Dias de Castro E, Leblanc A, Sarmento A, Cernadas J R
Allergy and Immunology Division, Hospital S. João, E.P.E., Porto, Portugal. Serviço de Imunoalergologia Hospital S. João Alameda Prof. Hernâni Monteiro 4200-319 Porto, Portugal. E-mail:
Allergy and Immunology Division, Hospital S. João, E.P.E., Porto, Portugal.
Eur Ann Allergy Clin Immunol. 2015 Nov;47(6):225-7.
Recent studies have demonstrated a low cross-reactivity between β-lactam antibiotics and carbapenems in IgE-mediated reactions. There are no studies on cross-reactivity of meropenem in patients with non-immediate hypersensitivity to cephalosporins. We describe a case of a 13-year-old male, admitted in Neurosurgery with a severe extradural empyema complicating frontal sinusitis, submitted to an emergent bifrontal craniotomy. A generalized maculopapular exanthema, fever and malaise, appeared by the 7th day of meningeal doses of ceftriaxone, clindamycin and vancomycin. Those were replaced by meropenem, with posterior worsening of the reaction and mucosal involvement. A new scheme with amikacin, metronidazole and linezolid was done with improvement. Skin prick, intradermal and patch tests to penicillins, ceftriaxone and meropenem were negative. Lymphocyte transformation test was positive to ceftriaxone and negative to meropenem.Non-immediate T cell mechanism seems to be involved. Diagnosis work-up couldn't exclude cross-reactivity between ceftriaxone and meropenem.
最近的研究表明，在IgE介导的反应中，β-内酰胺类抗生素与碳青霉烯类之间的交叉反应性较低。目前尚无关于美罗培南在对头孢菌素存在非速发型超敏反应的患者中交叉反应性的研究。我们描述了一例13岁男性病例，因严重的硬膜外脓肿并发额窦炎入住神经外科，接受了急诊双额开颅手术。在使用头孢曲松、克林霉素和万古霉素进行脑膜剂量治疗的第7天，出现了全身性斑丘疹、发热和不适。随后换用美罗培南，但反应加重并出现黏膜受累。改用阿米卡星、甲硝唑和利奈唑胺的新方案后病情改善。对青霉素、头孢曲松和美罗培南进行的皮肤点刺试验、皮内试验和斑贴试验均为阴性。淋巴细胞转化试验对头孢曲松呈阳性，对美罗培南呈阴性。似乎涉及非速发型T细胞机制。诊断检查不能排除头孢曲松和美罗培南之间的交叉反应性。
