Toxic epidermal necrolysis possibly linked to aztreonam in bone marrow transplant patients.
OBJECTIVE
After instituting aztreonam as part of antibiotic prophylaxis in bone marrow transplant (BMT) patients at the Seattle Department of Veterans Affairs Medical Center, the first two cases of toxic epidermal necrolysis (TEN) occurred in more than 250 BMT patients at this center. We have examined the possible cause-and-effect relationship between aztreonam and TEN.


METHODS
The first patient was a 23-year-old man with acute lymphocytic leukemia receiving a BMT from a related mismatched donor. He experienced profound conjunctivitis and superficial bulla covering 60 percent of his body surface area (BSA). The second patient, a 32-year-old man with lymphoma, received a BMT from a matched unrelated donor. He exhibited lymphocytosis, acute conjunctivitis, and bullous lesions covering 60 percent of his BSA.


METHODS
Aztreonam was discontinued in both patients. The first patient was treated with pigskin grafting and the second was treated with topical silver sulfadiazine.


RESULTS
Despite stabilization of symptoms, both patients eventually died of infectious complications.


CONCLUSIONS
Histological data in both patients were more consistent with TEN than graft-versus-host disease (GVHD) in that dermal infiltrates were sparse or absent. The onset of cutaneous symptoms was of more acute onset than acute GVHD, and ocular complaints are uncommon in acute GVHD. Furthermore, the onset of TEN bore a closer temporal relationship to aztreonam than to other drugs administered.
McDonald
B J
BJ
Bone Marrow Transplant Unit, Department of Veterans Affairs Medical Center, Seattle, WA 98108.
Singer
J W
JW
Bianco
J A
JA
D000328:Adult; D001398:Aztreonam / Q000009:adverse effects*; D001424:Bacterial Infections / Q000517:prevention & control; D016026:Bone Marrow Transplantation; D006086:Graft vs Host Disease / Q000150:complications / Q000517:prevention & control; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D013262:Stevens-Johnson Syndrome / Q000209:etiology*; D014916:Whole-Body Irradiation
D001398:Aztreonam