CASE REPORT
An 18-year-old male patient was treated for toxoplasma retinochoroiditis
with sulfasalazine, along one month. The patient had no past history of
allergies or drug intolerance. He presented in a local hospital with
fever, vomiting, cervical and inguinal nodules, abdominal pain, and
macular rash on all body. The patient was transferred to our Transplant
Center after onset of jaundice and encephalopathy. He was admited in
intensive care unit with facial edema, generalized scaling exanthema and
acute hepatitis. Serological tests for viral hepatitis and all
autoimmune antibodies were negative.
Laboratory
tests showed a total eosinophil count of 3220/mm3(normal, <500 mm3), high level of
transaminases (AST=1303 IU/L; ALT=1768 IU/L, lactate dehydrogenase level
of 2274 IU/L (normal, 240 to 480 IU/L), total bilirubin level of
18.47mg/dL, direct bilirubin level of 14.81mg/dL, prothrombin time (PT)
international normalized ratio (INR) of 5.18, and Factor V 17%.
Abddominal ultrasound examination identified no cronical liver disease.
The RegiSCAR7 system scored 5 points confirming the
diagnosis of DRESS. Skin biopsy observed Interface and spongiotic
dermatitis, consistent with drug eruption.
Therefore, the patient was worked up for urgent orthotopic liver
transplantation (OLT), which was performed 24 hours after admission. At
this time he was under
corticosteroids and clinical
support, including mechanic ventilation due progressive encephalopathy
and dyalisis due latic acydosis.
The orthotopic liver transplantation was uneventfull. Even though liver
function improved in postoperative period, the patient developed sepsis
requiring high doses of vasopressors. Broad-spectrum antibiotics were
introduced but patient remained hemodynamic unstable. The paitient died
at 7th postoperative day.
Blood cultures showed growth of aKlebsiella pneumoniae resistent to carbapenems.