Clostridium septicum myonecrosis in a pediatric patient with a self-reported penicillin allergy

2021 ◽  
Author(s):  
Parmvir Parmar ◽  
Joshua Feder ◽  
Anne Pham-Huy
Keyword(s):  
Pediatric Patients ◽  
Tissue Response ◽  
Penicillin Allergy ◽  
Severe Neutropenia ◽  
High Dose ◽  
Clostridium Septicum ◽  
Duration Of Therapy ◽  
Penicillin Therapy ◽  
History Of ◽  
Inflammatory Tissue

Infections with Clostridium septicum are especially rare in pediatric patients. C. septicum is the most common cause of spontaneous myonecrosis and is usually associated with comorbid malignancy. Treatment of choice for cases of C. septicum myonecrosis is prompt and thorough surgical debridement and antimicrobial therapy with high dose penicillin. The experience and management of C. septicum infections in patients who are unable to take penicillin are not well described, and the optimal duration of therapy is largely unknown. We describe a case of spontaneous myonecrosis in a 14-year-old receiving cytotoxic chemotherapy for Burkitt’s lymphoma who had an anecdotal history of a penicillin allergy. Her infection was initially treated with ceftazidime and metronidazole in concert with debridement but was ultimately cured with 3 weeks of intravenous penicillin therapy following a graded penicillin challenge in hospital. We observed a delayed inflammatory tissue response to a C. septicum skin, soft tissue infection that temporally corresponded to neutrophil reconstitution in our patient with severe neutropenia. Our experience demonstrates that C. septicum myonecrosis can present indolently and progress rapidly and highlights the need for clinical vigilance and repeat “second-look” surgeries. Our case also emphasizes the importance of de-labelling penicillin allergies.

Clinical Outcome in the Use of Cephalosporins in Pediatric Patients with a History of Penicillin Allergy

2012 ◽  
Vol 158 (4) ◽  
pp. 405-410 ◽  
Author(s):  
Kamran A. Ahmed ◽  
Stephanie J. Fox ◽  
Evangelo Frigas ◽  
Miguel A. Park
Keyword(s):  
Clinical Outcome ◽  
Pediatric Patients ◽  
Penicillin Allergy ◽  
History Of

Diagnostic value and safety of penicillin skin tests in children with immediate penicillin allergy

2020 ◽  
Vol 41 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Ilknur Kulhas Celik ◽  
Irem Turgay Yagmur ◽  
Ozge Yilmaz Topal ◽  
Muge Toyran ◽  
Ersoy Civelek ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Diagnostic Value ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Provocation Tests ◽  
Test Kit ◽  
History Of ◽  
Drug Provocation Tests ◽  
Immediate Reactions

Background: The first-line method in the diagnosis of patients who describe an immediate reaction after penicillin intake is a skin test (ST) with penicillin reagents. Objectives: We aimed to determine the safety and diagnostic value of penicillin STs in the diagnosis of immediate reactions to penicillins in pediatric patients. Methods: The study included pediatric patients with suspected immediate reaction to penicillin who were subjected to STs by using a standard penicillin test kit as well as suspected penicillin and the drug provocation tests (DPT) with the suspected penicillin at our clinic. Results: A total of 191 patients (53.9% boys) with a median age of 6.83 years (interquartile range, 4.2‐12 years) were included in the study. The time from drug intake to the onset of reaction was ≤1 hour in 138 patients (72.3%) and 1 to 6 hours in 53 patients (27.7%). Penicillin allergy (PA) was confirmed by diagnostic tests in 36 of the 191 patients (18.8%). In multivariate logistic regression analysis, the history of both urticaria and angioedema (odds ratio [OR] 27.683 [95% confidence interval {CI}, 3.143‐243.837]; p = 0.003) and anaphylaxis (OR 56.246 [95% CI, 6.598‐479.489]; p < 0.001) were the main predictors of a PA diagnosis. Although ST results were positive in 23 patients (63.8%), 13 patients (26.2%) had positive DPT results despite negative ST results. The negative predictive value (NPV) of STs was calculated 92.2% (155/168). None of our patients experienced immediate or delayed systemic and/or local reactions in relation to the STs. Conclusion: A history of urticaria with angioedema and anaphylaxis were the main predictors of true PA in children with suspected immediate reactions. STs with penicillin reagents are safe for use in children. Although STs have a high NPV, DPT is the gold standard for diagnosis. DPTs should be performed as the final step of the diagnostic evaluation of PA in patients with negative ST results.

Nafcillin-Induced Neutropenia in Children

PEDIATRICS ◽  
1978 ◽  
Vol 61 (1) ◽  
pp. 94-97
Author(s):  
Gerald R. Greene ◽  
Eddie Cohen
Keyword(s):  
Absolute Neutrophil Count ◽  
Neutrophil Count ◽  
Pediatric Patients ◽  
High Dose ◽  
Differential Analysis ◽  
Intravenous Therapy ◽  
Penicillin Therapy ◽  
Prolonged Recovery

Neutropenia developed in three pediatric patients treated intravenously with nafcillin. This association has not been, to our knowledge, previously reported in children. One of the patients is the youngest reported who had neutropenia associated with any penicillin; another patient had a prolonged recovery. The literature pertaining to marrow suppression by all penicillins is reviewed. This usually occurs 10 to 25 days after the inception of high-dose intravenous therapy and resolves when the penicillin therapy is discontinued. An absolute neutrophil count of less than 1,000/ml is an indication to change to an antibiotic other than a penicillin. Children receiving intravenous penicillins should have WBC counts with differential analysis two to three times a week.

