Cross With Caution: Antibiotic Cross-Reactivity and Co-Reactivity Patterns in Severe Cutaneous Adverse Reactions

Thompson, Grace; McLean‐Tooke, Andrew; Lucas, Michaela

doi:10.3389/fimmu.2021.601954

Cited by 4 publications

(1 citation statement)

References 24 publications

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“…As the main immune checkpoint inhibitors, PD-1 monoclonal antibodies have definite efficacy for various of solid tumors, but sometimes induce adverse skin reactions. 19 A study that included 2016 cases of camrelizumab (a PD-1 monoclonal antibody) monotherapy or combination therapy for advanced cancer showed that 834 of 1059 patients (78.8%) receiving camrelizumab monotherapy developed reactive cutaneous angiogenesis, 20 with an extremely high incidence. Recently, with the popularity of biologics and small-molecule drugs for the treatment of malignant tumors, reactive hyperplasia of the capillary endothelium has become more common, attracting the attention of otolaryngologists and dermatologists.…”

Section: Discussionmentioning

confidence: 99%

Clinical Retrospective Analysis of 243 Patients with Rhinofacial Ulcers

Ma¹,

Zhan²,

Sui³

et al. 2022

CCID

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The clinical and pathological data of patients with rhinofacial ulcers were retrospectively reviewed and analyzed to lay the foundation for standardized clinical treatment. Patients and Methods:We retrospectively analyzed the clinical data, etiology, pathological features, treatment methods, and prognosis of 243 patients with rhinofacial ulcers treated in the Departments of Otorhinolaryngology and Dermatology at six hospitals in Shandong Province, China from July 2014 to October 2021. The clinical characteristics and treatment methods of the rhinofacial ulcers were summarized to provide a basis for standardizing patients' diagnosis and treatment. Results: The male-to-female ratio of the 243 patients was 2.04:1, and their ages ranged from 25 to 91 years. The most common sites were the cheek, nasal dorsum, and upper lip. The common primary diseases were basal-cell carcinoma, squamous-cell carcinoma, and odontogenic fistula, but rare triggers played important roles in some cases, such as infection, autoimmune diseases, and adverse drug reactions. Surgical treatment was feasible for tumor ulcers; 71 patients with basal-cell carcinoma and 50 with squamous-cell carcinoma were treated with Mohs micrographic surgery. During the follow-up period of 1-84 months, most of the rhinofacial ulcers were cured, while natural killer/T-cell lymphoma, angiosarcoma, and melanoma were important causes of death. Conclusion: Various causes may lead to rhinofacial skin ulcers, and some cases lacking specificity of clinical manifestations are easily misdiagnosed in clinical practice. Histopathological biopsy is valuable for confirming the diagnosis, after which correct etiological treatment is very important.

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Section: Discussionmentioning

confidence: 99%

Clinical Retrospective Analysis of 243 Patients with Rhinofacial Ulcers

Ma¹,

Zhan²,

Sui³

et al. 2022

CCID

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Antibacterials/prednisolone/azathioprine

2021

Reactions Weekly

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Various skin toxicities, drug ineffective and lack of efficacy: 9 case reportsIn a cohort study, involving 9 patients (5 males and 4 females) aged 11-78 years were described, who presented with the diagnosis of beta-lactam antibiotic-related non-SJS/TEN severe cutaneous adverse reactions (SCAR) between March 2016 and June 2020 at a hospital in Australia, who developed drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome (7 patients), acute generalised exanthematous pustulosis (AGEP) (1 patient) or symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) (1 patient) following treatment with amoxicillin, flucloxacillin, benzylpenicillin, phenoxymethylpenicillin, piperacillin/tazobactam, cefepime, meropenem, ciprofloxacin, cefalexin, vancomycin or ceftriaxone. Additionally, two of these nine patients also experienced lack of efficacy during treatment with prednisolone for DRESS syndrome (1 patient) or azathioprine for autoimmune liver disease (1 patient) [not all dosages, routes, times to reactions onsets and outcomes stated].Case 1 from Table 2 of the article (a 34-year-old man): The man, who had upper respiratory tract infection, started receiving amoxicillin for the upper respiratory tract infection. Following the second dose of amoxicillin, he developed acute generalised exanthematous pustulosis (AGEP). He had a history of rash to an unknown antibiotic during the childhood. The symptoms of AGEP appeared as widespread pustulosis with neutrophilia, mild eosinophilia and hepatitis. The AGEP was suspected to be related to amoxicillin. Consequently, amoxicillin was stopped and an unspecified corticosteroid was started. As a result, the AGEP improved. An allergy test was performed after 7 months of his initial reaction, which resulted positive for amoxicillin. Thus, amoxicillin was considered to be the culprit responsible for the development of AGEP. According to the Naranjo probability scale, the causal association between the drug and reaction was assessed to be score of 6. Additionally, a delayed intradermal test showed positive results with various other drugs as well, which was determined to be due to the cross reactivity.Case 2 from Table 2 of the article (A 56-year-old woman): The woman who had cellulitis, started receiving flucloxacillin for the cellulitis. Her medical history was significant for obesity, hypertension, osteoarthritis and possible anaphylaxis to contrast. After 24 hours of flucloxacillin initiation, she developed drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Her symptoms of DRESS syndrome includes vomiting, diarrhoea, and acute kidney injury along with a widespread erythematous exanthema and eosinophilia. The DRESS syndrome was suspected to be related to flucloxacillin. Consequently, flucloxacillin was replaced with cefazolin [cephazolin] and clindamycin. Thereafter, she was treated with prednisolone along with antihistamines and corticosteroids [specific drugs not stated]. An allergy test was performed after 10 months of her initial re...

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