Antibiotics hypersensitivity reactions during COVID-19 pandemic

Abstract

During the COVID-19 pandemic, there have emerged publications about various skin manifestations mainly caused by the related coronavirus, also including some case reports on dermal drug-related adverse reactions. In Armenia, the doctors in COVID-19 hospitals periodically consulted with allergists-immunologists regarding allergic conditions that many patients already suffered on admission or manifested after it. We present the series of three most interesting drug-induced cases with various skin manifestations in patients with COVID-19 pneumonia who requited antibiotic therapy. The causative significance of antibiotics was assessed according to Naranjos algorithm. In the first case (a 58-year-old female patient), a diagnosis of maculopapular exanthem was made based on the clinical picture. Although the coronavirus per se can result in similar manifestations, previous history of allergic reaction to ampicillin led to the conclusion that ceftriaxone (both are beta-lactam antibiotics) was the most probable cause. The second case (a 53-year-old male patient), clinically manifested as vasculitis, caused some difficulties because this is quite often skin manifestations related to SARS-CoV-2, and is rarely induced by medications. Taking into account the history of reaction to beta-lactam antibiotic, as well as the fact that the patient took amoxicillin without a prescription before hospitalization and with overt skin lesions at that time, amoxicillin was assessed as a possible cause. In the third case (a 64-years-old female patient), diagnosed with a bullous drug-induced skin eruption, despite isolated cases of such lesions can be manifestations of SARS-CoV-2 infection, moxitec (fluoroquinolone antibiotic) was assessed as the most probable cause, especially taking into account herpes in history. According to current recommendations, an issue of drug tests was discussed with all three patients to confirm the causative significance of indicated drugs and/or to select an alternative drug, if necessary. In this regard, the subjects were included in the database of patients with severe drug hypersensitivity reactions by their informed consent.