Death due to serious toxic epidermal necrolysis evoked by cefoperazone sodium and sulbactam sodium

A 68-year-old female with infection after left knee replacement received an IV infusion of cefoperazone sodium and sulbactam sodium 2.0 g twice daily. It was about to the ending of the second time of IV infusion, the patient developed anhelation, dyspnea, sweating profusely, and fever. The IV infusion was stopped immediately. Three days after drug withdrawal, the patient presented with millet to soya bean size red rash on her trunk which had clear ambit and faded after pressing. It was considered as erythema morbilliforme and needed to be investigated by a dermatologist. The patient received loratadine granules 10 mg once daily and topical application of calamine lotion. Eight days after drug withdrawal, the patient developed skin ulceration on her waist, back, right scapular, and paravertebrae. There were blisters on the left elbow ulnar side and skin peelings on her her waist and back. She was diagnosed as toxic epidermal necrolysis due to cefoperazone sodium and sulbactam sodium by the Department of Dermatology consultation. The patient received IV infusion of calcium gluconate; calglucon; glucal 20 ml, methylprednisolone 80 mg, and human immuno-globulin 2.5 g once daily; intravenous injection of diphenhydramine hydrochloride 20 mg every 12 hours; and topical application of nanoparticulate silver antibacterial gel. The patient developed pulmonary infection and the symptoms of skin peeling off had no improvement. On day 14 of drug withdrawal, her family members decided to give up treatment because of economic reason. It was told that the patient died on the third day after discharge by telephone follow-up. Key words: Cefoperazone; Epidermal necrolysis, toxic