A Failure of Rapid Drug Desensitization
ABSTRACT We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxy...
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| Veröffentlicht in: | Military medicine 2023-01, Vol.188 (1-2), p.e421-e425 |
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| container_issue | 1-2 |
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| container_title | Military medicine |
| container_volume | 188 |
| creator | Prewitt, Benjamin S Mendoza, Jun C Coop, Christopher A Weiss, Samuel Quinn, James M |
| description | ABSTRACT
We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxycycline allergy, shellfish allergy, and untreated latent syphilis presented to the emergency room for a posterior migraine with associated nausea, vomiting, photophobia, right-sided paresthesias, and “shaky” vision. He was diagnosed with neurosyphilis and underwent rapid drug desensitization with the goal to receive a continuous infusion of PCN G. The patient’s hospital course was complicated by intermittent drug reactions consisting of tachycardia, rash, and dyspnea, followed by periods of being able to tolerate the infusion. After being able to tolerate the recommended dose of PCN infusion, the patient was discharged home to complete the course. However, he returned almost immediately after a recurrence of symptoms at home requiring the use of intramuscular epinephrine. Ultimately, the patient was transitioned to ceftriaxone and completed the infusion course as an inpatient because of continued intermittent recurrence of drug reaction symptoms. |
| doi_str_mv | 10.1093/milmed/usab112 |
| format | Article |
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We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxycycline allergy, shellfish allergy, and untreated latent syphilis presented to the emergency room for a posterior migraine with associated nausea, vomiting, photophobia, right-sided paresthesias, and “shaky” vision. He was diagnosed with neurosyphilis and underwent rapid drug desensitization with the goal to receive a continuous infusion of PCN G. The patient’s hospital course was complicated by intermittent drug reactions consisting of tachycardia, rash, and dyspnea, followed by periods of being able to tolerate the infusion. After being able to tolerate the recommended dose of PCN infusion, the patient was discharged home to complete the course. However, he returned almost immediately after a recurrence of symptoms at home requiring the use of intramuscular epinephrine. Ultimately, the patient was transitioned to ceftriaxone and completed the infusion course as an inpatient because of continued intermittent recurrence of drug reaction symptoms.</description><identifier>ISSN: 0026-4075</identifier><identifier>EISSN: 1930-613X</identifier><identifier>DOI: 10.1093/milmed/usab112</identifier><identifier>PMID: 33748854</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adult ; Ceftriaxone - therapeutic use ; Drug Hypersensitivity - complications ; Drug Hypersensitivity - diagnosis ; Drug-Related Side Effects and Adverse Reactions - complications ; Humans ; Hypersensitivity - complications ; Male ; Neurosyphilis - complications ; Neurosyphilis - diagnosis ; Neurosyphilis - drug therapy ; Penicillins - therapeutic use</subject><ispartof>Military medicine, 2023-01, Vol.188 (1-2), p.e421-e425</ispartof><rights>Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US. 2021</rights><rights>Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-17247ff9660d5f1ea887834a77756037b9c68c6efd7bc3841bb00880ccce683c3</citedby><cites>FETCH-LOGICAL-c397t-17247ff9660d5f1ea887834a77756037b9c68c6efd7bc3841bb00880ccce683c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33748854$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Prewitt, Benjamin S</creatorcontrib><creatorcontrib>Mendoza, Jun C</creatorcontrib><creatorcontrib>Coop, Christopher A</creatorcontrib><creatorcontrib>Weiss, Samuel</creatorcontrib><creatorcontrib>Quinn, James M</creatorcontrib><title>A Failure of Rapid Drug Desensitization</title><title>Military medicine</title><addtitle>Mil Med</addtitle><description>ABSTRACT
