{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:16:57Z","timestamp":1787026617502,"version":"build-2736575974"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Managing complex infections after immunotherapy in patients with advanced head and neck cancer is clinically challenging, especially when severe adverse drug reactions like carbapenem hypersensitivity and tigecycline-associated coagulopathy further limit treatment options. This case demonstrates the potential contribution of clinical pharmacists in such difficult scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 74-year-old man with oral squamous cell carcinoma developed severe sepsis after one cycle of PD-1 inhibitor (penpulimab) plus EGFR inhibitor (cetuximab). The clinical pharmacist sequentially recommended escalation to meropenem, switch to piperacillin-tazobactam, and addition of vancomycin. Later, the pharmacist recognized possible imipenem-related central nervous system effects, leading to discontinuation of all carbapenems due to possible cross-hypersensitivity. Subsequently, tigecycline was initiated, its associated coagulopathy was managed, and a switch to doxycycline was made.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient\u2019s fever resolved, and coagulation substantially improved; the infection was finally controlled. Causality was assessed using the Naranjo scale (imipenem 7, meropenem 5) and the RUCAM scale (penpulimab 6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this case, the clinical pharmacist\u2019s dynamic assessment and use of quantitative adverse reaction tools (Naranjo and RUCAM scales) contributed to successful infection control and management of drug toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1863232","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T04:24:59Z","timestamp":1782793499000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: A case of carbapenem hypersensitivity and tigecycline-associated coagulopathy after immunotherapy for advanced oral cancer"],"prefix":"10.3389","volume":"13","author":[{"given":"Yifei","family":"Peng","sequence":"first","affiliation":[{"name":"Leshan Hospital of Traditional Chinese Medicine, Affiliated to Chengdu University of Traditional Chinese Medicine","place":["Leshan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Peng","sequence":"additional","affiliation":[{"name":"Leshan Hospital of Traditional Chinese Medicine, Affiliated to Chengdu University of Traditional Chinese Medicine","place":["Leshan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4073","DOI":"10.1200\/JCO.21.01440","article-title":"Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update","volume":"39","author":"Schneider","year":"2021","journal-title":"J 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