Recurrent fatal drug-induced toxic epidermal necrolysis (Lyell's syndrome) after putative beta-lactam cross-reactivity: Case report and scrutiny of antibiotic imputability.

Abstract

OBJECTIVE:

A series of antibiotics may be responsible for toxic epidermal necrolysis. We report two successive episodes of toxic epidermal necrolysis in the same patient. Drug imputability criteria designate a cross-reactivity between two antibiotics of different chemical classes but sharing the beta-lactam ring in common.

DESIGN:

Descriptive case report and review of the literature.

SETTING:

Medical intensive care unit in a university medical center. PATIENT AND MAIN RESULTS: A 75-yr-old woman developed a first episode of toxic epidermal necrolysis (involving 40% of the body surface) after intake of cefotaxime, a third-generation cephalosporin. Perfusions of high-dose immunoglobulins rapidly improved the lesions, followed by partial reepithelialization in 5 days. Sepsis required the administration of meropenem, which is a carbapenem antibiotic. The epidermal destruction immediately recurred, with extension to previously uninvolved skin areas and fatal consequences.

CONCLUSIONS:

The beta-lactam ring present in cephalosporins and carbapenems represents the putative chemical structure responsible for the presently reported cross-reactivity to two antibiotics of different classes. Drugs having any chemical similarity to the initial culprit compound should be strictly avoided when possible in the management of toxic epidermal necrolysis.

• Authors: Philippe Paquet, Eric Jacob, Pierre Damas, Gérald E Piérard
• Journal: Critical care medicine (Crit Care Med) Vol. 30 Issue 11 Pg. 2580-3 (Nov 2002) ISSN: 0090-3493 [Print] United States
• PMID: 12441773 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Thienamycins
• Meropenem
• Cefotaxime

Topics

• Aged
• Anti-Bacterial Agents (adverse effects, pharmacology)
• Cefotaxime (adverse effects, pharmacology)
• Drug Interactions
• Fatal Outcome
• Female
• Humans
• Meropenem
• Stevens-Johnson Syndrome (etiology)
• Thienamycins (adverse effects, pharmacology)