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Renal biopsy revealed diffuse and marked interstitial and tubular infiltration by mononuclear cells and eosinophils; acute tubulointerstitial nephritis (TIN) was diagnosed. The rash progressed to erythema multiforme major after rechallenge with vancomycin in the setting of MRSA peritoneal catheter\u2010related peritonitis and then to fatal toxic epidermal necrolysis in the setting of steroid taper and persistent serum vancomycin levels. This case further implicates vancomycin as a drug that infrequently can cause severe acute TIN and exfoliative dermatitis. When a renally excreted drug such as vancomycin is administered, serum drug levels should be serially monitored and high\u2010dosage steroids be maintained or tapered slowly until serum drug levels become undetectable.<\/jats:p>","DOI":"10.1592\/phco.21.15.1233.33901","type":"journal-article","created":{"date-parts":[[2004,6,4]],"date-time":"2004-06-04T05:56:42Z","timestamp":1086328602000},"page":"1233-1239","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Biopsy\u2010Proved Acute Tubulointerstitial Nephritis and Toxic Epidermal Necrolysis Associated with Vancomycin"],"prefix":"10.1002","volume":"21","author":[{"given":"Stephen I\u2010Hong","family":"Hsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,1,17]]},"reference":[{"key":"e_1_2_1_2_2","first-page":"631","article-title":"Vancomycin","volume":"52","author":"Geraci 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