Inhaled tobramycin solution-associated recurrent eosinophilia and severe persistent bronchospasm in a patient with cystic fibrosis: a case report.
BACKGROUND
Delivery of tobramycin by inhalation to the lungs of patients with cystic fibrosis (CF) who are infected with Pseudomonas aeruginosa has been proven to be effective and safe. The aerosol administration allows high concentrations of tobramycin to be delivered to the site of infection with limited systemic absorption. In rare patients, systemic absorption of inhaled tobramycin may be significant enough to produce toxic effects, such as renal and vestibular toxicities.


METHODS
We report a patient with CF who developed recurrent eosinophilia and severe persistent bronchospasm following repeated administration of preservative-free tobramycin by inhalation, beginning at 16 months of age. Also, he developed similar signs and symptoms when he was administered tobramycin intravenously on one occasion at 5 1/2 years. The patient had a history of environmental allergies. Temporal sequence of his signs and symptoms after each administration of tobramycin (similar to re-challenge testing), and his improvement after discontinuation of the drug strongly suggest an adverse drug reaction.


CONCLUSIONS
Hypersensitivity reaction should be considered in patients who develop recurrent eosinophilia and deterioration of pulmonary function following the use of tobramycin by inhalation or by intravenous administration.
Santos
Roberto P
RP
Department of Pediatrics, University Hospital, State University of New York Upstate Medical University, Syracuse, New York 13210, USA. Roberto.Santos@UTSouthwestern.edu <Roberto.Santos@UTSouthwestern.edu>
Awa
Emad
E
Anbar
Ran D
RD
D000280:Administration, Inhalation; D001986:Bronchial Spasm / Q000139:chemically induced* / Q000188:drug therapy; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D011241:Prednisone / Q000627:therapeutic use; D011657:Pulmonary Eosinophilia / Q000139:chemically induced* / Q000503:physiopathology; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects*
D011241:Prednisone; D014031:Tobramycin