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Sarah N. Walsh, MD; Katherine Kerchner, MD; Omar P. Sangüeza, MD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Report of a Case

A 76-year-old man with malignant fibrous histiocytoma was admitted for failure to thrive following 2 courses of chemotherapy. On hospital day 2, treatment with vancomycin was started for Staphylococcus bacteremia. In light of an elevated creatinine level and a vancomycin trough level of 63.3 µg/mL (normal, 5-10 µg/mL), the vancomycin was not administered on hospital day 10. Nine days later, the patient developed painful blistering on his palms bilaterally (vancomycin trough level, 22.6 µg/mL).

Dermatologic examination revealed tense bullous lesions on an erythematous base, some hemorrhagic, involving the palms bilaterally (Figure 1). No other areas were affected.

Figure appears in full text version. Figure 1. Initial appearance of the lesions as tense bullae on an erythematous base involving the palmar surfaces bilaterally.

A punch biopsy specimen showed a subepidermal vesicular dermatitis with neutrophils. Direct immunofluorescence revealed strong linear deposition of IgA and C3 . . . [Full Text of this Article]

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