Onset of Hemophagocytic Lymphohistiocytosis during Piperacillin-Tazobactam Therapy in Three Children with Acute Focal Bacterial Nephritis
| Autor: | Yusaku Tazawa, Setsuko Kitaoka, Yo-hei Watanabe, Atsushi Sato, Satoru Kumaki, Hiroki Miyabayashi, Masue Imaizumi, Rie Noguchi, Takaya Metoki, Taiki Sato, Ryoichi Onuma |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Urinary system Antibiotics Penicillanic Acid Gastroenterology Lymphohistiocytosis Hemophagocytic General Biochemistry Genetics and Molecular Biology 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Immune system Bone Marrow Internal medicine medicine Humans 030212 general & internal medicine Child Abscess Histiocyte Piperacillin Hemophagocytic lymphohistiocytosis Nephritis business.industry General Medicine medicine.disease Piperacillin Tazobactam Drug Combination Amikacin Child Preschool Acute Disease Piperacillin/tazobactam Female Tomography X-Ray Computed business medicine.drug |
| Zdroj: | The Tohoku Journal of Experimental Medicine. 245:55-59 |
| ISSN: | 1349-3329 0040-8727 |
| Popis: | Hemophagoytic lymphohistiocytosis (HLH) is a rare life-threatening disorder caused by overactivation of the immune system, associated with infections, autoimmune disorders, and malignancies. The pathological hallmark of HLH is phagocytosis of blood cells and platelets by activated macrophages and histiocytes. In this report, we describe the onset of HLH in three children, aged 2, 5 and 7 years old, during the treatment of acute focal bacterial nephritis (AFBN) with an antibiotic, piperacillin-tazobactam (PIPC-TAZ). AFBN is acute localized bacterial infection of the kidney without abscess formation. PIPC-TAZ was chosen for the treatment of AFBN, because it not only has indications for complicated urinary tract infections, but also covers most of the causative bacteria of urinary tract infections, including β-lactamase-producing Escherichia coli. The clinical courses of the three patients were similar, and they were treated with PIPC-TAZ and amikacin (AMK) for AFBN. Fever went down 2 to 5 days later, and AMK was discontinued by day 6. However, fever recurred on 13 to 15 days after introduction of PIPC-TAZ therapy, even though all of the patients had no signs of recurrence of AFBN. The clinical features and laboratory tests of two patients fulfilled the criteria of HLH, whereas the other patient had initiated therapy before fulfilling the criteria. Cessation of PIPC-TAZ combined with corticosteroid therapy improved clinical symptoms. HLH of our patients was probably induced by PIPC-TAZ, as judged by the timing of the onset of HLH and the positivity of the drug-lymphocyte stimulation test. In conclusion, prolonged antibiotic therapy with PIPC-TAZ could be a cause of HLH. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|