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Case Report
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| Postoperative Stevens-Johnson syndrome secondary to piperacillin-tazobactam: A case report | ||||||
| Mihir M Shah1, Kelsey Larson1, Neilendu Kundu1, R Matthew Walsh2 | ||||||
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1MD, Resident, General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
2MD, Faculty, General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA. | ||||||
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| Shah MM, Larson K, Kundu N, Walsh RM. Postoperative Stevens–Johnson syndrome secondary to piperacillin–tazobactam: A case report. International Journal of Case Reports and Images 2013;4(6):316–320. |
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Abstract
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Introduction:
Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are severe, potentially fatal cutaneous reactions to medications affecting only 1–2 per million individuals each year. They present as tenderness, erythema and blistering of both the skin and mucus membranes. We describe a case of Stevens–Johnson syndrome linked to piperacillin–tazobactam treatment, which is a previously unreported cause and a rare occurrence in postoperative patients.
Case Report: A 37-year-old female with chronic pancreatitis post-total pancreatectomy with auto-islet transplant was re-admitted on postoperative day 12 with abdominal pain and leukocytosis. Her workup revealed a small intra-abdominal fluid collection suspicious for an abscess and she was empirically started on piperacillin–tazobactam. She developed hives on her extremities with associated itching after four days of treatment. Piperacillin–tazobactam was discontinued, diphenhydramine was administered for symptomatic relief, and she was discharged on an oral regimen of ciprofloxacin and metronidazole. She returned the following day with a rash extending onto her chest, abdomen, feet, face, lips and mouth, with newly appeared bullae covering approximately 35–50% of body surface. A skin biopsy was consistent with SJS, with piperacillin–tazobactam identified as the likely causative agent. Conclusion: The most common medications linked to TEN/SJS are sulfonamide antibiotics (especially sulfamethoxazole/trimethoprim), cephalosporins, quinolones, allopurinol, carbamazepine, phenytoin, phenobarbital, and NSAIDs (oxicam-type). While medications the most common cause, mycoplasma pneumoniae and herpes simplex virus (HSV) have also been linked to SJS. The mortality rate of biopsy-confirmed SJS ranges from 1–5%, whereas the mortality of TEN ranges from 25–35%. Though many patients experience pruritis and/or rashes as side-effects to medications given post-operatively, it is important to keep in mind more serious reactions such as TEN and SJS as these conditions as they have a substantial associated morbidity and even mortality. | |
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Keywords:
Stevens-Johnson syndrome, Toxic epidermal necrolysis, Piperacillin–tazobactam
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Author Contributions
Mihir Shah – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Kelsey Larson – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published Neilendu Kundu – Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published R Matthew Walsh – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© Mihir Shah et al. 2013; This article is distributed the terms of Creative Commons attribution 3.0 License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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