Sameed Muhammad, Nwaiser Christine, Bhandari Prashant, Schmalzle Sarah A
Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA.
Medical School, American University of Antigua College of Medicine, Osbourn, Antigua and Barbuda.
BMJ Case Rep. 2019 Aug 20;12(8):e230144. doi: 10.1136/bcr-2019-230144.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered variants of a disease continuum that results in a life-threatening exfoliative mucocutaneous disease. These are categorised as type IV cell-mediated delayed hypersensitivity reactions, and antibiotics are often implicated as a cause. Penicillins and other beta-lactam antibiotics are known to cause both immediate and delayed hypersensitivity reactions. While immediate IgE-mediated cross-reactivity between penicillins and carbapenems is well studied, less information on the risk of type IV delayed cell-mediated cross-reactivity between the two is available. We present a case of meropenem-induced SJS in a patient with documented history of SJS from amoxicillin. There are few cases of cross-reactivity with carbapenems reported in the literature, but based on the potential for life-threatening reaction, it is likely prudent to avoid the use of any beta-lactams in a patient with a history of SJS, TEN or any other severe cutaneous adverse reactions to another beta-lactam antibiotic.
史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）被认为是一种疾病连续体的变体，该疾病连续体可导致危及生命的剥脱性皮肤黏膜疾病。这些被归类为IV型细胞介导的迟发型超敏反应，抗生素常被认为是病因。已知青霉素和其他β-内酰胺类抗生素会引起速发型和迟发型超敏反应。虽然青霉素和碳青霉烯类之间由IgE介导的速发型交叉反应已得到充分研究，但关于两者之间IV型迟发型细胞介导的交叉反应风险的信息较少。我们报告一例有阿莫西林所致SJS病史的患者发生美罗培南诱发SJS的病例。文献中报道的与碳青霉烯类交叉反应的病例很少，但基于可能出现危及生命的反应，对于有SJS、TEN病史或对其他β-内酰胺类抗生素有任何其他严重皮肤不良反应的患者，避免使用任何β-内酰胺类抗生素可能是谨慎的做法。
