Ann Dermatol.  2016 Feb;28(1):98-101. 10.5021/ad.2016.28.1.98.

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

• Kim TI
• Jeong KH
• Shin MK
• Kim NI

• KMID: 2429489
• DOI: http://doi.org/10.5021/ad.2016.28.1.98

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.

Keyword

Acute generalized exanthematous pustulosis; Drug hypersensitivity syndrome; Piperacillin

MeSH Terms

Acute Generalized Exanthematous Pustulosis*
Anti-Bacterial Agents
beta-Lactamases
Drug Hypersensitivity Syndrome
Eosinophilia*
Exanthema*
Fever
Humans
Hypersensitivity*
Lymphocytosis
Piperacillin
Prognosis
Sodium
Anti-Bacterial Agents
Piperacillin
Sodium
beta-Lactamases

Figure

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  Fig. 1 Diffuse erythematous eruption with nonfollicular pinhead-sized pustules on both extremities and the trunk appearing after 9 days of treatment with piperacillin/tazobactam (A~C), subsequent improved status of the skin with desquamations on the neck, arm, and abdomen (D~F), and erythematous patches with previous desquamations on the 20th day after initiation of the antibiotic therapy (G~I).

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  Fig. 2 Histopathology showing a subcorneal pustule with epidermal spongiosis and perivascular inflammation of lymphocytes and eosinophils in the upper dermis (H&E; A: ×40, B: ×100, C and D: ×200).

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  Fig. 3 Eosinophil and neutrophil percentages with references according to day. Day 0 indicates the day before treatment with piperacillin/tazobactam, and day 1 indicates the first day of treatment. AGEP: acute generalized exanthematous pustulosis, DRESS: drug-related rash with eosinophilia and systemic symptoms.

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