Acute Generalized Exanthematius Pustulosis Caused by a Selective Allergy to Imipenem-Cilastatin: A Case Report

Abstract

GEP is a severe cutaneous reactions to drugs, 1 approximately 90% of cases are caused by medications and other particular cases are induced by viral infections or mercury hypersensitivity. 2 Typically, patients with AGEP present with rapid onset of many non-follicular, sterile pustules on an erythematous base. The most common sites are intertriginous zones, trunk, and upper extremities, conversely mucous membrane is rarely involved. Fever and leukocytosis are often accompanied with skin manifestation. Histology is a confirmation test. Discontinuation of the causative drug and symptomatic treatment is the best management. All skin lesions resolved spontaneously within 15 days. 3,4 Imipenem, a broad spectrum carbapenem antibiotic, has potent activity against Gram positive, Gram negative and obligate anaerobic bacteria. Imipenem is widely used to treat nosocomial infections, especially Pseudomonas aeruginosa, extended beta lactamase producing and Amp-C producing pathogens. Imipenem is well tolerated, and has a low incidence of adverse drug reaction. The most common adverse effects are gastrointestinal disturbance, cutaneous hypersensitivity reaction and seizures in patients with cerebral cortical lesions, a history of seizure, or renal insufficiency. [5][6][7] This report describes AGEP caused selectively by imipenem in the patient, who was able to tolerate ertapenem. Case ReportA 65-year-woman with systemic sclerosis and CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) was re-admitted due to relapsing Salmonellosis. At the last admission, she presented with fever, abdominal pain, and acute diarrhea. Salmonella group B was isolated from blood culture. She was diagnosed with Salmonella group B septicemia and treated with intravenous ertapenem for 2 weeks. Around 3 weeks after being discharged from hospital, she had fever, malaise, anorexia and back pain for one week. Plain thoracic spine radiograph revealed a fracture of the 7 th and 9 th thoracic spine. She had a declined renal function, T1W with Gadolinium was not performed. Blood and urine cultures were positive as Salmonella group B being resistant to third