AUTHOR=Shen Ya , Cui Shun-shun , Teng Xiao-bao , Han Ming-feng 

TITLE=Drug-induced hypersensitivity syndrome related to piperacillin-tazobactam: a case report and review of the literature

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1338247

DOI=10.3389/fmed.2024.1338247

ISSN=2296-858X

ABSTRACT=Allergic reactions to drugs caused by piperacillin-tazobactam are common in clinical practice.However, we also found a few cases of drug-induced hypersensitivity syndrome (DiHS)/ Drug reaction with eosinophilia and systemic symptoms (DRESS) caused by piperacillin-tazobactam in our clinical work. We report a case of a 60-year-old female patient who was treated with piperacillintazobactam anti-infective therapy after the diagnosis of hematogenous lung abscess, developed fever, rash, and blood abnormalities after 26 days of application, and was later diagnosed as DIHS, which was improved after the administration of glucocorticoid and anti-allergic drugs. In addition, we also retrospectively analyzed 17 cases of DiHS caused by piperacillin-tazobactam from the PubMed databases between March 1980 and September 2023. The majority of the patients had an incubation period of more than 14 days, and the common clinical features included elevated eosinophil count/percentage, fever, rash, liver damage, and lymph node enlargement. After treatment with topical or systemic glucocorticoids, symptoms, and laboratory parameters improved in 11 patients, and only one patient with co-morbid acute generalized eruptive pustulosis (AGEP) died because of the lack of improvement in his symptoms and the worsening of the underlying disease. 16 of the 17 patients improved and one died because of the underlying condition. The clinical features of DiHS were diverse and included a long incubation period, skin rash, elevated eosinophils, and impaired  organ function. Since some patients have atypical clinical features, clinicians should raise awareness of the disease, recognize these features early, and treat them promptly.