Hypersensitivity syndrome due to concomitant use of vancomycin and cefoperazone sodium and sulbactam sodium in a patient with renal failure

Abstract

A 51-year-old male patient with renal failure received IV infusions of vancomycin 1.0 g and cefoperazone sodium and sulbactam sodium 2.0 g twice daily for 7 days in a local hospital because of methicillin-resistant staphylococcus aureus infection. On day 22 of drug withdrawal, the patient developed edematous erythema on his face and lower limbs; on day 26 of drug withdrawal, he developed fever and the laboratory tests showed white blood cell (WBC) 19.7×109/L, neutrophile granulocyte 0.67, eosinophile granulocyte 0.16, C reactive protein (CRP) 76.5 mg/L, procalcitonin 10.9 μg/L, alanine aminotrans-ferase (ALT) 68 U/L, alkaline phosphatase (ALP) 452 U/L, γ-glutamyltransferase (γ-GT) 118 U/L, serum creatinine (Scr) 1 323.5 μmol/L, and prothrombin time (PT) 53.5 s. He was treated with IV infusions of methylprednisolone and the above two drugs again in the local hospital. Six days after remedication, his erythema merged and spread to the whole body, which accompanied by systemic desquamation and skin ulcers on his dorsal foot and around the mouth. Then the patient was transferred to the First People′s Hospital of Hangzhou and diagnosed as drug hypersensitivity syndrome, which was considered to be related to the concomitant use of vancomycin and cefoperazone sodium and sulbactam sodium. Symptomatic and supportive treatments were given, including IV infusions of piperacillin sodium and tazobactam sodium 4.5 g twice daily, methylprednisolone 30 mg (the dosage was gradually decreased to 20 mg once daily) twice daily, fresh frozen plasma 400 U, oral antihistamine drugs, topical external medicine, and etc. On day 22 of the above treatments, his edemas subsided and the whole erythema disappeared. The laboratory tests showed WBC 5.6×109/L, eosinophile granulocyte 0, ALT 13 U/L, ALP 66 U/L, γ-GT 54 U/L, Scr 719 μmol/L, and PT 12.7 s. Key words: Hypersensitivity; Vancomycin; Cefoperazone sodium and sulbactam sodium