Reference : Recurrent fatal drug-induced toxic epidermal necrolysis (Lyell's syndrome) after puta...
Scientific journals : Article
Human health sciences : Dermatology
Recurrent fatal drug-induced toxic epidermal necrolysis (Lyell's syndrome) after putative beta-lactam cross-reactivity: Case report and scrutiny of antibiotic imputability.
Paquet, Philippe mailto [Centre Hospitalier Universitaire de Liège - CHU > > Dermatopathologie >]
Jacob, Eric [> > > >]
Damas, Pierre mailto [Centre Hospitalier Universitaire de Liège - CHU > > Soins intensifs >]
Pierard, Gérald mailto [Centre Hospitalier Universitaire de Liège - CHU > > Dermatopathologie >]
Critical Care Medicine
Lippincott Williams & Wilkins
Yes (verified by ORBi)
[en] Aged ; Anti-Bacterial Agents/adverse effects/pharmacology ; Cefotaxime/adverse effects/pharmacology ; Drug Interactions ; Epidermal Necrolysis, Toxic/etiology ; Fatal Outcome ; Female ; Humans ; Thienamycins/adverse effects/pharmacology
[en] OBJECTIVE: A series of antibiotics may be responsible for toxic epidermal necrolysis. We report two successive episodes of toxic epidermal necrolysis in the same patient. Drug imputability criteria designate a cross-reactivity between two antibiotics of different chemical classes but sharing the beta-lactam ring in common. DESIGN: Descriptive case report and review of the literature. SETTING: Medical intensive care unit in a university medical center. PATIENT AND MAIN RESULTS: A 75-yr-old woman developed a first episode of toxic epidermal necrolysis (involving 40% of the body surface) after intake of cefotaxime, a third-generation cephalosporin. Perfusions of high-dose immunoglobulins rapidly improved the lesions, followed by partial reepithelialization in 5 days. Sepsis required the administration of meropenem, which is a carbapenem antibiotic. The epidermal destruction immediately recurred, with extension to previously uninvolved skin areas and fatal consequences. CONCLUSIONS: The beta-lactam ring present in cephalosporins and carbapenems represents the putative chemical structure responsible for the presently reported cross-reactivity to two antibiotics of different classes. Drugs having any chemical similarity to the initial culprit compound should be strictly avoided when possible in the management of toxic epidermal necrolysis.

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