Vancomycin allergy presenting as fever of unknown origin.

A 37-year-old woman receiving long-term hemodialysis was admitted to the hospital with a fever of unknown origin (6 weeks of unexplained, persistent, low-grade fever). Although she had received vancomycin hydrochloride 5 days before the onset of fever, the drug was not suspected as the cause because of the duration of fever, the administration of vancomycin on prior occasions without incident, and the lack of allergic stigmata. After hospitalization, vancomycin and gentamicin sulfate were administered empirically.

Conversion of external arteriovenous hemodialysis shunt to internal fistula.

The preservation of arteriovenous (AV) access site is important to long-term survival of patient's requiring maintenance hemodialysis life-support therapy. Patients with chronic renal failure and uremia who are not suited for immediate application of a subcutaneous AV fistula or arteriovenous graft and who require an initial Teflon-Silastic AV shunt to initiate urgent hemodialysis need not lose these vessels when the AV shunt is removed. After venous maturation, these patients should have a subcutaneous AV fistula created from the uninfected, unclotted shunt before infection or clotting would cause loss of these vessels.