Cefepime
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Acute generalised exanthematous pustulosis: case report A 78-year-old man developed acute generalised exanthematous pustulosis (AGEP) during treatment with cefepime for Pseudomonas aeruginosa urinary tract infection. The man, who had a history of coronary artery disease, atrial fibrillation and benign prostatic hyperplasia, presented at the emergency department with hyperkalaemia, worsening of renal function and leucocytosis. He was admitted to the ICU because of septic shock and haemodynamic instability secondary to Pseudomonas aeruginosa urinary tract infection. Thereafter, he started receiving treatment with cefepime [route and dosage not stated]. He also needed unspecified vasopressor support. However, seven days after initiation of cefepime therapy, he had a spike of fever with a pustular rash on the erythematous base covering the upper extremities and trunk. No mucosal involvement was noted. Laboratory test results revealed leukocytosis with neutrophilia and elevated CRP. Cultures of urine, blood and pustules were negative for bacterial infection. On the next day, he developed persistent hypotension with no other symptoms. Repeated chest X-ray revealed new-onset bilateral interstitial opacities and consolidation. Subsequently, he tested positive for COVID-19 infection. He received unspecified supportive treatment for COVID-19. A skin biopsy of the rash revealed papillary dermal oedema with intracorneal/ subcorneal pustules. Also, in the surrounding dermis, mixed inflammatory infiltrates included neutrophils, rare eosinophils and lymphocytes. According to the EuroSCAR study group criteria, his score was 12, which confirmed the diagnosis of AGEP. The AGEP was considered to have developed secondary to cefepime treatment and COVID-19 infection. Cefepime was discontinued. The man was treated with unspecified topical emollients. Within a few days of treatment, his exanthema resolved with residual postpustular desquamation. Haraszti S, et al. Delayed Presentation of Acute Generalized Exanthematous Pustulosis Following Treatment with Cefepime in a Patient with COVID-19 without the Use of 803519477 Hydroxychloroquine. American Journal of Case Reports 21: 24 Oct 2020. Available from: URL: https://www.amjcaserep.com/abstract/index/idArt/926901
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Reactions 5 Dec 2020 No. 1833
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