• Tianying Zang, Bingyang Liu, Lunkun Ma, and Xiaojun Tang.
• Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
• Medicine (Baltimore). 2022 Nov 25; 101 (47): e32047e32047.

BackgroundRed man syndrome (RMS) is an adverse effect of vancomycin that usually occurs within minutes to tens of minutes after infusion. Previous literature reported that RMS rarely occurs again after the infusion speed is controlled.MethodsWe report a case of immediate and delayed RMS that presented with fever, persistent lower extremity rash, shock, lymphadenopathy and pulmonary edema. This patient subsequently diagnosed with Sjögren's Syndrome, the time from NVCM infusion to RMS onset of this case ranged from 10 minutes to 54 hours, which are all rare in clinic and hard to distinguish severe RMS and IgE-mediated anaphylaxis.ResultsAfter multidisciplinary consultation, the patient was diagnosed with RMS based on clinical manifestations and laboratory results. Patients' symptoms, signs, body temperature and disease progress were monitored, and an active search for causes was conducted. After a 20-day treatment, all the symptoms disappeared, the patient was transferred to immunology department to treat SS.Conclusion SubsectionsWe reported a patient repeatedly developed fever and even shock when the infusion speed is normal, which was rare and similar as anaphylaxis. Therefore, the progression of RMS and its differentiation from allergy need to be further studied.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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