piperacillin--tazobactam-drug-combination and Lung-Abscess

Topics: Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Cough; Diagnosis, Differential; Firmicutes; Humans; Lung; Lung Abscess; Lung Neoplasms; Male; Middle Aged; Piperacillin, Tazobactam Drug Combination; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

We report the case of a 66-year-old man with dental infection who presented to our emergency department complaining of a 3-month medical history of chest pain and productive cough, in association with malaise, fever, weight loss and anaemia. His chest radiograph showed a nearly total opacification of the right hemithorax and chest ultrasound findings were suggestive of empyema, subsequently confirmed by a chest CT. The patient started appropriate treatment. A follow-up chest CT performed to rule out bronchopleural fistula revealed a large lung abscess. The patient had the final diagnosis of a giant lung abscess, which was initially thought to be an empyema because of the clinical and radiologic similarities with this entity. The initial misdiagnosis led to prompt percutaneous drainage of the lung abscess in addition to antibiotherapy and respiratory physiotherapy with a good final outcome, which suggests the efficacy of this approach in similar cases.

Topics: Aged; Diagnostic Errors; Drainage; Empyema, Pleural; Humans; Lung Abscess; Male; Piperacillin, Tazobactam Drug Combination; Tomography, X-Ray Computed

To describe a case of a delayed-type hypersensitivity (DTH) reaction to piperacillin/tazobactam in which painful paresthesiae were a predominant feature.. A 27-year-old man with a history of intravenous drug abuse was admitted for treatment of a pulmonary parenchymal abscess in the setting of lower-limb deep-venous thrombosis and methicillin-sensitive Staphylococcus aureus bacteremia. He was treated with intravenous piperacillin/tazobactam 4.5 g 3 times daily; however, after 2 weeks of therapy, he developed symptoms (eg, fever, chills) and laboratory abnormalities (eg, white blood cell count 2.1 x 10(3)/mm3, erythrocyte sedimentation rate 63 mm/h) suggestive of a DTH reaction. This was accompanied by infusion-related painful paresthesiae. The symptoms and laboratory abnormalities resolved within 48 hours of treatment being switched to flucloxacillin.. Due to the close temporal association and the absence of any other obvious explanation, we believe these paresthesiae represent an additional feature of the DTH reaction to piperacillin/tazobactam in this patient. Use of the Naranjo probability scale indicated a probable relationship between the paresthesiae and administration of piperacillin/tazobactam.. To our knowledge, as of March 24, 2006, this is the first case in which a DTH reaction to piperacillin/tazobactam manifesting as fever, neutropenia, and thrombocytopenia has been associated with paresthesiae.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Humans; Hypersensitivity, Delayed; Lung Abscess; Male; Methicillin Resistance; Paresthesia; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Staphylococcus aureus