METRONIDAZOLE HYPERSENSITIVITY

OBJECTIVE: To report a case of a possible hypersensitivity reaction in duced by metronidazole. CASE SUMMARY: An Asian woman with a history of recurrent vaginitis had previously developed localized erythema while on intravaginal metronidazole and nystatin. While receiving oral metr onidazole for treatment of a current bacterial vaginosis, she develope d chills, fever, generalized erythema, and a rash within 60 minutes of the first dose. Treatment with diphenhydramine was instituted. The fo llowing day while in the hospital, the patient's condition worsened; s he experienced shortness of breath and increased edema of the extremit ies. Methylprednisolone was administered with diphenhydramine and her condition improved over the next 5 days. The patient's vaginitis was t reated with gentian violet and she was discharged on a tapering dosage of prednisone. DISCUSSION: Metronidazole-induced cutaneous reactions and systemic hypersensitivity reactions are reviewed. Alternatives to metronidazole and other potential cross-reactive drugs are suggested f or the treatment of recurrent vaginitis.CONCLUSIONS: Although the pati ent's initial reaction to metronidazole represented a rare event, writ ten documentation and communication in the patient's native language m ay have prevented the subsequent severe hypersensitivity reaction.