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.