PDF(Pubmed)
Abstract：
Drug-induced urticaria and angioedema cases are typically reversible upon discontinuation and can be triggered by antibiotics, angiotensin-converting enzyme inhibitors, or nonsteroidal anti-inflammatory drugs. Piperacillin-tazobactam, a common broad-spectrum antimicrobial, has been linked to severe adverse reactions, such as thrombocytopenia, hemolytic anemia, and Steven Johnson syndrome in some cases. A 35-year-old male presented to the emergency department with fever, cough, and acute breathlessness, complicating his ongoing treatment for pulmonary tuberculosis with bedaquiline and delamanid. He was admitted and received supportive care. On the third day of intravenous piperacillin-tazobactam, he developed drug-induced urticaria and angioedema, which resolved upon discontinuing the drug. Piperacillin/tazobactam-induced hypersensitivity reaction is an immunologic and IgE-mediated immediate reaction. IgE-mediated immediate reactions to three major phenotypes of allergic patients with confirmed to piperacillin/tazobactam are either (1) sensitized to the β-lactam ring or (2) sensitized to the lateral chain of aminopenicillins or (3) selective to piperacillin/tazobactam alone. A skin patch test is advised, or prescribed to avoid hypersensitivity reactions due to piperacillin/tazobactam. This case underscores the challenges of non-adherence to anti-tubercular therapy, leading to drug resistance and prolonged, costly, and sometimes intolerable treatments. Regular patient follow-up, counseling, monitoring, and healthcare provider involvement are essential to enhance treatment adherence. Adverse drug reactions must be promptly reported and managed, and patient-centric approaches are crucial. Digital patient records and standardized data collection are recommended for program evaluation and global policy development. Causality assessment for piperacillin-tazobactam was diagnosed as the probable cause of drug-induced urticaria and angioedema. This case highlights the importance of adherence to tuberculosis treatment to prevent drug resistance. Overall, patient-centered care, monitoring adverse events of drug added, and better data collection are crucial for successful tuberculosis management.
摘要：
药物引起的荨麻疹和血管性水肿病例在停药后通常是可逆的，并且可以由抗生素引发。血管紧张素转换酶抑制剂，或非甾体抗炎药。哌拉西林他唑巴坦,一种常见的广谱抗微生物剂，与严重的不良反应有关，比如血小板减少症,溶血性贫血,和史蒂文·约翰逊综合症。一名三十五岁男性因发烧前往急诊科,咳嗽,急性呼吸困难，使他正在进行的bedaquiline和delamanid肺结核治疗复杂化。他被录取并接受了支持性护理。在静脉注射哌拉西林他唑巴坦的第三天，他患上了药物引起的荨麻疹和血管性水肿,在停药后解决了。哌拉西林/他唑巴坦诱导的超敏反应是一种免疫和IgE介导的即时反应。IgE介导的对已确认为哌拉西林/他唑巴坦的三种主要表型的过敏患者的即时反应是（1）对β-内酰胺环敏感或（2）对氨基青霉素的侧链敏感或（3）对哌拉西林/他唑巴坦单独的选择性。建议进行皮肤贴片测试，或开处方以避免因哌拉西林/他唑巴坦引起的超敏反应。这一案例凸显了不坚持抗结核治疗的挑战，导致抗药性和延长，昂贵的,有时是无法忍受的治疗。定期患者随访,咨询,监测,和医疗保健提供者的参与对于提高治疗依从性至关重要。药物不良反应必须及时报告和管理,以患者为中心的方法至关重要。建议将数字患者记录和标准化数据收集用于计划评估和全球政策制定。哌拉西林他唑巴坦的因果关系评估被诊断为药物引起的荨麻疹和血管性水肿的可能原因。该病例强调了坚持结核病治疗对预防耐药性的重要性。总的来说,以病人为中心的护理，监测添加药物的不良事件，更好的数据收集对于成功的结核病管理至关重要.
