Resumen de Possible DRESS syndrome in a child with borreliosis
R. Silva, C. Botelho, S. Cadinha, C. Lisboa, J.R. Cernadas
To the Editor, Antibiotic hypersensitivity reactions are a major health concern as they can be a significant cause of morbidity and mortality, limit therapeutic options, and increase socio-economic costs. Diagnosis can be challenging, as great number of drugs can elicit different immune-mediated reactions. A combination of clinical history and different tests is generally necessary to confirm the diagnosis, since none has sufficient sensitivity to be used alone.1 In some non-immediate hypersensitivity reactions, the lymphocyte transformation test (LTT), which measures the in vitro proliferation of T lymphocytes in the presence of a suspected drug, can be the only tool to confirm the diagnosis.2 We report the case of a previously healthy 34-month-old girl who due to fever and odynophagia (interpreted as tonsillitis), was treated with amoxicillin without improvement. Three days later she began treatment with cefaclor, without result. She was then given two shots of penicillin, one in each buttock, with apyrexia after 48h. Two weeks later, in the same location where penicillin was administered, two nodular inflammatory lesions appeared, with progressive worsening (Figure 1). Due to the severity of these lesions, she was admitted to local hospital. Shortly after, she developed fever and was submitted to a surgical intervention at her buttocks for drainage of suspected abscess (not confirmed). Due to deterioration of her general status and suspected infectious panniculitis, she was transferred to our Central Hospital, and began flucloxacillin and clindamycin. Three days later, a diffuse exanthema (including both soles) appeared and an allergist was called. Flucloxacillin was stopped and the...
