Acute localized exanthematous pustulosis caused by cefoperazone and sodium sulbactam

Abstract

Acute localized exanthematous pustulosis is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 72-year-old woman presented with multiple erythematous pustules on her face, which had appeared two days after using cefoperazone and sodium sulbactam. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules resolved within about two weeks after the patient discontinued the antibiotics. This report discusses the case of a woman with a cutaneous drug reaction consistent with acute localized exanthematous pustulosis that occurred after cefoperazone and sodium sulbactam were administered.

Acute localized exanthematous pustulosis: Clinical features, pathophysiology, and therapy

“…In patients with AGEP, however, the pustular eruption tends to begin in intertriginous areas then disseminates throughout the body. Among the other symptoms reported, fever was noted in 10 cases, 7,8,11,12,14,16,20,24,27,31 and lymphadenopathies in one case 8 . No general weakness was reported.…”

“…Among drug‐induced ALEP, antibiotics were the most frequent causative agent. Amoxicillin‐clavulanic acid was reported in six cases 8,14,17,25,29,31 amoxicillin in six cases 6,14,24,30,32,34 and cephalosporin in two cases 12,20 . Levofloxacin, 26 sulfamethoxazole‐trimethoprim, 22 iperacillin/tazobactam, 15 and clindamycine 13 have been reported in one case each.…”

“…Amoxicillin-clavulanic acid was reported in six cases 8,14,17,25,29,31 amoxicillin in six cases 6,14,24,30,32,34 and cephalosporin in two cases. 12,20 Levofloxacin, 26 sulfamethoxazoletrimethoprim, 22 iperacillin/tazobactam, 15 and clindamycine 13 have been reported in one case each. Drugs other than antibiotics have also been implicated in ALEP such as paracetamol, 27 ibuprofen, 11,23 allopurinol, 33 nimesulide, 28 docetaxel, 21 infliximab, 10 lamotrigine, 5 bemiparin, 9 finasteride, 18 sorafenib, 19 heparin calcium, 3 and metronidazole.…”

Allergic Reactions and Cross-Reactivity Potential with Beta-Lactamase Inhibitors

“…Twelve reports were identified in which patients had reactions following administration of either ampicillin–sulbactam or cefoperazone–sulbactam [32,33,34,35,36,37,38,39,40,41,42,43]. Only one of these reports was definitely associated with the sulbactam component of the antibiotic.…”

“…In the second case, the patient experienced Kounis syndrome after ten minutes of an ampicillin–sulbactam infusion [34]. In the third report, the patient experienced acute localized exanthematous pustulosis with multiple pustules and underlying erythema after receipt of cefoperazone–sulbactam [35]. In the fourth case, the patient experienced erythema, vesicles, and blisters with biopsy-proven linear deposits of IgA on the dermal–epidermal junction after seven days of therapy with ampicillin–sulbactam [36].…”