• Chu-Ting Chen, Khai-Jing Ng, Yu Lin, and Ming-Chang Kao.
• Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City.
• Medicine (Baltimore). 2018 Dec 1; 97 (51): e13371.

RationaleRed man syndrome (RMS) is the most common allergic reaction to vancomycin. It generally occurs during rapid infusion of vancomycin; only few cases have been reported as results of local vancomycin administration. We hereby report a rare case where RMS developed after insertion of vancomycin-loaded bone cement in a primary total knee replacement (TKR).Patient ConcernsA 74-year-old woman was admitted for a left TKR due to severe osteoarthritis. Erythematous changes over face, trunk, and extremities developed after the use of vancomycin-loaded bone cement.DiagnosesAccording to the clinical manifestations, the patient was diagnosed with vancomycin-induced RMS.InterventionsShe was treated with fluid challenge and intravenous ephedrine, followed by intravenous diphenhydramine and hydrocortisone.OutcomesThe patient's symptoms and signs relieved within 1 h after treatment.LessonsVancomycin-induced RMS may occur after the routine use of vancomycin-loaded bone cement in the primary TKR replacement.

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