HLH-like Hypersensitivity Reaction Secondary to Prolonged Piperacillin/Tazobactam: A Case Series Article Swipe
C Martín
,
Clément Triaille
,
Philippe Bégin
,
François Graham
,
Philippe Ovetchkine
,
Louis Paradis
,
Kathryn Samaan
,
Stéphanie Tremblay
,
Fabien Touzot
,
Marie‐Paule Morin
,
Roxane Labrosse
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.70962/cis2025abstract.173
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.70962/cis2025abstract.173
Background Prolonged (>10 days) use of intravenous (IV) piperacillin/tazobactam has been associated with a risk of developing hemophagocytic lymphohistiocytosis (HLH) syndrome. However, clinical and biological descriptions of this rare complication are lacking in the literature, such as management guidelines. Objectives and Methods We describe a series of five children who presented with an HLH-like hypersensitivity reaction after prolonged use of IV piperacillin/tazobactam therapy between February 2024 and October 2024 in a single pediatric tertiary center. Results Five patients aged between 6 and 15 years received IV piperacillin/tazobactam for various bacterial infections. The reaction occurred between 7 and 19 days after the start of therapy. While initial infections were well controlled, all patients presented with a reoccurrence of high fever, malaise, and a maculopapular rash in 4 of them. All developed biological abnormalities with elevated ferritin (range: 913-124895 µg/L), LDH (range: 565-3130 U/L), liver enzymes (ALT range: 113-363 U/L), and severe neutropenia (range: 0.1-0.4 x 109/L). Eosinophils were normal in 4/5 and mildly elevated (0.8 x 109/L) in 1/5. Increased HLADR+ CD8+ T cell frequency was observed in 3/3 patients tested (range: 25-30%). Investigations for classical secondary HLH triggers were negative. Piperacillin/tazobactam discontinuation led to resolution of fever and associated symptoms within 24 hours in all patients. All biological features resolved within a few days. Only one child received a short course of steroids for severe pruritus and myalgia. One patient reported a similar reaction after a previous course of 14 days of piperacillin/tazobactam therapy, 1.5 years earlier. Four patients were evaluated in allergology: 1/4 reacted to intradermal testing for piperacillin/tazobactam. Patch tests and one dose provocation challenge were negative (tested in 4 and 2 patients, respectively). Conclusion We provide further evidence that prolonged use of IV piperacillin/tazobactam may be associated with hypersensitivity reactions reminiscent of HLH (although only 1/5 formally fulfilled HLH-2004 criteria). We propose the term of HLH-like hypersensitivity reactions. Usual allergy testing is not useful to the diagnosis. Spontaneous resolution of symptoms can be expected after discontinuation of piperacillin/tazobactam. Clinicians should be aware of this rare disorder to avoid overtreatment or unnecessary investigations.
Related Topics
Concepts
Piperacillin/tazobactam
Piperacillin
Tazobactam
Hypersensitivity reaction
Medicine
Dermatology
Immunology
Bacteria
Biology
Genetics
Pseudomonas aeruginosa
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.70962/cis2025abstract.173
- OA Status
- diamond
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4409786311
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4409786311Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.70962/cis2025abstract.173Digital Object Identifier
- Title
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HLH-like Hypersensitivity Reaction Secondary to Prolonged Piperacillin/Tazobactam: A Case SeriesWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-04-25Full publication date if available
- Authors
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C Martín, Clément Triaille, Philippe Bégin, François Graham, Philippe Ovetchkine, Louis Paradis, Kathryn Samaan, Stéphanie Tremblay, Fabien Touzot, Marie‐Paule Morin, Roxane LabrosseList of authors in order
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https://doi.org/10.70962/cis2025abstract.173Publisher landing page
- Open access
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YesWhether a free full text is available
- OA status
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diamondOpen access status per OpenAlex
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https://doi.org/10.70962/cis2025abstract.173Direct OA link when available
- Concepts
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Piperacillin/tazobactam, Piperacillin, Tazobactam, Hypersensitivity reaction, Medicine, Dermatology, Immunology, Bacteria, Biology, Genetics, Pseudomonas aeruginosaTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
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10Other works algorithmically related by OpenAlex
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