Drug reaction with eosinophilia and systemic symptoms syndrome related to piperacillin-tazobactam use

Piperacillin‑tazobactam‑induced myocardial injury with heart failure: A case report

Piperacillin-tazobactam is a clinically used antibiotic consisting of the semisynthetic penicillin piperacillin and the β-lactamase inhibitor tazobactam. Piperacillin-tazobactam is a broad-spectrum antibiotic used clinically to treat infections caused by gram-positive and gram-negative aerobic and anaerobic bacteria. The most common adverse reactions are gastrointestinal symptoms and skin reactions. There have been a few reported cases of possible drug hypersensitivity, with thrombocytopenia as the most commonly observed adverse event. The present article reported a rare case of myocardial injury with heart failure following treatment of pneumonia with piperacillin-tazobactam in a 75-year-old female patient. Specifically, this patient presented with fever, chills, flushing and tachypnea, in addition to elevated leukocyte, neutrophil, cardiac enzyme and brain natriuretic peptide levels. This patient also presented with a mild ST-segment elevation on the electrocardiogram following piperacillin-tazobactam treatment. Improvements in the aforementioned adverse reactions were observed and the underlying infection didn't come back following the discontinuation of piperacillin-tazobactam treatment. Therefore, the present observations suggest that piperacillin-tazobactam may have induced myocardial injury and heart failure. Possible occurrence of similar adverse reactions in the heart should be considered before choosing piperacillin-tazobactam as treatment in clinical practice.

DRESS Syndrome: Renal Involvement in Two Cases - A Comprehensive Analysis and Literature Review of Improved Diagnosis and Treatment

BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare hypersensitivity reaction involving the skin and various visceral organs; the kidneys are the second most affected organ. Many drugs are reported to be associated with DRESS, particularly antiepileptic agents and allopurinol. Certain human leukocyte antigen (HLA) haplotypes, in combination with a particular drug, can further contribute to an increased risk of DRESS. Symptoms often develop 2 to 8 weeks after drug initiation. If diagnosis is delayed, DRESS can be a life-threatening condition. CASE REPORT We present cases of 2 patients. The first patient was an 86-year-old Polish woman who developed acute kidney injury and skin lesions with accompanying leucocytosis and eosinophilia during long-term antibiotic therapy with piperacillin/tazobactam and ciprofloxacin. The second patient was a 37-year-old Asian woman with predialysis chronic renal disease stage V in the course of IgA nephropathy. Two weeks after starting allopurinol in a standard dose, she presented with maculopapular rash, facial edema, fever, liver injury, and eosinophilia. Renal function started to deteriorate, but she did not require dialysis. In both cases, the discontinuation of the above-mentioned drugs and the introduction of steroid therapy and intravenous immunoglobulins allowed for clinical improvement and recovery. In the second case, the extended 4-locus HLA typing was performed retrospectively, and allele HLA-B*5801 was found. CONCLUSIONS Due to the rare occurrence and heterogeneous manifestation of DRESS, its diagnosis can pose many difficulties. In-depth analysis of symptoms, medicines taken, and laboratory findings enable the implementation of appropriate treatment and recovery.