Rigamonti Elia, Bedussi Francesca, Blanc Jerome, Gianella Pietro, Vanini Gianluca
Service of Internal Medicine, Ospedale Regionale di Lugano (Italiano), Ente Ospedaliero Cantonale, Lugano, Switzerland.
Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland.
Eur J Case Rep Intern Med. 2020 Mar 5;7(4):001464. doi: 10.12890/2020_001464. eCollection 2020.
We present a case of an 85-year-old woman diagnosed with uncomplicated pyelonephritis, who was treated with intravenous ceftriaxone. Her chronic medications were phenprocoumon, diltiazem and bisoprolol. During the infectious phase, the patient presented tachycardia - despite high-dose beta-blocker treatment - and developed left acute heart failure, with acute renal failure (pre-renal origin). After introduction of furosemide diuretic therapy, clinical conditions improved and better control of the volemic status and heart rate was achieved. Several days after ceftriaxone and digoxin therapy initiation, worsening multiple non-blanching palpable purpuric lesions with bullae and papules, limited to the lower extremities, were noted. Skin biopsy was performed and a diagnosis of leucocytoclastic vasculitis, with associated panniculitis, was made. Ceftriaxone was discontinued and systemic corticosteroids were introduced, with a clear improvement in the cutaneous condition.
Leucocytoclastic vasculitis is a rare but significant side effect related to the administration of ceftriaxone.The importance of skin biopsy in the differential diagnosis of skin eruptions.
我们报告一例85岁女性，诊断为非复杂性肾盂肾炎，接受静脉注射头孢曲松治疗。她的长期用药包括苯丙香豆素、地尔硫䓬和比索洛尔。在感染阶段，尽管进行了高剂量β受体阻滞剂治疗，患者仍出现心动过速，并发展为左心急性心力衰竭，伴有急性肾衰竭（肾前性）。在引入呋塞米利尿治疗后，临床状况改善，血容量状态和心率得到更好控制。在开始使用头孢曲松和地高辛治疗几天后，发现双下肢出现多个非苍白性可触及的紫癜性病变，并伴有大疱和丘疹，且病变不断恶化。进行了皮肤活检，诊断为白细胞破碎性血管炎，并伴有脂膜炎。停用头孢曲松并引入全身性皮质类固醇后，皮肤状况明显改善。
白细胞破碎性血管炎是与头孢曲松给药相关的一种罕见但重要的副作用。皮肤活检在皮疹鉴别诊断中的重要性。
