Ceftriaxone induced fixed drug eruption in patient with common variable immunodeficiency
- Authors: Shubina A.S.1, Myasnikova T.N.1, Frolov E.A.1, Smirnov V.V.1, Latysheva E.A.1
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Affiliations:
- National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia
- Issue: Vol 19, No 3 (2022)
- Pages: 410-420
- Section: Case reports
- URL: https://rusalljournal.ru/raj/article/view/1563
- DOI: https://doi.org/10.36691/RJA1563
Cite item
Abstract
Adverse drug reactions are one of the most complex and difficult diagnostic problems in the practice of allergists and clinical immunologists. This article presents a clinical case of a patient with an inborn error of immunity, known as common variable immune deficiency with the onset of the disease in adulthood and the presence of numerous infectious, structural, and immune complications. The patient had an adverse drug reaction represented by fixed drug eruption to the vital antibiotic therapy with ceftriaxone. We provide detailed information about this type of drug allergy and the structural features of cephalosporins and their cross-reactivity. In the diagnostic process, we ran phased drug allergy testing, including patch tests and a dose provocative test, which is considered a gold standard for this type of diagnostics. The diagnosis of fixed drug eruption to ceftriaxone and the absence of cross-reactivity to other cephalosporins in this patient were confirmed based on test results. Prohibiting the use of only one drug (ceftriaxone), which is especially important for a patient with primary immunodeficiency was made possible due to the compiled individual recommendations.
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About the authors
Alina S. Shubina
National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia
Author for correspondence.
Email: Shubenjn96@mail.ru
ORCID iD: 0000-0003-0379-1218
MD
Russian Federation, MoscowTatiana N. Myasnikova
National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia
Email: t_miasnikova@mail.ru
ORCID iD: 0000-0001-8491-195X
SPIN-code: 4684-3112
MD, Cand. Sci. (Med.)
Russian Federation, MoscowEvgeny A. Frolov
National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia
Email: frolovevgeny@rambler.ru
ORCID iD: 0000-0002-0800-5960
SPIN-code: 5963-4062
MD
Russian Federation, MoscowValery V. Smirnov
National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia
Email: smirnov_v_v_1@staff.sechenov.ru
ORCID iD: 0000-0002-8232-6682
SPIN-code: 4171-3871
Dr. Sci. (Pharm.); Professor
Russian Federation, MoscowElena A. Latysheva
National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia
Email: ea.latysheva@nrcii.ru
ORCID iD: 0000-0002-1606-205X
SPIN-code: 2063-7973
MD, Dr. Sci. (Med.)
Russian Federation, MoscowReferences
- Edwards IR, Aronson JK. Adverse drug reactions: defenitions, diagnosis, and management. Lancet. 2000;356(9237):1255–1259. doi: 10.1016/S0140-6736(00)02799-9
- Johansson S, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: report of the nomenclature review committee of the world allergy organization. J Allergy Clin Immunol. 2004;113(5):832–836. doi: 10.1016/j.jaci.2003.12.591
- Gomes ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Curr Opin Allergy Clin Immunol. 2005;5(4):309–316. doi: 10.1097/01.all.0000173785.81024.33
- Pichler WJ. Drug hypersensitivity reactions: classification and relationship to T cell activation. Drug Hypersensitivity. Basel: Karger; 2007. Р. 168–189. doi: 10.1159/000104199
- Dilek N, Özkol HU, Akbaş A, et al. Cutaneous drug reactions in children: a multicentric study. Postepy Dermatol Alergol. 2014;31(6):368–371. doi: 10.5114/pdia.2014.43881
- Turk BG, Gunaydin A, Ertam I, et al. Adverse cutaneous drug reactions among hospitalized patients: five year surveillance. Cutan Ocul Toxicol. 2013;32(1):41–45. doi: 10.3109/15569527.2012.702837
- Romanova TS. Features of in vivo diagnosis of drug allergy occurring in a delayed type [dissertation abstract]. Moscow; 2019. 24 р. (In Russ). Available from: https://search.rsl.ru/ru/record/01008700524. Accessed: 15.06.2022.
