Lambourne Jonathan, Kitchen Joanne, Hughes Claudine, Merry Concepta
Department of Infectious Disease and Genitourinary Medicine, St James's Hospital, Dublin, Ireland.
Ann Pharmacother. 2006 May;40(5):977-9. doi: 10.1345/aph.1G526. Epub 2006 Apr 18.
To describe a case of a delayed-type hypersensitivity (DTH) reaction to piperacillin/tazobactam in which painful paresthesiae were a predominant feature.
A 27-year-old man with a history of intravenous drug abuse was admitted for treatment of a pulmonary parenchymal abscess in the setting of lower-limb deep-venous thrombosis and methicillin-sensitive Staphylococcus aureus bacteremia. He was treated with intravenous piperacillin/tazobactam 4.5 g 3 times daily; however, after 2 weeks of therapy, he developed symptoms (eg, fever, chills) and laboratory abnormalities (eg, white blood cell count 2.1 x 10(3)/mm3, erythrocyte sedimentation rate 63 mm/h) suggestive of a DTH reaction. This was accompanied by infusion-related painful paresthesiae. The symptoms and laboratory abnormalities resolved within 48 hours of treatment being switched to flucloxacillin.
Due to the close temporal association and the absence of any other obvious explanation, we believe these paresthesiae represent an additional feature of the DTH reaction to piperacillin/tazobactam in this patient. Use of the Naranjo probability scale indicated a probable relationship between the paresthesiae and administration of piperacillin/tazobactam.
To our knowledge, as of March 24, 2006, this is the first case in which a DTH reaction to piperacillin/tazobactam manifesting as fever, neutropenia, and thrombocytopenia has been associated with paresthesiae.
描述1例以疼痛性感觉异常为主要特征的对哌拉西林/他唑巴坦的迟发型超敏反应（DTH）。
一名有静脉药物滥用史的27岁男性因下肢深静脉血栓形成和甲氧西林敏感金黄色葡萄球菌菌血症并发肺实质脓肿入院治疗。他接受每日3次静脉注射4.5 g哌拉西林/他唑巴坦治疗；然而，治疗2周后，他出现了提示DTH反应的症状（如发热、寒战）和实验室异常（如白细胞计数2.1×10³/mm³、红细胞沉降率63 mm/h）。同时伴有与输液相关的疼痛性感觉异常。在改用氟氯西林治疗48小时内，症状和实验室异常消失。
由于时间上的紧密关联且无任何其他明显解释，我们认为这些感觉异常是该患者对哌拉西林/他唑巴坦的DTH反应的另一个特征。使用Naranjo概率量表表明感觉异常与哌拉西林/他唑巴坦给药之间可能存在关联。
据我们所知，截至2006年3月24日，这是首例对哌拉西林/他唑巴坦的DTH反应表现为发热、中性粒细胞减少和血小板减少并伴有感觉异常的病例。
