First Case of Symmetric Drug-Related Intertriginous and Flexural Exanthema Induced by Meropenem.

Abstract

No residual lesions were observed. She subsequently tolerated linezolid. Skin biopsy of a macular lesion revealed superficial perivascular dermatitis of unspecific characteristics with a lymphocytic perivascular infiltrate limited to the epidermis. Eight weeks later, despite strict recommendations to avoid β-lactams, the patient took amoxicillin-clavulanic acid for a week with no adverse reactions. A detailed medical history compiled in the allergy department did not show any latex allergy or atopic disease. Written informed consent was obtained, and patch tests were performed with penicillin (10%), meropenem, ertapenem, and imipenem (5%). Readings at 48 and 96 hours yielded negative results. Skin prick tests (SPTs) and intradermal tests (IDTs) with immediate and delayed readings with benzylpenicilloyl octa-L-lysine, benzylpenilloate, penicillin, imipenem, and ertapenem yielded negative results. SPT with meropenem (100 mg/mL) was negative, whereas IDT with meropenem (1 mg/mL) became positive at 48 hours (Figure). All skin tests were performed on an area of previously inflamed skin. Given that the patient met the 5 clinical criteria [2] and had positive skin test results to meropenem, she was diagnosed with meropenem-induced SDRIFE, and carbapenems were forbidden. The positive result in the delayed IDT reading and the histopathological findings point to a type 4 hypersensitivity mechanism, as reported elsewhere [4,5]. First Case of Symmetric Drug-Related Intertriginous and Flexural Exanthema Induced by Meropenem