title: Fatal toxic epidermal necrolysis and severe granulocytopenia following therapy with cefuroxime.
abstract: Toxic epidermal necrolysis (TEN) is one of the most threatening adverse reactions to various drugs. No case of concomitant occurrence TEN and severe granulocytopenia following the treatment with cefuroxime has been reported to date. Herein we present a case of TEN that developed eighteen days of the initiation of cefuroxime axetil therapy for urinary tract infection in a 73-year-old woman with chronic renal failure and no previous history of allergic diathesis. The condition was associated with severe granulocytopenia and followed by gastrointestinal hemorrhage, severe sepsis and multiple organ failure syndrome development. Despite intensive medical treatment the patient died. The present report underlines the potential of cefuroxime to simultaneously induce life threatening adverse effects such as TEN and severe granulocytopenia. Further on, because the patient was also taking furosemide for chronic renal failure, the possible unfavorable interactions between the two drugs could be hypothesized. Therefore, awareness of the possible drug interaction is necessary, especially when given in conditions of their altered pharmacokinetics as in case of chronic renal failure.
authors.affiliation: University Department of Medicine, Dubrava University Hospital, Avenija Gojka Suska 6, Zagreb, Croatia. ivica.grgurevic@zg.htnet.hr
authors.forename: Ivica
authors.initials: I
authors.lastname: Grgurević
authors.forename: Vlatko
authors.initials: V
authors.lastname: Pejsa
authors.forename: Jadranka
authors.initials: J
authors.lastname: Morović-Vergles
authors.forename: Ivan
authors.initials: I
authors.lastname: Dobrić
authors.forename: Vladimir
authors.initials: V
authors.lastname: Gasparović
authors.forename: Neven
authors.initials: N
authors.lastname: Tudorić
mesh_terms: D000368:Aged; D000380:Agranulocytosis / Q000139:chemically induced* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002444:Cefuroxime / Q000009:adverse effects / Q000031:analogs & derivatives*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D013262:Stevens-Johnson Syndrome / Q000209:etiology* / Q000628:therapy; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime; C040738:cefuroxime axetil