PENICILLIN ANTIBODIES IN CHILDREN

PEDIATRICS ◽  
1968 ◽  
Vol 42 (2) ◽  
pp. 342-348
Author(s):  
Melvin S. Rosh ◽  
Henry R. Shinefield
Keyword(s):  
Adverse Reaction ◽  
Degradation Product ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Positive Skin ◽  
Positive History ◽  
Penicillin Therapy ◽  
History Of ◽  
Circulating Antibodies ◽  
Untoward Reaction

Skin and circulating antibodies against penicillin were determined in 73 children with a positive history of penicillin allergy and 99 children with a negative history of penicillin allergy. Eight percent with positive histories had positive skin tests to benzylpenicillin and a degradation product of penicillin (penicilloyl-polylysine), and/or positive hemagglutination tests for circulating penicillin antibodies. One individual had detectable skin antibodies without circulating penicillin antibodies; and conversely, one patient with circulating antibodies did not have any evidence of skin antibodies. The absence of penicillin antibodies in 85% of those children with a rash following the administration of penicillin confirms the suspicion that physicians are over diagnosing penicillin hypersensitivity in children. With the use of an inhibitor of penicilloyl-polylysine (penicilloyl epsilon-aminocaproate), data is presented which suggests that all positive skin tests to penicilloyl-polylysine may not be due to an antibody-antigen reaction. The authors recommend that any child who has suspected penicillin allergy should be tested for skin and circulating antibodies no less than 1 month and no more than 1 year following the untoward reaction. Observations suggest that a patient without penicillin antibodies may tolerate penicillin therapy with no adverse reaction. However, until further experience is obtained, penicillin should not be used indiscriminately in the absence of penicillin antibodies.

ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor

2009 ◽  
Vol 29 (02) ◽  
pp. 155-157 ◽  
Author(s):  
H. Hauch ◽  
J. Rischewski ◽  
U. Kordes ◽  
J. Schneppenheim ◽  
R. Schneppenheim ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Agents ◽  
Tolerance Induction ◽  
Intravenous Immunoglobulins ◽  
Factor Ix ◽  
High Dose ◽  
Allergic Reactions ◽  
Success Rates ◽  
Serious Infections ◽  
History Of

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.

Family History of Diabetes Is Associated with Increased Risk of Recurrent DKA in Pediatric Patients in Rhode Island

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1378-P
Author(s):  
JANAKI D. VAKHARIA ◽  
SUNGEETA AGRAWAL ◽  
JANINE BACIC ◽  
LISA S. TOPOR
Keyword(s):  
Family History ◽  
Rhode Island ◽  
Pediatric Patients ◽  
Family History Of Diabetes ◽  
Increased Risk ◽  
History Of

Minocycline-Induced Agranulocytosis Presenting as Ecthyma Gangrenosum

2017 ◽  
Vol 1 (3) ◽  
pp. 161-164 ◽  
Author(s):  
Katherine Nolan ◽  
Reema Ishteiwy ◽  
John Alexis ◽  
Martin Zaiac ◽  
Anna Nichols
Keyword(s):  
Care Facility ◽  
Urgent Care ◽  
Severe Neutropenia ◽  
Dramatic Improvement ◽  
Therapy Discontinuation ◽  
Incision And Drainage ◽  
Ecthyma Gangrenosum ◽  
Minimal Improvement ◽  
History Of ◽  
Acute And Chronic Inflammation

A 51-year-old female with a history of rheumatoid arthritis was admitted for progressive fevers, chills and malaise. Five weeks prior, she started minocycline for an RA exacerbation. Two weeks after starting minocycline she developed an abscess on her right ankle that was treated at an urgent care facility with ceftriaxone and trimethoprim-sulfamethoxazole. She had minimal improvement so was switched to clindamycin. She developed additional abscesses on her right ankle and right axilla and spiking fevers so she was treated with incision and drainage under general anesthesia. Routine blood work obtained prior to surgery revealed severe neutropenia (0.74 103/ul) and the patient was urgently referred to the emergency department.  Skin biopsy was obtained on admission and revealed ulceration, necrosis, acute and chronic inflammation, vasculitis with vascular thrombosis and rod-shaped bacteria in blood vessel walls and lumina consistent with ecthyma gangrenosum. The following day tissue and blood cultures confirmed the growth of Pseudomonas aureginosa. Bone-marrow biopsy showed decreased granulopoiesis and hematopoiesis, and a diagnosis of minocycline-induced agranulocytosis presenting as ecthyma gangrenosum was made.  The patient had dramatic improvement with appropriate antibiotic therapy, discontinuation of minocycline and initiation of filgrastrim. She has remained healthy without recurrence for 17 months.    

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

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