Cefepime/piperacillin/tazobactam

Abstract

DRESS syndrome: case report A 58-year-old man developed DRESS syndrome during treatment with piperacillin/tazobactam and experienced worsening of DRESS syndrome secondary to cefepime [dosages, not all routes, and exact duration of treatment to reaction onset not stated]. The man had a relevant medical history of non-alcoholic steatohepatitis cirrhosis after a remote liver transplant that was complicated by recurrent cholangitis. He was presented with a 10 day history of increasingly worsening rash and fever. He developed a rash after several days of treatment with IV piperacillin/tazobactam. Hence, piperacillin/tazobactam was substituted with cefepime. However, the rash worsened over the next week with symptoms that included increased itching, diarrhoea, marked peripheral and periorbital oedema, and oral burning. On examination, he was hypotensive with moderate distress. His head and neck examination showed periorbital oedema with blanchable erythema of the scalp and face. Also, his bilateral upper and lower extremities were found to be oedematous, without appreciable pitting. The rash was morbilliform that covered bilateral posterior as well as anterior upper and lower extremities, anterior and posterior trunks, head, and scalp. Murphy’s sign was negative, and he was alert and oriented. Further, his complete and differential blood count showed an eosinophil count of 1.19k/μL. Also, he had mild transaminitis and elevated ALP and creatinine levels. Blood cultures were negative and urinalysis revealed proteinuria. A peripheral smear noted atypical lymphocytes whereas, antinuclear antibody and hepatitis panel were negative. Based upon the above findings piperacillin/tazobactam induced DRESS syndrome was diagnosed, which worsened due to cefepime. Cefepime was discontinued and he was admitted for DRESS management. Over the following week, improvement was observed.