Nowadays, adverse reactions incidence by aminopenicillins is increasing due to the high use of these antibiotics . Most of them described reactions are inmediate . Delayed reactions are rare.
CASE REPORT
We report a case 49 years old man who was referred to unit to drug allergy study. One month before, he was treated with Amoxycillin- Clavulanic acid, metamizol and paracetamol because of a soulder surgery. One week after treatment, he was showing skin itching and exanthema during a week. And a week after this episode had finished, he started desquamation in hands.
METHODS
Patch tests with Metamizol ( 1mg/ml), Paracetamol 10% pet and Amoxycillin – clavulanic acid 10% petOral challenge tests with Paracetamol ( 750 mg), Metamizol (575 mg) and Amoxycillin – clavulanic acid (750 mg)Oral challenge tests during 4 days with Paracetamol, Metamizol and Amoxycillin- Clavulanic acid with therapeutic doseSkin test ( prick and intradermal) with PPL, MDM, Penicillin G, Amoxycillin, Amoxycillin- clavulanic acid, Ampicillin, Ceftriaxone and Cefuroxime with immediate and delayed lecture were performed.Oral challenge test with Bencilpenicillin (650mg) and oral challenge during 4 days more with therapeutic dose.
RESULTS
Patch tests with Metamizol ( 1mg/ml), Paracetamol 10% and Amoxycillin – clavulanic acid 10% were negatives at 48 , 96 hours and 7 days readings.Oral challenge tests with Paracetamol ( 750 mg), Metamizol (575 mg) and Amoxycillin – clavulanic acid (750 mg) in unique dose were negatives.Oral challenge tests during 4 days with Paracetamol 650/8 hours and Metamizol 500mg?/8 hours: were negatives.Oral challenge during 4 days with Amoxycillin- Clavulanic acid (750mg/8 hours): was positive. One week after treatment had finished, he experienced a desquamation hands episode with a completed skin change.Skin test ( prick and intradermal) with PPL, MDM, Penicillin G, Amoxycillin, Amoxycillin- clavulanic acid, Ampicillin, Ceftriaxone and Cefuroxime gave positive intradermal reactions to Amoxycillin, Ampicillin and Amoxycillin – Clavulanic acid at 24 hours lecture.Oral challenge test with Bencilpenicillin (650mg) and oral challenge during 4 days with 400mg/8 hours were negatives.
CONCLUSIONS
We have presented a patient who experienced an episode of selective delayed hypersensitivity to Aminopenicillins with tolerance of other penicillins with different lateral chains.