D'Errico Stefano, Frati Paola, Zanon Martina, Valentinuz Eleonora, Manetti Federico, Scopetti Matteo, Santurro Alessandro, Fineschi Vittorio
Department of Medicine, Surgery and Health, University of Trieste, 34149 Trieste, Italy.
Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Antibiotics (Basel). 2020 Apr 25;9(5):209. doi: 10.3390/antibiotics9050209.
Antibiotic cross-reactivity represents a phenomenon of considerable interest as well as antibiotic resistance. Immediate reactions to cephalosporins are reported in the literature with a prevalence of only 1%-3% of the population, while anaphylactic reactions are rarely described (approximately 0.0001%-0.1%) as well as fatalities. Allergic reaction to cephalosporins may occur because of sensitization to unique cephalosporin haptens or to determinants shared with penicillins. Cross-reactivity between cephalosporins represents, in fact, a well-known threatening event involving cephalosporins with similar or identical R1- or R2-side chains. The present report describes the case of a 79-year-old man who suddenly died after intramuscular administration of ceftriaxone. Serum dosage of mast cell tryptase from a femoral blood sample at 3 and 24 hours detected values of 87.7μg/L and 93.5μg/L, respectively (cut-off value 44.3 μg/L); the serum-specific IgE for penicillins, amoxicillin, cephaclor and also for the most common allergens were also determined. A complete post-mortem examination was performed, including gross, histological and immunohistochemical examination, with an anti-tryptase antibody. The cause of death was identified as anaphylactic shock: past administrations of cefepime sensitized the subject to cephalosporins and a fatal cross-reactivity of ceftriaxone with cefepime occurred due to the identical seven-position side chain structure in both molecules. The reported case offers food for thought regarding the study of cross-reactivity and the need to clarify the predictability and preventability of the phenomenon in fatal events.
抗生素交叉反应性是一个备受关注的现象，与抗生素耐药性一样。文献报道，对头孢菌素的即刻反应在人群中的发生率仅为1%-3%，而过敏反应很少被描述（约0.0001%-0.1%），死亡情况也很少见。对头孢菌素的过敏反应可能是由于对独特的头孢菌素半抗原或与青霉素共有的决定簇致敏所致。事实上，头孢菌素之间的交叉反应是一个众所周知的危险事件，涉及具有相似或相同R1或R2侧链的头孢菌素。本报告描述了一名79岁男性在肌内注射头孢曲松后突然死亡的病例。在3小时和24小时从股静脉血样本中检测肥大细胞类胰蛋白酶的血清剂量，分别检测到87.7μg/L和93.5μg/L（临界值44.3μg/L）；还测定了针对青霉素、阿莫西林、头孢克洛以及最常见过敏原的血清特异性IgE。进行了完整的尸检，包括大体检查、组织学检查和免疫组织化学检查，使用抗类胰蛋白酶抗体。死亡原因被确定为过敏性休克：既往使用头孢吡肟使该患者对头孢菌素致敏，由于两种分子中相同的7位侧链结构，头孢曲松与头孢吡肟发生了致命的交叉反应。该报告病例为交叉反应性研究以及明确该现象在致命事件中的可预测性和可预防性提供了思考。
