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Amoxicillin/clavulanic acid/cefepime/ceftriaxone Drug-induced hypersensitivity syndrome and inadvertent prescription of amoxicillin/clavulanic acid: case report

A 12-month-old girl drug-induced hypersensitivity syndrome (DISH) during antibiotic treatment with amoxicillin/clavulanic-acid, ceftriaxone and cefepime. Additionally, she developed features of DISH following inadvertent prescription of amoxicillin/clavulanic acid for an upper respiratory infection [dosages not stated; not all routes not stated]. The girl, who had congenital heart disease and chromosomal abnormality (deletion of short arm of chromosome 8), underwent cardiac surgery. On day 6 post-surgery, she was prescribed vancomycin and gentamicin for infection. On day 7 post-surgery, vancomycin and gentamicin were switched to oral amoxicillin/clavulanic acid due to loss of IV line. On day 8 post-surgery, she developed an urticarial maculopapular rash with facial oedema and fever, hepatomegaly and lymphadenopathy, as well as 10% of atypical lymphocytes and elevated levels of AST and ALT, suggestive of a mononucleosic syndrome. The girl’s therapy with amoxicillin/clavulanic acid was suspended on day 11. Epstein-Barr virus, cytomegalovirus and toxoplasmosis were IgG positive. Parainfluenza virus type 3 was also positive. Human herpesvirus 6 and 7 serologies and measles virus RNA were found to be negative. On day 18 post-surgery, she was seriously ill and vancomycin was re-started. Additionally, ceftriaxone was added. On day 29 post-surgery, endocarditis was confirmed by cardiac ultrasound, and daptomycin, cefepime and ciprofloxacin were started with a clinical improvement. She was discharged on day 48 post-surgery with a subtle rash in her legs. Four months later, the girl was inadvertently prescribed amoxicillin/clavulanic acid for an upper respiratory infection. On the 3rd day of antibiotic therapy, she presented again with an urticarial rash. As a result, amoxicillin/clavulanic acid was promptly suspended. A diagnosis of DRESS/DIHS was made, based on the RegiSCAR (European registry of severe cutaneous adverse reactions to drugs) criteria [final outcome not stated]. Loureiro R, et al. Drug induced hypersensitivity syndrome (DIHS) in a 12 month old child. European Journal of Pediatrics 178: 1646-1647 (plus oral presentation) abstr. 230, 803502933 No. 11, 2019. Available from: URL: http://doi.org/10.1007/s00431-019-03466-w [abstract]

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Reactions 26 Sep 2020 No. 1823