697 cases of drug-induced liver injury identified between 2004 and 2021, 9 (0.5%) were attributed to intravenous vancomycin. The 9 cases included 6 men, median age 60 years (range, 23-85 days), and treatment for 26 days (range, 1-34 days). The clinical presentation was DRESS syndrome in 8 patients, of whom 6 received corticosteroids. Liver injury varied from hepatocellular to cholestatic and from mild (n = 5) to fatal (n = 1). In survivors, liver injury and DRESS syndrome ultimately resolved. HLA typing demonstrated the HLA-A∗32:01 allele in 7 vancomycin cases (78%, all with DRESS syndrome), versus 1 of 81 cases (1.2%) exposed but not attributed to vancomycin, and 113 of 1708 cases (6.6%) without vancomycin exposure. The allele frequency in vancomycin cases was 0.44 compared with less than 0.04 in US populations. CONCLUSIONS:
Vancomycin-induced liver injury is commonly associated with DRESS syndrome and linked to HLA-A∗32:01. HLA-A∗32:01 testing could be considered early to risk-stratify patients using long-term intravenous vancomycin therapy.
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Authors | Bilal A Asif, Christopher Koh, Elizabeth J Phillips, Jiezhun Gu, Yi-Ju Li, Huiman Barnhart, Naga Chalasani, Robert J Fontana, Paul H Hayashi, Victor J Navarro, Jay H Hoofnagle, Drug Induced Liver Injury Network (DILIN) |
Journal | The journal of allergy and clinical immunology. In practice
(J Allergy Clin Immunol Pract)
(Sep 20 2023)
ISSN: 2213-2201 [Electronic] United States |
PMID | 37739311
(Publication Type: Journal Article)
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Copyright | Published by Elsevier Inc. |