Challenges in Managing Vancomycin Flushing Syndrome Following Vancomycin-Loaded Bone Cement for Periprosthetic Joint Infection: A Case Report

Document Type : CASE REPORT

Authors

Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Periprosthetic joint infection (PJI) is a critical complication following arthroplasties, often treated with 
a two-stage revision using antibiotic-loaded bone cement spacers. Although these spacers can 
effectively manage infections, they occasionally cause severe adverse reactions. We reported the case 
of a 68-year-old female who developed vancomycin flushing syndrome (VFS), previously known as the 
red man syndrome, following the insertion of a vancomycin-loaded bone cement spacer during the firststage revision surgery for PJI after undergoing total knee arthroplasty. Six hours postoperatively, she 
developed pruritus, diffuse rash, tachycardia, and hypotension. VFS was diagnosed based on clinical 
presentation after excluding other potential causes. She was treated with intravenous epinephrine, 
antihistamines, steroids, and fluid resuscitation without requiring spacer removal. The patient recovered 
uneventfully, underwent second-stage reimplantation after 6 weeks, and remained asymptomatic at 2-
year follow-up. This highlights the importance of anticipating and managing this potentially severe 
reaction through a multidisciplinary approach, considering the risks and benefits of retaining versus 
removing antibiotic-loaded bone-cement spacers.
 Level of evidence: IV

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 674-678

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History

  • Receive Date: 31 March 2024
  • Revise Date: 11 June 2024
  • Accept Date: 26 June 2024

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