Correspondence

Vancomycin and Priapism

N Engl J Med 1998; 338:1701June 4, 1998

Article

To the Editor:

A 37-year-old man who had had severe diabetes since the age of 7, including complications of retinopathy, nephropathy, neuropathy, macroangiopathy, and microangiopathy, and who had received a cadaveric kidney–pancreas transplant three years earlier was hospitalized for acute infectious prepatellar bursitis of the left knee. Since receiving his transplant, he had taken 125 mg of cyclosporine orally twice daily, 10 mg of prednisone daily, 1 g of mycophenolate mofetil orally daily, and a single tablet of double-strength trimethoprim–sulfamethoxazole daily. Intravenous treatment with 2 g of cefazolin every eight hours and 2 g of aztreonam every eight hours was instituted as empirical therapy for septic bursitis. Methicillin-resistant Staphylococcus aureus was isolated from culture material obtained from the incision and drainage of the bursa, and treatment was switched to 1 g of vancomycin intravenously per day. After two doses, the patient reported priapism. A urologist was consulted, and bilateral corpus-cavernosum phlebotomy was performed, with resolution of the patient's symptoms.

Treatment was then switched to oral double-strength trimethoprim–sulfamethoxazole twice daily, and the patient was sent home. He was readmitted five days later with continued drainage from his left knee. Vancomycin (500 mg intravenously every 12 hours) was inadvertently administered, and after six doses, the patient again reported priapism. He subsequently underwent bursal excision, was given minocycline and rifampin, and was discharged. His knee was healed after the completion of this 10-day course of antibiotics.

Vancomycin has been available since 1958, with well-established toxic and untoward effects. Common adverse effects include fever, chills, phlebitis at the infusion site, rashes, ototoxicity, nephrotoxicity, red man syndrome, neutropenia, and thrombocytopenia.1,2 The Physicians ' Desk Reference does not list priapism as a toxic effect of vancomycin.2 A Medline search for the years 1966 to 1998, with vancomycin, priapism, and adverse effects as the key words, did not reveal any published reports of vancomycin use and priapism.

In our patient, we cannot rule out the possibility of an interaction between vancomycin and one or more of the immunosuppressive medications that he was taking.

John S. Czachor, M.D.
Piero Garzaro, M.D.
Wright State University School of Medicine, Dayton, OH 45409

John R. Miller, B.S.
Miami Valley Hospital, Dayton, OH 45409

2 References

1. 1

   Fekety R. Vancomycin and teicoplanin. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's principles and practice of infectious diseases. 4th ed. Vol. 1. New York: Churchill Livingstone, 1995:346-54.
   

2. 2

   Physicians' desk reference. 52nd ed. Montvale, N.J.: Medical Economics, 1998:1506-8.
   

Citing Articles (4)

Citing Articles

1. 1

   Shabnam Sood, William James, Maria-Jesus Bailon. (2008) Priapism associated with atypical antipsychotic medications: a review. International Clinical Psychopharmacology 23:1, 9-17
   CrossRef

2. 2

   2006. Vancomycin. , 3593-3606.
   CrossRef

3. 3

   Zafar Maan, Manit Arya, Hitendra RH Patel. (2003) Priapism – a review of the medical management. Expert Opinion on Pharmacotherapy 4:12, 2271-2277
   CrossRef

4. 4

   &NA;. (1998) Vancomycin. Reactions Weekly &NA;:705, 10-11
   CrossRef