ABSTRACT
Toxic epidermal necrolysis (TEN) is a lethal entity, characterized by extensive epidermal necrosis and multiorgan failure. Hemophagocytic syndrome (HFS) is also a rare and lethal syndrome characterized by hyperinflammation that leads to the appearance of fever, pancytopenia, organomegaly and hemophagocytosis. The concomitance of these diseases is extremely uncommon. We report a 38 years old female, who during the course of a HFS secondary to Hodgkin Lymphoma (HL), presented a TEN secondary to antibiotics. She was admitted due to a consumptive syndrome, lymphadenopathy, visceromegaly and severe pancytopenia. Laboratory and bone marrow tests confirmed HFS. Due to constant fever, imipenem was indicated. On the third day she started with pain and skin rash. She evolved with positive Nikolsky sign. Cutaneous biopsy was concordant with extensive TEN, which was managed with intravenous immunoglobulin and dexamethasone. A complete response and normalization of the blood count were achieved. Finally, the lymph node biopsy showed HL of mixed cellularity type, which was managed with 8 cycles of ABVD chemotherapy, achieving complete remission.
Subject(s)
Humans , Female , Adult , Hodgkin Disease/complications , Stevens-Johnson Syndrome/etiology , Lymphohistiocytosis, Hemophagocytic/etiology , Vinblastine , Bleomycin , Hodgkin Disease/pathology , Hodgkin Disease/drug therapy , Antineoplastic Combined Chemotherapy Protocols , Doxorubicin , Imipenem/adverse effects , Stevens-Johnson Syndrome/pathology , Stevens-Johnson Syndrome/drug therapy , Treatment Outcome , Dacarbazine , Lymphohistiocytosis, Hemophagocytic/pathology , Lymphohistiocytosis, Hemophagocytic/drug therapy , Anti-Bacterial Agents/adverse effectsABSTRACT
Carbapenems are beta-lactamase antibiotics, presently considered as most potent agents for treatment of infections caused by Gram-negative bacilli. The aim of this study was to determine resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumonniae as prevalent nosocomial agents to commonly used antibiotics including carbapenems such as imipenem and meropenem. A total of 202 gram-negative bacilli including K. pneumoniae, P aeruginosa and A. baumannii isolated from hospitalized patients in Milad hospital of Tehran were subject for susceptibility testing. Susceptibility testing was performed by disk diffusion and MIC methods as recommended by Clinical Laboratory Standards Institute [CLSI]. All isolates of K. pneumonia were susceptible to imipenem and meropenem. Resistance in non-fermenting gram-negative bacilli [NFGB] was prevalent. P. aeruginosa isolates exhibited 7.5% and 40.2% resistance to imipenem and meropenem respectively. The majority isolates of Acinetobacter baumannii were multi-drug resistant and resistance of this organism to imipenem and meropenem was 27.7% and 38.5% respectively. Our study revealed that in spite of resistance of K. pneumoniae to commonly used antibiotics, all isolates were susceptible to imipenem and meropeem. More than 80% isolates of A. bammanni were resistant to commonly used antibiotics. About 40.2% isolates of P. aeruginosa and [38.5%] isolates of A. baumannii were resistant to meropenem respectively