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

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 2year 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.