A Case of Oral-Vancomycin-Induced Rash in a Patient with Acute Kidney Injury
Round 1
Reviewer 1 Report
The presented case is very interesting and this presentation is of high value to the physicians who have patients with CDI and treat them with vancomycin.
I noticed that the text „remained negative after five days of incubation. EKG showed normal sinus rhythm, right atrial enlargement, and prolonged QTc 508 msec. The stool test for Clostridioides difficile toxin was positive.“ is repeated twice and therefore should be deleted.
Also, is it possible to present inflammatory biomarker values (like CRP or PCT) in Table 1?
Author Response
I appreciate your time reviewing the article and your valuable feedback.
I noticed that the text „remained negative after five days of incubation. EKG showed normal sinus rhythm, right atrial enlargement, and prolonged QTc 508 msec. The stool test for Clostridioides difficile toxin was positive.“ is repeated twice and therefore should be deleted.
Removed.
Also, is it possible to present inflammatory biomarker values (like CRP or PCT) in Table 1?
Unfortunately, inflammatory markers were not collected.
Reviewer 2 Report
Case presentation was comprehensive and related. Discussion was very detailed and presented well. This article definitely would increase the awareness for the clinicians and thus have impact on clinical practice.
Would suggest to add a picture of the maculopapular rash, if available.
All the related case reports that were published are in acute care hospital. So consider adding that as one of the important risk factor for rash associated with oral vancomycin in the conclusion.
It will be intriguing to the readers to know why this patient has developed rash on Day 8 when his kidney function and diarrhea were improving. One of the possibility is T cell mediated delayed drug reaction and consider adding this to the article.
Minor editions:
In case presentation, 3rd paragraph, positive stool test was written twice.
In the same paragraph, missing text " remained negative after five days of incubation"
Overall, This article is very fascinating and well written that has good literature support.
Author Response
Would suggest to add a picture of the maculopapular rash, if available.
Unfortunately, I don't have a picture of the rash.
All the related case reports that were published are in acute care hospital. So consider adding that as one of the important risk factor for rash associated with oral vancomycin in the conclusion.
Added to the conclusion
It will be intriguing to the readers to know why this patient has developed rash on Day 8 when his kidney function and diarrhea were improving. One of the possibility is T cell mediated delayed drug reaction and consider adding this to the article.
Added to the article.
Minor editions:
In case presentation, 3rd paragraph, positive stool test was written twice.
In the same paragraph, missing text " remained negative after five days of incubation"
All fixed.
