PMC6481134_01
Graphical representation of laboratory value trends of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (Alk Phos) over the course of the admission. Each marker is noted to peak approximately 3-4 weeks into admission.
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fig1
On day 22 of vancomycin therapy, liver enzymes were noted to be uptrending, with aspartate aminotransferase peaking at 2,563 units/L, alanine aminotransferase peaking at 1,192 units/L, and alkaline phosphatase peaking at 1,076 units/L (Figure 1).
Representative photograph of the maculopapular rash noted on right upper extremity is shown in the image above. Similar presentation was also noted on left upper extremity (not shown).
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fig2
On day 25 of vancomycin therapy, a diffuse maculopapular rash erupted involving bilateral upper and lower extremities as well as the upper chest (Figures 2 and 3).
Representative photograph of maculopapular rash noted on left lower extremity is shown above. Similar presentation was also noted on right lower extremity (in background).
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fig3
On day 25 of vancomycin therapy, a diffuse maculopapular rash erupted involving bilateral upper and lower extremities as well as the upper chest (Figures 2 and 3).
Graphical representation of the absolute eosinophil count (Eosinophil #) (pink line) over the course of the admission, with the normal range demarcated by Eosinophil # (Low) (green line) as the minimum and the Eosinophil # (High) (blue line) as the maximum values and blue (max) and green (min) values. Absolute eosinophil count increased several fold above the upper limit of normal approximately 3-4 weeks into admission.
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fig4
By day 29, the eosinophil count began uptrending, with absolute eosinophil count noted at 600/mul on day 35 (Figure 4).