Linear Immunoglobulin A disease and Vancomycin: two real ancestral enemies?

We read with great interest the article of Chanal et al,1 recently published in your Journal. We would like to congratulate with the authors, as for the first time it seems that we have the largest study on drug-induced linear IgA disease (DILAD). Authors found that in 67% of DILAD patients the most common offender drug was Vancomycin (VCM). However, we noticed that just patient 17 showed a relative association, although weak, between LAD and VCM, as Naranjo algorithm score2 (NAS) scored 5 for VCM and 0 for all other concurrent medications. Conversely, patients 1,4, 9,18, and 23 scored 6 for VCM and 5 for all other concurrent medications and patients 20 and 22 scored 6 for VCM and all other concurrent medications. Authors also obtained similar results even with the Bégaud imputability score.3 Additionally, in all cases NAS was not higher than 6, which means a slight probability.