Amoxicillin/piperacillin/tazobactam

Abstract

Pruritus, urticaria and lymphangitis: 2 case reports In a case report, two male patients were described, of whom a 68-year-old man and 62-year-old man developed pruritus, urticaria and lymphangitis during treatment with piperacillin/tazobactam or amoxicillin, respectively. Case 1 (A 68-year-old man): The man, who was placed on the liver transplantation waitlist for cirrhosis due to hepatitis C viral infection, was admitted for cholangitis in August 2017. He received an empirical treatment with IV piperacillin/tazobactam [all dosage not stated] (piperacillin 4g three times a day). Previously, he had tolerated piperacillin/tazobactam. Forty five minutes after the first dose, pruritus and urticaria developed on the trunk and neck without any other symptoms. He showed rapid recovery with cetirizine. In December 2018, he reported a similar episode, which was treated with dexchlorpheniramine. In June 2019, he underwent skin tests with several penicillins and cephalosporins reagents. Skin prick test and intradermal test showed negative results. Hence, 60 minutes following the intradermal test, he underwent drug provocation test with single blind piperacillin/ tazobactam with 30-minute increments, which resulted in initial reaction. A few minutes prior to the second dose, he reported itching on the scalp and arms. Lymphangitic infiltration was noted. Drug provocation test was held. The skin tests were consider positive, and he was treated with cetirizine. Case 2 (A 62-year-old man): The man had reported drug-induced hypersensitivity reactions in October 2012 with generalised urticaria and pruritus of soles and palms. He had ingested amoxicillin 1000mg for sinusitis [frequency not stated]. Five minutes following the administration of amoxicillin, during eating of a shrimps containing meal, the reaction started. Six weeks following the incident, he underwent allergy workup. Skin test and intradermal test were negative. Immediately after the skin test, he underwent drug provocation test with amoxicillin, which was positive. Lymphangitis was noted. Drug provocation test was promptly discontinued. He was treated with cetirizine. Further, no other symptoms were noted.