Red man syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Red man syndrome is characterized by symptoms consistent with anaphylactoid reactions. These symptoms may include dyspnea, hypotension, urticaria, pain and spasm of chest and back muscles, wheezing, pruritus, and upper body flushing giving the typical appearance and thus the name "Red man syndrome”. On discontinuation of the offending agent, these symptoms can resolve as early as 20 minutes but in some cases may require several hours. Vancomycin is the most common agent responsible for Red man syndrome.

Causes

The most common cause of red man syndrome is:

• Vancomycin infusion for less than 1 hour in patients who are not pre-treated with diphenhydramine

Other Antibiotics

Red man syndrome can result as a result of hypersensitivity to:

• Ciprofloxacin
• Amphotericin B
• Rifampicin
• Teicoplanin

Symptoms

Some associated symptoms of red man syndrome include:

• Headache
• Chills
• Hypotension
• Dizziness
• Chest pain
• Dyspnea
• Pruritis, urticaria
• Rash
  • Erythematous rash that involves the
  • Face
  • Neck and
  • Upper torso
• Spasm of chest and back muscles
• Wheezing
• Upper body flushing giving the typical appearance of "red man"

Anaphylactoid Reaction

Red man syndrome has similar features to anaphylactoid reaction. This is as a result of:

• Absence of elevation in tryptase levels