Summary

A 58-year-old Caucasian woman was admitted for knee replacement but during the postoperative period she developed sepsis due to pneumonia, which was treated with coamoxiclav and then piperacillin (for 2 weeks). She had renal failure, which needed haemofiltration. During her recovery she had diarrhoea due to Clostridium difficile, which was not controlled with metronidazole. Vancomycin was therefore given, but she developed urticarial erythematous skin rash and hence it was stopped. She was not on any other new medications and a vasculitic screen was negative. A dermatologist reviewed her file as well. The skin rash subsided after 2 weeks with topical emollients and chlorphenamine tablets. Her diarrhoea eventually settled and she went home well. Though classically described in men, this “red man” syndrome (features of urticarial erythematous rash due to oral vancomycin) has been previously reported in case reports and in literature reviews.