piperacillin--tazobactam-drug-combination and Exanthema

A heart transplant 62-year-old patient referred for coronavirus-19 disease (COVID-19) pneumonia. At admission, he was febrile, tachypnoeic, and mild hypoxic with dry cough; during hospitalization, a diffuse morbilliform skin rash appeared. He was treated with tocilizumab with symptoms improvement, without a complete pulmonary function recovery. Skin rash, highly suggestive for COVID-19 cutaneous involvement, persisted for ten days despite tocilizumab administration.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Anticoagulants; Cardiomyopathy, Dilated; Cough; COVID-19; COVID-19 Drug Treatment; Diarrhea; Enoxaparin; Enzyme Inhibitors; Exanthema; Fever; Glucocorticoids; Heart Transplantation; Humans; Hydroxychloroquine; Hypoxia; Immunocompromised Host; Immunosuppressive Agents; Male; Methylprednisolone; Middle Aged; Nausea; Piperacillin, Tazobactam Drug Combination; Pulmonary Disease, Chronic Obstructive; Renal Insufficiency, Chronic; SARS-CoV-2; Tachypnea; Treatment Outcome

Topics: Aged, 80 and over; Anti-Bacterial Agents; Betamethasone; Blister; Diagnosis, Differential; Exanthema; Glucocorticoids; Humans; Immunoglobulin A; Linear IgA Bullous Dermatosis; Male; Piperacillin, Tazobactam Drug Combination; Prednisolone; Treatment Outcome; Vancomycin

Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome, or drug-induced hypersensitivity syndrome (DIHS), is a life-threatening multiorgan systemic reaction characterized by rash, fever, lymphadenopathy, hepatitis, and leukocytosis with eosinophilia. Aromatic anticonvulsant drugs and allopurinol have been reported to be the most frequent eliciting agents. Our search of the literature revealed only 2 cases induced by piperacillin and 1 case by ceftriaxone.We present 2 cases of DRESS syndrome induced by the beta-lactam drugs ceftriaxone and piperacillin-tazobactam. An allergological workup including skin prick test, intradermal tests, patch tests, and lymphocyte transformation test (LTT) was performed. LTT was shown to be a useful technique in both cases to help to identify the drugs involved.

Topics: Adrenal Cortex Hormones; Adult; Anticonvulsants; beta-Lactams; Ceftriaxone; Cell Proliferation; Cells, Cultured; Colitis, Ulcerative; Drug Hypersensitivity; Eosinophilia; Epilepsy; Exanthema; Female; Histamine Antagonists; Humans; Lymphocyte Activation; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

Drug hypersensitivity is classically divided into IgE mediated and non-IgE mediated disease. We report a rare case of consequent IgE mediated and non-IgE mediated reactions within the beta lactam class of antibiotics.. An 84-year-old man developed toxic epidermal necrolysis (TEN) due to ceftriaxone, a third generation cephalosporin, involving 72% of the body surface area. The patient recovered but within weeks subsequently developed an acute IgE mediated allergic reaction to piperacillin/tazobactam, an extended spectrum penicillin. Further IgE RAST revealed positive results to penicillin major determinant.. This case demonstrates the complexity of drug hypersensitivity reactions. While it is accepted that IgE mediated penicillin allergy is a predisposition to cephalosporin allergy, this case displays an unusual correlation between drug hypersensitivity and drug class. There have been few studies that evaluate the cross reactivity with penicillin or other beta-lactams in subjects with primary hypersensitivity to cephalosporins. This clinical scenario emphasizes the need of more studies on cephalosporin allergy in particular as shown by this case of sequential non-IgE mediated cephalosporin induced TEN reaction pursuant by an IgE mediated penicillin allergy.

Topics: Aged, 80 and over; Cephalosporins; Drug Hypersensitivity; Exanthema; Humans; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Stevens-Johnson Syndrome

Topics: Anti-Bacterial Agents; Exanthema; Humans; Infant, Newborn; Infant, Premature; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sepsis; Tazobactam

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Drug Eruptions; Exanthema; Female; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Skin Diseases, Vesiculobullous