Photo Credit: Nadezhda Kozhedub

Vancomycin-induced liver damage, often associated with drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and the human leukocyte antigen (HLA)-A∗32:01 gene, suggests the potential utility of early HLA testing for patients on long-term oral vancomycin treatment to assess their risk.

The following is a summary of “Vancomycin-Induced Liver Injury, DRESS, and HLA-A∗32:01,” published in the January 2024  issue of Allergy & Immunology by Asif, et al.

When vancomycin is given through an IV, it can cause liver injury, resulting in “drug reaction with eosinophilia and systemic symptoms” (DRESS syndrome). For a study, researchers sought to get a better idea of the symptoms and HLA connections of liver damage caused by vancomycin and to explain the physical, chemical, and time-related features of liver damage caused by vancomycin. 

People who were part of the US Drug-induced Liver Injury Network between 2004 and 2020 and had liver damage after being exposed to vancomycin recently were looked at. Blood samples that had been kept were used to sequence HLA genes. Between 2004 and 2021, 1697 cases of drug-induced liver damage were found. Of those, 9 (0.5%) were linked to intravenous vancomycin. Six of the nine cases were men, and the average age was 60 years (range, 23 to 85 days). The treatment lasted 26 days (range, 1 to 34 days). In 8 cases, the symptoms were DRESS syndrome, and 6 were given antibiotics. The types of liver damage were hepatic to cholestatic, and the severity ranged from mild (n = 5) to deadly (n = 1). 

Liver damage and DRESS syndrome eventually went away in survivors. The HLA-A∗32:01 gene was found in 7 vancomycin cases (78% of them had DRESS syndrome), compared to 1 of 81 cases (1.2%) that were exposed but not linked to vancomycin and 113 of 1708 cases (6.6%) that were not exposed to vancomycin. In vancomycin cases, the gene frequency was 0.44, while in the US population, it was less than 0.04. Vancomycin can damage the liver, which is often linked to DRESS syndrome and HLA-A∗32:01. Patients who will be on long-term oral vancomycin treatment might benefit from HLA-A∗32:01 tests early on to help determine their risk level.

Source: sciencedirect.com/science/article/abs/pii/S2213219823010218