Answer Happy

HD is a 52-year-old white male, who had surgery on his right
foot following a crush injury sustained in a car accident. The
surgical wound developed signs of infection and a culture of the
wound was taken during surgical debridement but was negative for
growth. HD was placed on Vancomycin along with Ceftriaxone, and
ciprofloxacin. 19 days later HD developed a rash over most of his
body and a fever. Blood tests indicated a high eosinophil count and
elevated aspartate aminotransferase (AST) and alanine
aminotransferase (ALT) at twice the normal levels. A subsequent
genetic test revealed HD had the HLA-A*32:01 haplotype.
What is the reaction to vancomycin experienced by HD called?
What would you suggest be done about HD’s reaction to
vancomycin?
FOR CLINICAL USE Test Details Gene Genotype Phenotype Alleles Tested CYP2C19 *1/01 *2/2 Normal Metabolizer Normal Metabolizer CYP2D6 *2, +3, +4,*4B,*5, 6, 7, 8, 9, *17 *2,3,*4, *4M, *6,*7, 48, 49,*10,*12, *14A,*14B, 17,29,35,41 CYP3A5 CYP3A4 *3/3 *1/1B - 1639G > AG/G *1/01 *1D, 2, 3, 3B,*3C, *6,7,8,9 *1B, *2, 13, *12*17,*22 -1639G>A *2, 3, 4, 5, 6, *11 VKORC1 Poor Metabolizer Normal Metabolizer Low Warfarin Sensitivity Normal Metabolizer Normal Metabolizer Normalfunction Negative CYP2C9 CYP2B6 *6,9 SLCO101 521T>C388A>G *1/1 521T>CT/T rs 75527207 G/G *1/*1 CFTR Numerous DPYD Normal Metabolizer Numerous *2, *3A, *3B, *3C4 TPMT Poor Metabolizer Normal G6PD HLA-B*15:02 Numerous All HLAB 15 HLA-B*57:01 *2/3 Bor B/B negative/negative negative positive negative negative negative negative positive/ negative All HLAB*57 HLA-B*58:01 Negative Positive Negative Negative Positive All HLAB*58 HLA-A31:01 All HLAA*31 HLA-A*32:01 All HLAA*32 Cancer Biopsy, cfDNA & IHC Test Details: Cancer Gene Gene Status Phenotype BRAF Wild type wt) wt BCR-ABL Not detected id) wt EGFR wt wt KRAS Wt wt MGMT Methylated promoter Unmethylated promotewt gene Not done MGMT-negative BRCA1-positive BRCA1 ER PR Not done HER2 Not detected absent