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Case Reports
. 2024 Sep 23;19(1):542.
doi: 10.1186/s13019-024-03025-x.

Toxic epidermal necrolysis following heart transplantation may caused by cefoperazone sodium and sulbactam sodium

Zeng Xiaodong  1 , Wu Min  2 , Lei Liming  1 , Huang Jinsong  2 , Qi Xiao  2 , Liang Yuemei  3 , Wu Yijin  4
Affiliations
Case Reports

Toxic epidermal necrolysis following heart transplantation may caused by cefoperazone sodium and sulbactam sodium

Zeng Xiaodong et al. J Cardiothorac Surg. .

Abstract

Background: The outcome of heart transplantation is significantly affected by perioperative infections. Individualised immunosuppression strategies are essential to reduce the risk of such infections.

Case presentation: We report the successful management of a 56-year-old male patient diagnosed with dilated cardiomyopathy who underwent heart transplantation. During the perioperative period, the patient was prescribed cefoperazone sodium and sulbactam sodium, which induced a severe skin reaction: toxic epidermal necrolysis (TEN). The patient was treated with prednisone, immunoglobulins, etanercept, and other active immunomodulatory measures, together with an individualised anti-rejection regimen and physical therapy. The systemic rash resolved within a month, and the patient was successfully discharged after surgery.

Conclusion: Effective management of heart transplantation necessitates balancing immunosuppression and infection prevention. Individualised immunosuppressive strategies are critical for optimal clinical outcomes.

Keywords: Cefoperazone sodium and sulbactam sodium; Drug-induced dermatitis; Heart transplantation; Immunosuppression; Toxic epidermal necrolysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasound Doppler before (A) and after(B) heart transplantation. LV: left ventricle; LA: left atrium; RV: right ventricle; RA: right atrium; RVOT: right ventricular outflow tract; AAO: ascending aorta; LVEF: left ventricular ejection fraction
Fig. 2
Fig. 2
Timeline
Fig. 3
Fig. 3
Skin symptoms in patients with toxic epidermal necrolysis. (D0) Rash all over the body. (D3) Exfoliation of skin on the back. (D6) and (D12) Treatment and recovery of patient with toxic epidermal necrolysis. (D20) Skin rash all over the body improved significantly
Fig. 4
Fig. 4
Main therapeutic drugs for toxic epidermal necrolysis at various times after heart transplantation: In the early postoperative period, prednisone, immunoglobulin, and etanercept were used, and in the later period, immunoglobulin was mainly used in combination with low-dose prednisone
Fig. 5
Fig. 5
Immunosuppression strategies after heart transplantation: In the early postoperative period, prednisone and mycophenolate mofetil were used. According to the immune status, the dosage of prednisone was slowly reduced, the dosage of mycophenolate mofetil was slowly increased, and tacrolimus was added in the later stage
See this image and copyright information in PMC

References

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