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Meropenem-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in a patient with known type IV penicillin hypersensitivity
  1. Muhammad Sameed1,
  2. Christine Nwaiser2,
  3. Prashant Bhandari3 and
  4. Sarah A Schmalzle4,5
  1. 1 Internal Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
  2. 2 Medical School, American University of Antigua College of Medicine, Osbourn, Antigua and Barbuda
  3. 3 Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA
  4. 4 Infectious Diseases, University of Maryland, Baltimore, Maryland, USA
  5. 5 Infectious Disease, Institute of Human Virology, Baltimore, Maryland, USA
  1. Correspondence to Dr Muhammad Sameed, muhammad.sameed{at}


Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered variants of a disease continuum that results in a life-threatening exfoliative mucocutaneous disease. These are categorised as type IV cell-mediated delayed hypersensitivity reactions, and antibiotics are often implicated as a cause. Penicillins and other beta-lactam antibiotics are known to cause both immediate and delayed hypersensitivity reactions. While immediate IgE-mediated cross-reactivity between penicillins and carbapenems is well studied, less information on the risk of type IV delayed cell-mediated cross-reactivity between the two is available. We present a case of meropenem-induced SJS in a patient with documented history of SJS from amoxicillin. There are few cases of cross-reactivity with carbapenems reported in the literature, but based on the potential for life-threatening reaction, it is likely prudent to avoid the use of any beta-lactams in a patient with a history of SJS, TEN or any other severe cutaneous adverse reactions to another beta-lactam antibiotic.

  • dermatology
  • contraindications and precautions
  • drugs: infectious diseases
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  • Contributors MS: wrote the manuscript and did the literature search for this case, he was also the intern taking care of the patient. CN: helped in writing the case and acquiring pathology images. PB: was the senior resident on the team and guided the whole project. SAS: mentor and expert from infectious disease for the case, she helped revised the manuscript, added additional literature references and corrected multiple drafts of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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