Ceftriaxone
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DRESS syndrome: case report A 17-year-old boy developed DRESS syndrome during treatment with ceftriaxone for fever and coryza. The boy presented to the gastroenterology clinic with nausea, epigastric pain and icter within the past month. On review of his medical history, it was revealed that, 9 months ago, he had fever and coryza and had received three doses of IM ceftriaxone injection [dosage not stated]. Following third dose of ceftriaxone, he had developed allergic reactions in the form of swelling of eyelids and erythema on the whole body. As a result, he had been hospitalised. At that time, he had received treatment with unspecified corticosteroids for two weeks. Following 10 days of the treatment, he had presented to the hospital again with frequent cough, which led to hypoxia and cyanosis. Bronchoalveolar lavage had revealed cytomegalovirus infection and Pneumocystis carinii pneumonia. As a result, he had been shifted to an ICU and had been treated with ganciclovir and cotrimoxazole. After two months (current presentation), he presented with poor appetite, generalised bone pain, epigastric pain, weight loss and icter. His vital signs included BP of 120/70mm Hg, pulse rate of 100/minute, respiratory rate of 14/minute, and body temperature of 38°C. Physical examination of the liver, spleen and abdomen were palpable 3 cm below the costal margin along with a soft consistency. An underlying condition of oral candidiasis was evident. Laboratory tests revealed elevated transaminase level, eosinophilia and a direct hyperbilirubinemia. An abdominal ultrasound scan showed hepatosplenomegaly. The abdominopelvic CT scan showed a minimal fluid accumulation in his abdomen. In order to determine a definitive diagnosis, liver biopsy was performed and which showed hepatic failure with pathologic features of hepatocellular carcinoma (differential diagnosis). His serum α-fetoprotein level was highly elevated. Concerning the uncommon clinical setting, the pathologic specimen was reviewed by another pathologist, which reported hepatocyte regeneration following hepatitis. The high level of alpha-fetoprotein was explainable with the report and thus, a final diagnosis of DRESS syndrome secondary to ceftriaxone was made. The boy received treatment with high-dose of prednisone and within one month, his clinical and laboratory symptoms completely resolved. Thereafter, prednisone dose was tapered within the next two months and in the next three-month follow-up, he had no signs and symptoms representing recurrence. Hormati A, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS) presenting with primary diagnosis of hepatocellular carcinoma. Iranian Red Crescent 803501572 Medical Journal. 22: No. 3, Mar 2020. Available from: URL: http://doi.org/10.5812/IRCMJ.99053
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Reactions 19 Sep 2020 No. 1822
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