In the treatment of patients with severe drug eruption such as Stevens-Johnson syndrome and toxic epidermal necrosis (TEN), it is important to prohibit the use of suspected drugs. However, the use of antibiotics for severe infection diseases is unavoidable, even when an antibiotic is the suspected drug. In such a case, it is necessary for rapid and discreet determination of antibiotic selection.
A 61-year-old patient was hospitalized with TEN suspected to be caused by ceftriaxone or loxoprofen. He had been treated with levofloxacin for primate pneumonia and daptomycin for epidermal necrosis and peeling spanning the whole body in the intensive care unit (ICU). However, his lung oxygenation capacity rapidly deteriorated while respiratory therapy was performed using a respirator. We diagnosed him with ventilator-associated pneumonia (VAP) by considering his clinical situation, including X-ray results and bronchoscopy findings. Then we changed the antibiotics to aztreonam for Pseudomonas aeruginosa and vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) based on the results of the Gram stain of his sputum. In the next day, his lung oxygenation capacity was improved. After five days, MRSA and Corynebacterium were detected from the sputum and the Pseudomonas aeruginosa culture test was negative. Thus we decided to discontinue aztreonam. Consequently both TEN and VAP improved.
Through this case we were able to confirm that you must firstly consider the clinical conditions of the patient and his medical history, and then the results of microbe culture tests and drug sensitivity tests accordingly in the case of such a severe drug eruption.
