Vancomycin-related convulsion in a pediatric patient with neuroblastoma: A case report and review of the literature

Abstract

BACKGROUND

Vancomycin is often used as an anti-infective drug in patients receiving anti-tumor chemotherapy. There are concerns about its adverse drug reactions during treatment, such as nephrotoxicity, ototoxicity, hypersensitivity reactions, etc. However, potential convulsion related to high plasma concentrations of vancomycin in children receiving chemotherapy has not been reported.

CASE SUMMARY

A 3.9-year-old pediatric patient with neuroblastoma receiving vancomycin to treat post-chemotherapy infection developed an unexpected convulsion. No other potential disease conditions could explain the occurrence of the convulsion. The subsequently measured overly high plasma concentrations of vancomycin could possibly provide a clue to the occurrence of this convulsion. The peak and trough plasma concentrations of vancomycin were 59.5 mg/L and 38.6 mg/L, respectively, which were much higher than the safe range. Simulation with the Bayesian approach using MwPharm software showed that the area under the concentration-time curve over 24 h was 1086.6 mg· h/L. Therefore, vancomycin was immediately stopped and teicoplanin was administered instead combined with meropenem and fluconazole as the anti-infective treatment strategy.

CONCLUSION

Unexpected convulsion occurring in a patient after chemotherapy is probably due to toxicity caused by abnormal pharmacokinetics of vancomycin. Overall evaluation and close therapeutic drug monitoring should be conducted to determine the underlying etiology and to take the necessary action as soon as possible.

Keywords: Vancomycin; Neuroblastoma; Convulsion; Children; Adverse drug reaction; Case report

Core Tip: Vancomycin is often used as an anti-infective drug in patients receiving anti-tumor chemotherapy. We present a rare case of sudden onset of convulsion related to vancomycin treatment in a pediatric patient with neuroblastoma. This case demonstrates that unexpected convulsion occurring in patients after chemotherapy is probably due to the toxicity caused by abnormal pharmacokinetics of vancomycin. Close therapeutic drug monitoring is recommended to ensure the plasma concentration of vancomycin is within the normal range. A model-based Bayesian estimation tool could be used to estimate the area under the concentration-time curve and help health care practitioners create an individualized dosing plan.