We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxycycline allergy, shellfish allergy, and untreated latent syphilis presented to the emergency room for a posterior migraine with associated nausea, vomiting, photophobia, right-sided paresthesias, and “shaky” vision. He was diagnosed with neurosyphilis and underwent rapid drug desensitization with the goal to receive a continuous infusion of PCN G. The patient’s hospital course was complicated by intermittent drug reactions consisting of tachycardia, rash, and dyspnea, followed by periods of being able to tolerate the infusion. After being able to tolerate the recommended dose of PCN infusion, the patient was discharged home to complete the course. However, he returned almost immediately after a recurrence of symptoms at home requiring the use of intramuscular epinephrine. Ultimately, the patient was transitioned to ceftriaxone and completed the infusion course as an inpatient because of continued intermittent recurrence of drug reaction symptoms.</description><subject>Adult</subject><subject>Ceftriaxone - therapeutic use</subject><subject>Drug Hypersensitivity - complications</subject><subject>Drug Hypersensitivity - diagnosis</subject><subject>Drug-Related Side Effects and Adverse Reactions - complications</subject><subject>Humans</subject><subject>Hypersensitivity - complications</subject><subject>Male</subject><subject>Neurosyphilis - complications</subject><subject>Neurosyphilis - diagnosis</subject><subject>Neurosyphilis - drug therapy</subject><subject>Penicillins - therapeutic use</subject><issn>0026-4075</issn><issn>1930-613X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkM9LwzAUx4Mobk6vHqXgQT10S_rSJD2OzakwEETBW0jTVCL9ZdIc9K-3o9vFi6cHj8_3-x4fhC4JnhOcwaK2VW2KRfAqJyQ5QlOSAY4ZgfdjNMU4YTHFPJ2gM-8_MSY0E-QUTQA4FSKlU3SzjDbKVsGZqC2jF9XZIlq78BGtjTeNt739Ub1tm3N0UqrKm4v9nKG3zf3r6jHePj88rZbbWEPG-5jwhPKyzBjDRVoSo4TgAqjinKcMA88zzYRmpix4rkFQkucYC4G11oYJ0DBDt2Nv59qvYHwva-u1qSrVmDZ4maQYGKOcwoBe_0E_2-Ca4TsJOAVISTKcnKH5SGnXeu9MKTtna-W-JcFyp1COCuVe4RC42teGfLc_4AdnA3A3Am3o_iv7BYpIejI</recordid><startdate>20230104</startdate><enddate>20230104</enddate><creator>Prewitt, Benjamin S</creator><creator>Mendoza, Jun C</creator><creator>Coop, Christopher A</creator><creator>Weiss, Samuel</creator><creator>Quinn, James M</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20230104</creationdate><title>A Failure of Rapid Drug Desensitization</title><author>Prewitt, Benjamin S ; Mendoza, Jun C ; Coop, Christopher A ; Weiss, Samuel ; Quinn, James M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-17247ff9660d5f1ea887834a77756037b9c68c6efd7bc3841bb00880ccce683c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Ceftriaxone - therapeutic use</topic><topic>Drug Hypersensitivity - complications</topic><topic>Drug Hypersensitivity - diagnosis</topic><topic>Drug-Related Side Effects and Adverse Reactions - complications</topic><topic>Humans</topic><topic>Hypersensitivity - complications</topic><topic>Male</topic><topic>Neurosyphilis - complications</topic><topic>Neurosyphilis - diagnosis</topic><topic>Neurosyphilis - drug therapy</topic><topic>Penicillins - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Prewitt, Benjamin S</creatorcontrib><creatorcontrib>Mendoza, Jun C</creatorcontrib><creatorcontrib>Coop, Christopher A</creatorcontrib><creatorcontrib>Weiss, Samuel</creatorcontrib><creatorcontrib>Quinn, James M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Military medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Prewitt, Benjamin S</au><au>Mendoza, Jun C</au><au>Coop, Christopher A</au><au>Weiss, Samuel</au><au>Quinn, James M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Failure of Rapid Drug Desensitization</atitle><jtitle>Military medicine</jtitle><addtitle>Mil Med</addtitle><date>2023-01-04</date><risdate>2023</risdate><volume>188</volume><issue>1-2</issue><spage>e421</spage><epage>e425</epage><pages>e421-e425</pages><issn>0026-4075</issn><eissn>1930-613X</eissn><abstract>ABSTRACT
We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxycycline allergy, shellfish allergy, and untreated latent syphilis presented to the emergency room for a posterior migraine with associated nausea, vomiting, photophobia, right-sided paresthesias, and “shaky” vision. He was diagnosed with neurosyphilis and underwent rapid drug desensitization with the goal to receive a continuous infusion of PCN G. The patient’s hospital course was complicated by intermittent drug reactions consisting of tachycardia, rash, and dyspnea, followed by periods of being able to tolerate the infusion. After being able to tolerate the recommended dose of PCN infusion, the patient was discharged home to complete the course. However, he returned almost immediately after a recurrence of symptoms at home requiring the use of intramuscular epinephrine. Ultimately, the patient was transitioned to ceftriaxone and completed the infusion course as an inpatient because of continued intermittent recurrence of drug reaction symptoms.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33748854</pmid><doi>10.1093/milmed/usab112</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Adult Ceftriaxone - therapeutic use Drug Hypersensitivity - complications Drug Hypersensitivity - diagnosis Drug-Related Side Effects and Adverse Reactions - complications Humans Hypersensitivity - complications Male Neurosyphilis - complications Neurosyphilis - diagnosis Neurosyphilis - drug therapy Penicillins - therapeutic use |
| title | A Failure of Rapid Drug Desensitization |
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