- Romanova TS, Myasnikova TN, Khludova LG, et al. Medicinal fixed erythema in the practice of an allergist-immunologist. Russian Journal of Allergy. 2017;14(1):36–40. (In Russ). doi: 10.36691/RJA335
- Mizukawa Y, Yamazaki Y, Shiohara T. In vivo dynamics of intraepidermal CD8+ T cells and CD4+ T cells during the evolution of fixed drug eruption. Br J Dermatol. 2008;158(6):1230–1238. doi: 10.1111/j.1365-2133.2008.08516.x
- Teraki Y, Shiohara T. IFN-gamma-producing effector CD8+ T cells and IL-10-producing regulatory CD4+ T cells in fixed drug eruption. J Allergy Clin Immunol. 2003;112(3):609–615. doi: 10.1016/s0091-6749(03)01624-5
- Byrd RC, Mournighan KJ, Baca-Atlas M, et al. Generalized bullous fixed-drug eruption secondary to the influenza vaccine. JAAD Case Rep. 2018;4(9):953–955. doi: 10.1016/j.jdcr.2018.07.013
- Gavin M, Sharp L, Walker K, et al. Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome. Proc (Bayl Univ Med Cent). 2019;32(4):601–602. doi: 10.1080/08998280.2019.1644147
- Savlevich EL, Kozlov VS, Zharkikh MA. Study of the efficacy and safety of a new cephalosporin antibiotic in the treatment of acute bacterial rhinosinusitis. Bulletin Otorhinolaryngology. 2016;81(6): 73–77. (In Russ). doi: 10.17116/otorino201681673-77
- Pichichero ME. Use of selected cephalosporins in penicillin-allergic patients: a paradigm shift. Diagn Microbiol Infect Dis. 2007;57(3, Suppl):13–18. doi: 10.1016/j.diagmicrobio.2006.12.004
- Piovani D, Clavenna A, Cartabia M, et al. The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clinical Pharmacology. 2012;68(6):997–1005. doi: 10.1007/s00228-011-1204-3
- Romano A, Valluzzi RL, Caruso C, et al. Evaluating immediate reactions to cephalosporins: time is of the essence. J Allergy Clin Immunol Pract. 2021;9(4):1648–1657. doi: 10.1016/j.jaip.2020.11.032
- Hassoun-Kheir N, Bergman R, Weltfriend S. The use of patch tests in the diagnosis of delayed hypersensitivity drug eruptions. Int J Dermatol. 2016;55(11):1219–1224. doi: 10.1007/s12016-022-08924-2
- Latysheva TV, Latysheva EA, Danilycheva IV, et al. Features of the course of chronic spontaneous urticaria in patients with general variable immune insufficiency and hypogammaglobulinemia. Russian Journal of Allergy. 2021;18(4):140–148. (In Russ). doi: 10.36691/RJA1488
- Ozkaya E, Mirzoyeva L, Jhaish MS. Ceftriaxone-induced fixed drug eruption: first report. Am J Clin Dermatol. 2008;9(5):345–347. doi: 10.2165/00128071-200809050-00011
- Kaur I, Singh J. Cutaneous drug reaction with intravenous ceftriaxone. Indian J Pharmacol. 2009;41(6):284–285. doi: 10.4103/0253-7613.59933
- Byrne A, Ben-Shoshan M. An adolescent male presenting with nonpigmenting fixed drug eruption to ceftriaxone. J Allergy Clin Immunol. 2016;137(2):41. doi: 10.1016/j.jaci.2015.12.136
- Mitre V, Applebaum DS, Albahrani Y, et al. Generalized bullous fixed drug eruption imitating toxic epidermal necrolysis: a case report and literature review. Dermatol Online J. 2017;23(7):13030/qt25v009gs. doi: 10.5070/D3237035734
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