Abstract

We describe a rare case of a 54-year-old female with hairy cell leukemia, who following treatment for neutropenic sepsis, developed an extensive severe maculopapular exanthema with perifollicular hemorrhage. Cladribine, cotrimoxazole, allopurinol, domperidone, amikacin, piperacillin/tazobactam, and meropenem had all been given in the 9 days prior to eruption onset. Three months later, drug patch testing/delayed intradermal testing was positive to cotrimoxazole, trimethoprim, amikacin, piperacillin/tazobactam, and meropenem, with additional evidence of penicillin crossreactivity. Drug challenge tests were negative to allopurinol and domperidone. She was diagnosed with multiple drug hypersensitivity to cotrimoxazole, amikacin, piperacillin/tazobactam, and meropenem. Multiple drug hypersensitivity is a novel syndrome mainly seen with severe delayed type IV drug eruptions, involving long-lasting strong T-cell reactivity to two or more structurally unrelated drugs.

Author Details

Authors

• Katie Townsend¹,³,⁴
• Claire Leck¹
• Thippeswamy Billahalli¹
• Elizabeth Barachina¹
• Timothy J. Watts¹,²

Departments

• ¹ Department of Respiratory Medicine & Allergy, Homerton Healthcare NHS Foundation Trust,
• ² National Heart & Lung Institute, Imperial College London,
• ³ Department of Immunology, Royal Free London Hospital NHS Foundation Trust, and
• ⁴ University College London Institute of Immunity and Transplantation, Pears building, Rowland Street, London, United Kingdom

Address

Dr. Katie Townsend, BM BCh, MRCP, UCL Pears Building, Rowland Hill Street, London, NW3 2QG, UK
Email: [email protected]

Citation