{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T08:23:36Z","timestamp":1765268616584,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,27]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered variants of a disease continuum that results in a life-threatening exfoliative mucocutaneous disease. These are categorised as type IV cell-mediated delayed hypersensitivity reactions, and antibiotics are often implicated as a cause. Penicillins and other beta-lactam antibiotics are known to cause both immediate and delayed hypersensitivity reactions. While immediate IgE-mediated cross-reactivity between penicillins and carbapenems is well studied, less information on the risk of type IV delayed cell-mediated cross-reactivity between the two is available. We present a case of meropenem-induced SJS in a patient with documented history of SJS from amoxicillin. There are few cases of cross-reactivity with carbapenems reported in the literature, but based on the potential for life-threatening reaction, it is likely prudent to avoid the use of any beta-lactams in a patient with a history of SJS, TEN or any other severe cutaneous adverse reactions to another beta-lactam antibiotic.<\/jats:p>","DOI":"10.1136\/bcr-2019-230144","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T05:55:19Z","timestamp":1566366919000},"page":"e230144","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Meropenem-induced Stevens-Johnson syndrome\/toxic epidermal necrolysis in a patient with known type IV penicillin hypersensitivity"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3166-9674","authenticated-orcid":false,"given":"Muhammad","family":"Sameed","sequence":"first","affiliation":[{"name":"Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Nwaiser","sequence":"additional","affiliation":[{"name":"Medical School, American University of Antigua College of Medicine, Osbourn, Antigua and Barbuda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prashant","family":"Bhandari","sequence":"additional","affiliation":[{"name":"Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah A","family":"Schmalzle","sequence":"additional","affiliation":[{"name":"Infectious Diseases, University of Maryland, Baltimore, Maryland, USA"},{"name":"Infectious Disease, Institute of Human Virology, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,20]]},"reference":[{"key":"2025082723271376000_12.8.e230144.1","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1016\/j.jaip.2017.06.017","article-title":"The 3 Cs of Antibiotic Allergy-Classification, Cross-Reactivity, and Collaboration","volume":"5","author":"Trubiano","year":"2017","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025082723271376000_12.8.e230144.2","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1001\/jama.2018.19283","article-title":"Evaluation and Management of Penicillin Allergy: A Review","volume":"321","author":"Shenoy","year":"2019","journal-title":"JAMA"},{"key":"2025082723271376000_12.8.e230144.3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu126"},{"key":"2025082723271376000_12.8.e230144.4","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1993.01680220104023"},{"key":"2025082723271376000_12.8.e230144.5","doi-asserted-by":"crossref","first-page":"642","DOI":"10.4103\/0378-6323.168328","article-title":"Tacrolimus for treatment of toxic epidermal necrolysis","volume":"81","author":"Dogra","year":"2015","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"2025082723271376000_12.8.e230144.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2012.12.009"},{"key":"2025082723271376000_12.8.e230144.7","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jid.5701033"},{"key":"2025082723271376000_12.8.e230144.8","doi-asserted-by":"publisher","DOI":"10.1177\/2042098611404094"},{"key":"2025082723271376000_12.8.e230144.9","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2009.252"},{"key":"2025082723271376000_12.8.e230144.10","unstructured":"Wilmington DE . MERREM IV (meropenem) [package insert]. \u00a0AstraZeneca Pharmaceuticals LP."},{"key":"2025082723271376000_12.8.e230144.11","unstructured":"Titusville NJ . DORIBAX (doripenem for injection) [package insert]. Janssen Pharmaceuticals, Inc. 2007."},{"key":"2025082723271376000_12.8.e230144.12","unstructured":"PRIMAXIN (imipenem and cilastin) for injection, for intravenous use [package insert]. Whitehouse Station NJ. Merck Sharp and Dohme Corp., a subsidiary of Merck & Co., Inc. 2016."},{"key":"2025082723271376000_12.8.e230144.13","first-page":"1","article-title":"The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China","volume":"2018","author":"Yang","year":"2018","journal-title":"Journal of Immunology Research Hindawi"},{"key":"2025082723271376000_12.8.e230144.14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.14205\/2310-6980.2014.02.01.2","article-title":"Case Report: Stevens-Johnson Syndrome from Ertapenem","volume":"2","author":"Ragunathan","year":"2014","journal-title":"Global Journal of Immunology and Allergic Diseases"},{"key":"2025082723271376000_12.8.e230144.15","doi-asserted-by":"crossref","first-page":"2580","DOI":"10.1097\/00003246-200211000-00029","article-title":"Recurrent fatal drug-induced toxic epidermal necrolysis (Lyell\u2019s syndrome) after putative beta-lactam cross-reactivity: Case report and scrutiny of antibiotic imputability","volume":"30","author":"Paquet","year":"2002","journal-title":"Crit Care Med"},{"issue":"Suppl 3","key":"2025082723271376000_12.8.e230144.16","doi-asserted-by":"crossref","first-page":"P92","DOI":"10.1186\/2045-7022-4-S3-P92","article-title":"New insights in Stevens Johnson syndrome\/ toxic epidermal necrolysis syndrome","volume":"4","author":"Schroeder","year":"2014","journal-title":"Clin Transl Allergy"},{"key":"2025082723271376000_12.8.e230144.17","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1111\/j.1398-9995.2009.02058.x","article-title":"Cross-reactivity and tolerability of imipenem in patients with delayed-type, cell-mediated hypersensitivity to beta-lactams","volume":"64","author":"Schiavino","year":"2009","journal-title":"Allergy"},{"key":"2025082723271376000_12.8.e230144.18","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1111\/all.12299","article-title":"Absence of cross-reactivity to carbapenems in patients with delayed hypersensitivity to penicillins","volume":"68","author":"Romano","year":"2013","journal-title":"Allergy"},{"key":"2025082723271376000_12.8.e230144.19","doi-asserted-by":"crossref","unstructured":"Diao M , Thapa C , Ran X , et al . A retrospective analysis of infections and antibiotic treatment in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. J Dermatolog Treat 2018:1\u201319.doi:10.1080\/09546634.2018.1509047","DOI":"10.1080\/09546634.2018.1509047"},{"key":"2025082723271376000_12.8.e230144.20","first-page":"46","volume-title":"Recommendations for the Management of Beta-Lactam Intolerance. 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