PEMPHIGUS ERYTHEMATOSUS INDUCED BY CEFTAZIDIME

A 37-year-old Italian man was given a prescription for ceftazidime to treat folliculitis of the beard that had been present for approximatel y ten years. The drug was administered intramuscularly at home at a do se of 1 g/day. After a few days of treatment the patient began to expe rience diffuse pruritus over the entire trunk. On day 8 of treatment, flaccid bullae and crusted lesions appeared on the chest and gradually spread to the back and scalp. On day 10 of treatment the patient was hospitalized. Physical examination revealed the above lesions of the t runk and scalp (Fig. 1); there was no mucous membrane involvement. The patient was unaware of any allergies or hypersensitivity to drugs of any type. Laboratory studies, including complete blood count, erythroc yte sedimentation rate, assays for antinuclear and antidouble-stranded antibodies, lupus erythematosus cells, rheumatoid factor, complement levels, and immunoelectrophoresis showed normal or negative findings. Human leukocyte antigen (HLA) typing showed the presence of the follow ing antigens: A11,-, B7, B18, Cw7,-, DR2, DR11, DQ1, and DQ3. Histolog ic examination of one of the bullous lesions on the chest revealed the presence of a subcorneal blister and a few acantholytic cells. Direct immunofluorescence on perilesional skin showed deposits of immunoglob ulin IgG and C3 among the cells and along the dermo-epidermal junction ; indirect immunofluorescence was negative. On the basis of these find ings, the diagnosis of pemphigus erythematosus was made and ceftazidim e was discontinued. This led to marked regression of the symptoms and, after 40 days of topical cortisone treatment, the lesions had complet ely disappeared.