Female, extremely premature, with mild non-oxygen-dependent bronchopulmonary dysplasia and hyaline membrane disease requiring 2 doses of surfactant for its management.
The patient was hospitalized at 9 months of age for symptoms of viral pneumonia caused by adenovirus infection and mechanical ventilation (computerized dose 3, requiring non-invasive ventilation in the pediatric critical patient unit; cefletone IM dose 7 mg).
viculool exanthema associated with antibiotic treatment, twelfth day of hospitalization and fifth day after ceftriaxone suspension the patient presented isolated febrile rises up to 38 °C, without hemodynamic compromise.
The rash began on the trunk and involved the upper extremities and face; then it was confluent and generalized, adding a peeling and subsequent facial edema.
There was no mucosal involvement and palpable lymph nodes were found.
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Laboratory tests revealed a normal white blood cell count (5,910), with an increased absolute lymphocyte count 3,110 (normal value 1,2-3)N [VN] 2,0-40.5% (VN) (620.5/mm). (VN)
Elevated transaminases Increased bilirubin
The patient had negative blood cultures, normal renal function and chest X-ray findings consistent with viral pneumonia, without evident condensations.
The patient was evaluated by dermatology and classified as DRESS, probably secondary to ceftriaxone.
She was treated with prednisone at a dose of 1 mg/kg/day, antihistamines, topical skin lumps and low potency corticoids.
The patient recovered satisfactorily, with disappearance of the rash and correction of laboratory parameters (eosinophilia and liver tests).
Two weeks after discharge, the patient developed a maculopapular rash associated with feverish rises up to 38 °C, with no other symptoms.
Due to suspicion of reactivation of DRESS syndrome, she was hospitalized in the special care unit, where tests were controlled, among which stood out leukocytosis of 11,420 (VN 5.0-10.0) platelets with preserved kidney function 70.
In the context of a second hospitalization due to the clinical picture, a detailed diagnostic study was conducted, immunoglobulins G and M positive for cytomegalovirus.
Other viruses such as hepatitis B and C virus, human immunodeficiency virus, human immunodeficiency virus, mycoplasma infection and EbVstein-HCV virus were ruled out and herpes virus 6 was not requested (serology performed).
The clinical picture described was interpreted as reactivation of DRESS syndrome associated with cytomegalovirus reactivation.
The patient was treated with oral prednisone at a dose of 1 mg/kg/day, with subsequent slow decrease (6 weeks), associated with topical corticosteroids.
The patient had a favorable evolution, with no new relapses at 3 months of follow-up.
