Ceftriaxone induced fixed drug eruption in patient with common variable immunodeficiency

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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, Moscow

Tatiana 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, Moscow

Evgeny 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, Moscow

Valery 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, Moscow

Elena 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, Moscow

References

  1. 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
  2. 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
  3. 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
  4. Pichler WJ. Drug hypersensitivity reactions: classification and relationship to T cell activation. Drug Hypersensitivity. Basel: Karger; 2007. Р. 168–189. doi: 10.1159/000104199
  5. 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
  6. 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
  7. 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.
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. Kaur I, Singh J. Cutaneous drug reaction with intravenous ceftriaxone. Indian J Pharmacol. 2009;41(6):284–285. doi: 10.4103/0253-7613.59933
  21. 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
  22. 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

Supplementary files

Supplementary Files
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1. Fig. 1. The structural formula of ceftriaxone: 1 ― R1-chain; 2 ― four-membered beta-lactam ring; 3 ― dihydrothiazine ring; 4 ― R2-chain.

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2. Fig. 2. Patient R., 38 years old, diagnosed with general variable immune insufficiency. Reaction to the administration of ceftriaxone intramuscularly: skin rashes of grayish-purple color, rounded shape, size from 1 to 3 cm in diameter, without itching.

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3. Fig. 3. The same patient. The result of intradermal testing with ceftriaxone directly into the spot on the skin of the back: a ― evaluation of the result after 2 hours: hyperemia, papule in the area of the post-inflammatory spot; b ― evaluation of the result after 6 hours: hyperemia and papule remain in the area of the post-inflammatory spot; c ― evaluation of the result after 12 hours: hyperemia and papule remain in the area of the post-inflammatory spot.

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