Vancomycin-induced linear IgA bullous dermatosis

To the Editor.—

Linear IgA bullous dermatosis (LABD) is an idiopathic vesiculobullous disease with a nondiagnostic clinical appearance. It is best characterized pathologically by subepidermal bullous formation with homogeneous linear IgA deposition at the blister base.^1-4Although LABD is most often idiopathic, drug-induced disease may occur rarely.^5,6We describe a patient with vancomycin-induced LABD in whom the eruption was documented clinically, histopathologically, and immunologically on rechallenge.

Report of a Case.—

A 68-year-old man with coronary artery disease was admitted to the New England Deaconess Hospital (Boston) for a coronary artery bypass graft. On admission, his medications included atenolol, diltiazem hydrochloride, tolazamide (Tolinase) nitropaste, intravenous heparin, digoxin, and prazosin hydrochloride. There was no history of drug allergy. On hospital day 2, the patient underwent coronary artery bypass grafting, which was complicated by cardiogenic shock and acute tubular necrosis. An intra-aortic balloon pump and atrioventricular pacing was needed. Intravenously administered