Delayed exfoliative dermatitis induced by piperacillin sodium and sulbactam sodium in a patient with negative skin test

A 59-year-old female patient received liver-protective drugs such as compound glycyrrhizin for liver cirrhosis and anti-infective agent piperacillin sodium and sulbactam sodium (2.5 g by an IV infusion, twice daily) for pneumonia, with the precondition of negative skin test. On day 4, the patient developed scattered small maculopapular rashes on her face, which then increased all over the body, located mainly in the trunk, and appeared as red round and irregular shapes, accompanied by local swelling of the mouth, and chapped lips. Considering that it was caused by piperacillin sodium and sulbactam sodium, the drug was discontinued and symptomatic and supportive treatments with methylprednisolone, desloratadine cirate disodium, and appropriate topical drugs were given immediately. Liver-protective drugs were continued and moxifloxacin was given for infection. On day 2 of drug withdrawal, the patient developed nasal and scattered skin desquamation on the nose and neck. Exfoliative dermatitis was diagnosed. On day 8 of admission, the erythema on the whole body became lighter, no new skin rashes appeared, and methylprednisolone was stopped. On day 13, the patient′s original rashes became lighter, crusted, and partially subsided. Key words: Hypersensitivity, delayed; Dermatitis, exfoliative; Piperacillin; Sulbactam; Skin tests