Benzathine benzylpenicillin
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Eosinophilic panniculitis: case report A 39-year-old woman developed eosinophilic panniculitis after receiving benzathine benzylpenicillin. The woman, who had more than 10 years’ occupational exposure to benzathine benzylpenicillin, received an IM injection of benzathine benzylpenicillin 1.2MU for infectious tonsillitis. Twenty-four hours later, she developed localised pruritus and a progressive painful inflammatory plaque at the injection site. Treatment with moxifloxacin was ineffective. Upon examination, a erythematous infiltrated plaque, measuring 15cm in diameter, was present on her left buttock. Laboratory tests revealed an IgE level of 1454 UI/L. Results of a skin biopsy showed subcutaneous inflammation, adopting a mixed septal and lobular pattern composed mainly of eosinophils with a few histiocytes. The woman underwent patch, prick and intradermal tests to benzathine benzylpenicillin and benzylpenicillin [penicillin G] at diluted concentrations. At 48 hours, a positive reaction was observed to intradermal benzathine benzylpenicillin and benzylpenicillin at 0.1%. The intradermal test site developed an erythematous, infiltrated, itchy plaque that was still evident 15 days later. Skin biopsy of the positive test site revealed a clear perivascular dermal eosinophilic infiltrate. She received treatment with prednisone and her condition slowly improved. Author comment: "[T]he previous [benzathine benzylpenicillin] injection along with positive specific skin test results lead us to suspect a delayed hypersensitivity reaction (type IVb). . . We can speculate that the routine professional contact with penicillin was responsible for sensitization." Masferrer E, et al. Eosinophilic panniculitis triggered by intramuscular penicillin and occupational setting. Allergy 66: 436-437, No. 3, Mar 2011. Available from: 803050974 URL: http://dx.doi.org/10.1111/j.1398-9995.2010.02490.x - Spain
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Reactions 19 Mar 2011 No. 1343
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