Assuntos
Antifúngicos/efeitos adversos , Toxidermias/etiologia , Fluconazol/efeitos adversos , Testes do Emplastro/métodos , Administração Oral , Adulto , Candidíase Vulvovaginal/tratamento farmacológico , Toxidermias/patologia , Feminino , Fluconazol/administração & dosagem , Humanos , Joelho/patologia , Lábio/patologiaRESUMO
We describe a rare case of a 54-year-old female with hairy cell leukemia, who following treatment for neutropenic sepsis, developed an extensive severe maculopapular exanthema with perifollicular hemorrhage. Cladribine, cotrimoxazole, allopurinol, domperidone, amikacin, piperacillin/tazobactam, and meropenem had all been given in the 9 days prior to eruption onset. Three months later, drug patch testing/delayed intradermal testing was positive to cotrimoxazole, trimethoprim, amikacin, piperacillin/tazobactam, and meropenem, with additional evidence of penicillin cross-reactivity. Drug challenge tests were negative to allopurinol and domperidone. She was diagnosed with multiple drug hypersensitivity to cotrimoxazole, amikacin, piperacillin/tazobactam, and meropenem. Multiple drug hypersensitivity is a novel syndrome mainly seen with severe delayed type IV drug eruptions, involving long-lasting strong T-cell reactivity to two or more structurally unrelated drugs.