Abstract
The authors describe two cases of toxic epidermal necrolysis (TEN) caused by delayed hypersensitivity to semisynthetic penicillins. The first patient developed erythema of the lower limbs following an i.m. injection of ampicillin, which progressed to TEN as therapy was continued. Fever and eosinophilic leukocytosis were also present. In the second case, TEN developed following oral amoxicillin therapy, and was preceded by a diffuse, maculopapular eruption. In both cases, symptoms resolved with the prompt administration of steroids. Both patients underwent allergological testing: prick test and, if results were negative, intradermal tests with penicilloyl-polylysine (PPL), minor determinant mixture (MDM), penicillin, amoxicillin and ampicillin. Patch testing with penicillin, ampicillin and amoxicillin was also performed. Both patients developed positive reactions to the intradermal tests after 6 h, and to patch tests after 48-72 h (for ampicillin, amoxicillin and penicillin in the first case, and for ampicillin and amoxicillin in the second). The lymphocyte transformation test (LTT), performed only in the first case, was positive for ampicillin. As these cases demonstrate, delayed hypersensitivity should be suspected in cases of drug-related TEN. Patch testing is a simple and useful allergological test for these types of cases.
| Original language | English |
|---|---|
| Pages (from-to) | 53-55 |
| Number of pages | 3 |
| Journal | Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología |
| Volume | 3 |
| Issue number | 1 |
| Publication status | Published - 1993 |
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Keywords
- β-lactam antibiotics
- delayed hypersensitivity
- Lyell's syndrome
- patch test
- toxic epidermal necrolysis
ASJC Scopus subject areas
- Immunology and Allergy
Cite this
Two cases of toxic epidermal necrolysis caused by delayed hypersensitivity to β-lactam antibiotics. / Romano, A.; Di Fonso, M.; Pocobelli, D.; Giannarini, L.; Venuti, A.; Garcovich, A.
In: Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología, Vol. 3, No. 1, 1993, p. 53-55.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Two cases of toxic epidermal necrolysis caused by delayed hypersensitivity to β-lactam antibiotics
AU - Romano, A.
AU - Di Fonso, M.
AU - Pocobelli, D.
AU - Giannarini, L.
AU - Venuti, A.
AU - Garcovich, A.
PY - 1993
Y1 - 1993
N2 - The authors describe two cases of toxic epidermal necrolysis (TEN) caused by delayed hypersensitivity to semisynthetic penicillins. The first patient developed erythema of the lower limbs following an i.m. injection of ampicillin, which progressed to TEN as therapy was continued. Fever and eosinophilic leukocytosis were also present. In the second case, TEN developed following oral amoxicillin therapy, and was preceded by a diffuse, maculopapular eruption. In both cases, symptoms resolved with the prompt administration of steroids. Both patients underwent allergological testing: prick test and, if results were negative, intradermal tests with penicilloyl-polylysine (PPL), minor determinant mixture (MDM), penicillin, amoxicillin and ampicillin. Patch testing with penicillin, ampicillin and amoxicillin was also performed. Both patients developed positive reactions to the intradermal tests after 6 h, and to patch tests after 48-72 h (for ampicillin, amoxicillin and penicillin in the first case, and for ampicillin and amoxicillin in the second). The lymphocyte transformation test (LTT), performed only in the first case, was positive for ampicillin. As these cases demonstrate, delayed hypersensitivity should be suspected in cases of drug-related TEN. Patch testing is a simple and useful allergological test for these types of cases.
AB - The authors describe two cases of toxic epidermal necrolysis (TEN) caused by delayed hypersensitivity to semisynthetic penicillins. The first patient developed erythema of the lower limbs following an i.m. injection of ampicillin, which progressed to TEN as therapy was continued. Fever and eosinophilic leukocytosis were also present. In the second case, TEN developed following oral amoxicillin therapy, and was preceded by a diffuse, maculopapular eruption. In both cases, symptoms resolved with the prompt administration of steroids. Both patients underwent allergological testing: prick test and, if results were negative, intradermal tests with penicilloyl-polylysine (PPL), minor determinant mixture (MDM), penicillin, amoxicillin and ampicillin. Patch testing with penicillin, ampicillin and amoxicillin was also performed. Both patients developed positive reactions to the intradermal tests after 6 h, and to patch tests after 48-72 h (for ampicillin, amoxicillin and penicillin in the first case, and for ampicillin and amoxicillin in the second). The lymphocyte transformation test (LTT), performed only in the first case, was positive for ampicillin. As these cases demonstrate, delayed hypersensitivity should be suspected in cases of drug-related TEN. Patch testing is a simple and useful allergological test for these types of cases.
KW - β-lactam antibiotics
KW - delayed hypersensitivity
KW - Lyell's syndrome
KW - patch test
KW - toxic epidermal necrolysis
UR - http://www.scopus.com/inward/record.url?scp=0027157727&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0027157727&partnerID=8YFLogxK
M3 - Article
C2 - 8281332
AN - SCOPUS:0027157727
VL - 3
SP - 53
EP - 55
JO - Journal of Investigational Allergology and Clinical Immunology
JF - Journal of Investigational Allergology and Clinical Immunology
SN - 1018-9068
IS - 1
ER -