cefepime and Precursor-B-Cell-Lymphoblastic-Leukemia-Lymphoma

Cefepime is increasingly used as empiric treatment for fever in the setting of neutropenia. We present a patient with acute-on-chronic renal disease who received cefepime at the appropriate dose for his glomerular filtration rate but developed cefepime-associated encephalopathy. Here, we review neurologic toxicities of cefepime and present suggestions for work-up and management.

Topics: Adolescent; Anti-Bacterial Agents; Cefepime; Cephalosporins; Fever of Unknown Origin; Humans; Male; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Renal Insufficiency

Voriconazole is a triazole antifungal agent superior to amphotericin B in the treatment of invasive aspergillosis. It is generally well tolerated and has excellent oral bioavailability, providing significant benefit in the treatment of invasive fungal infections. There have been numerous reports of dermatologic reactions to this agent, including erythroderma, cheilitis, Stevens-Johnson syndrome, discoid lupus erythematosus, pseudoporphyria, squamous cell carcinoma, and photosensitivity reactions. Pseudoporphyria, a dermatologic condition mimicking porphyria cutanea tarda, has been described as an adverse effect of voriconazole use. Clinical findings include photosensitivity, vesicles, bullae, milia, and scarring in sun-exposed areas. Photo-onycholysis is a phenomenon of nail discoloration and onycholysis that has been described in the setting of a phototoxic drug reaction and pseudoporphyria. Implicated drugs have most commonly been tetracyclines, fluoroquinolones, and psoralens; others have been reported as well. We report a case of a pediatric patient with leukemia who developed symptoms consistent with pseudoporphyria and later photo-onycholysis while being treated with voriconazole. To our knowledge, this is the first reported case of pseudoporphyria due to voriconazole in a pediatric patient and the first reported case of photo-onycholysis as a consequence of voriconazole use.

Topics: Ankle; Aspergillosis; Blister; Catheter-Related Infections; Cefepime; Cephalosporins; Cheilitis; Child; Cicatrix; Clindamycin; Dermatitis, Phototoxic; Echinocandins; Humans; Hypokalemia; Immunocompromised Host; Levofloxacin; Lipopeptides; Magnesium Deficiency; Male; Micafungin; Onycholysis; Photosensitivity Disorders; Porphyrias; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Vancomycin; Voriconazole