Antibacterials

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 59-year-old man developed cutaneous leucocytoclastic vasculitis and a possible systemic vasculitis during treatment with amikacin, cefepime, gentamicin, linezolid, meropenem and piperacillin/tazobactam.

The man was hospitalised for a severe respiratory failure and required intubation for worsening of respiratory condition. Subsequently, antibiotic therapy was commenced comprising amikacin, cefepime, gentamicin, linezolid, meropenem along with piperacillin/tazobactam [dosages and routes not stated]. He was eventually diagnosed with COVID-19. His blood cell count showed severe eosinophilia, which eventually decreased after receiving off-label treatment with methylprednisolone 1 mg/kg/day for the COVID-19. On day 35 of hospitalisation, he developed symmetrically distributed maculopapular purpuric exanthema on the trunk, face and extremities. His mucous membranes were spared, without any lymphadenopathies. His laboratory tests resulted normal for liver function, and anti-neutrophil cytoplasmic antibody, cryoglobulins and antinuclear antibody were also found to be normal. Thereafter, his skin biopsy showed a superficial and deep perivascular neutrophilic infiltrate with sparse leucocytoclasis, red blood cell extravasation and fibrinoid necrosis of vessel walls. The histopathology report was consistent with a classical picture of leucocytoclastic vasculitis, and thus, a possibility of DRESS was ruled out. A drug-related cutaneous leucocytoclastic vasculitis and a possible systemic vasculitis was thus diagnosed. It was finally concluded that, the COVID-19 infection might have triggered the drug-related cutaneous leucocytoclastic vasculitis and possibly systemic vasculitis in this patient [durations of treatments to reactions onsets and outcomes not stated].