Acute Generalized Exanthematous Pustulosis: A Rare Clinical Entity With Use of Piperacillin/Tazobactam

Talati, Sapan; Lala, M P; Kapupara, Hiteshkumar; Thet, Zeyar

doi:10.1097/mjt.0b013e31818d5f6d

Cited by 11 publications

(7 citation statements)

References 5 publications

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“…Lithium salts that are widely used in the treatment of bipolar disorders are also associated with cardiac complications such as myocarditis (Talati et al, 2009), severe bradycardia (Waring, 2007), prolongation of the QT interval (van Noord et al, 2009), and severe ventricular arrhythmias potentially leading to VF and sudden death (Cruchaudet et al, 2002). Recently, a case of Brugada syndrome was reported in a 78-year-old patient with severe depression treated for 25 years with imipramine, amineptine, levomepromazine, and lorazepam.…”

Section: Sudden Deaths Of Cardiac Origin Associated With Psychotropicmentioning

confidence: 99%

Sudden Death of Cardiac Origin and Psychotropic Drugs

Timour¹,

Frassati²,

Descotes³

et al. 2012

Front. Pharmacol.

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Mortality rate is high in psychiatric patients versus general population. An important cause of this increased mortality is sudden cardiac death (SCD) as a major side-effect of psychotropic drugs. These SCDs generally result from arrhythmias occurring when the posology is high and may attain a toxic threshold but also at dosages within therapeutic range, in the presence of risk factors. There are three kinds of risk factors: physiological (e.g., low cardiac rate of sportsmen), physiopathological (e.g., hepatic insufficiency, hypothyroidism) and “therapeutic” (due to interactions between psychotropic drugs and other medicines). Association of pharmacological agents may increase the likelihood of SCDs either by (i) a pharmacokinetic mechanism (e.g., increased torsadogenic potential of a psychotropic drug when its destruction and/or elimination are compromised) or (ii) a pharmacodynamical mechanism (e.g., mutual potentiation of proarrhythmic properties of two drugs). In addition, some psychotropic drugs may induce sudden death in cases of pre-existing congenital cardiopathies such as (i) congenital long QT syndrome, predisposing to torsade de pointes that eventually cause syncope and sudden death. (ii) A Brugada syndrome, that may directly cause ventricular fibrillation due to reduced sodium current through Nav1.5 channels. Moreover, psychotropic drugs may be a direct cause of cardiac lesions also leading to SCD. This is the case, for example, of phenothiazines responsible for ischemic coronaropathies and of clozapine that is involved in the occurrence of myocarditis. The aims of this work are to delineate: (i) the risk of SCD related to the use of psychotropic drugs; (ii) mechanisms involved in the occurrence of such SCD; (iii) preventive actions of psychotropic drugs side effects, on the basis of the knowledge of patient-specific risk factors, documented from clinical history, ionic balance, and ECG investigation by the psychiatrist.

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Section: Sudden Deaths Of Cardiac Origin Associated With Psychotropicmentioning

confidence: 99%

Sudden Death of Cardiac Origin and Psychotropic Drugs

Timour¹,

Frassati²,

Descotes³

et al. 2012

Front. Pharmacol.

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“…Piperacillin/tazobactam has been reported to eause AGEP when used to treat pneumonia and cellulitis in geriatric patients (12,13). To the best of our knowledge, there are no previous reports of ALEP associated with piperacillin/tazobactam, and only 2 reports of ALEP localized in areas other than the facial area.…”

Section: Discussionmentioning

confidence: 70%

Acute Localized Exanthematous Pustulosis on Inguinal Area Secondary to Piperacillin/tazobactam

Huilaja¹,

Kallioinen²,

Soronen³

et al. 2014

Acta Derm Venerol

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“…The classic diagnostic triad of AGEP includes nonfollicular intraepidermal or subcorneal pustules (<5 mm) arising on widespread edematous erythema, fever with a temperature of greater than 38℃, and a neutrophil count greater than 7,000 cells/µl 1 . Based on the clinical findings of relatively acute onset, nonfollicular pustules, and fever with neutrophilia, the patient had been diagnosed with AGEP before skin lesions appeared again with facial edema.…”

Section: Discussionmentioning

confidence: 99%

“…Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics 1 . Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement 2 .…”

Section: Introductionmentioning

confidence: 99%

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

et al. 2016

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Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.

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Acute Generalized Exanthematous Pustulosis: A Rare Clinical Entity With Use of Piperacillin/Tazobactam

Cited by 11 publications

References 5 publications

Sudden Death of Cardiac Origin and Psychotropic Drugs

Sudden Death of Cardiac Origin and Psychotropic Drugs

Acute Localized Exanthematous Pustulosis on Inguinal Area Secondary to Piperacillin/tazobactam

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

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