Cotrimoxazole
- PDF / 170,378 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 32 Downloads / 152 Views
1 S
Cotrimoxazole Drug reaction with eosinophilia and systemic symptoms: case report
A 15-year-old boy developed drug reaction with eosinophilia and systemic symptoms (DRESS) during treatment with cotrimoxazole for swelling and redness around the left thumb. The boy, who had history of right tibial osteochondroma and eczema, presented with rash and fever. He developed swelling and redness around the left thumb with pus; thus, visited a local care facility and received treatment with a single dose of ceftriaxone followed by a week course of cotrimoxazole [trimethoprim-sulfamethoxazole; route and dosage not stated]. Subsequently, his thumb began to improve after the 4th day of antibiotics. However, on day 6, he developed fever and a new rash spread to full body. He developed leukopenia and thrombocytopenia and was referred to the emergency department. Initial physical examination showed dry mucous membranes, cervical and inguinal lymphadenopathy, facial oedema, diffuse petechial and purpuric rash with underlying erythema and cracked lips. He appeared ill and received a normal saline bolus and was started on unspecified broadspectrum antibacterials. His blood test was significant for leukopenia, thrombocytopenia, hyponatremic and coagulopathic along with a mild transaminitis. He had also developed acute kidney injury. Eventually, he was admitted for further evaluation and treatment. After discussion with a pediatric dermatologist, and given the recent exposure to cotrimoxazole and appearance of the rash, the most likely diagnosis was DRESS [duration of treatment to reaction onset not stated]. Cotrimoxazole was discontinued and the boy was treated with vancomycin, cefepime and doxycycline. His Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) score was 5, indicated a probable diagnosis of DRESS. The, he received unspecified steroids. After 48 hours, he started to clinically improve. Vancomycin and cefepime were discontinued and doxycycline was continued for a full 10 day course. Laboratory studies gradually improved throughout his stay and he completed a course of doxycycline and unspecified steroid taper without return of rash or illness. Eventually, he was discharged. Cohen A, et al. Full-Body Rash and Fever in a 15-Year-Old Male. Clinical Pediatrics 59: 933-937, No. 9, Sep 2020. Available from: URL: http:// doi.org/10.1177/0009922820902431
0114-9954/20/1818-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
803497010
Reactions 22 Aug 2020 No. 1818
Data Loading...
