Hypersensitivity due to ceftriaxone mimicking measles in a child
A 7-year-old boy was brought with a history of fever of four days duration with cough and cold. The boy was earlier treated with an injection outside by a private practitioner. On examination, he was toxic with high fever of 102° F, congestion of eyes and throat with maculopapular rash over his face and neck []. He was tachypneic with bilateral crepitations and decreased breath sounds in the right infrascapular region. He was admitted and treated with injection ampicillin for the respiratory infection. On the next day, the rashes increased and appeared on the chest and upper extremities with increasing congestion of eyes. He was thought to have measles as he had contact with a person who had similar illness few weeks back near his home. He was treated with vitamin A, oxygen by face mask, nebulized salbutamol and intravenous fluids. Since fever spikes were persistent and TLC was elevated (21,000/cu.mm) with neutrophilia (90%), antibiotics were changed to injection ceftriaxone after test dose. After a period of two hours he was found to have increasing rashes with audible wheeze, loose stools and vomiting. By this time the rash was found throughout his body with clearing from face. Salbutamol nebulizations were increased in frequency and the child was monitored closely.\nOver the next eight hours child became better, was able to sit up comfortably with minimal distress and he was taking oral feeds. The rashes appeared less prominent. He received the second dose of injection ceftriaxone that afternoon and following that he felt dizzy, vomited and began to have distress. His rash once again increased and became prominent, this time, throughout the entire body involving the face with urticarial lesions in-addition to macula-papular lesions []. He appeared red and was warm with itching all over the body, especially around his ears. Drug allergy was suspected and was promptly treated with oxygen, parenteral pheniramine maleate, dexamethasone, and nebulization with salbutamol. Injection ceftriaxone was discontinued. Within half an hour, his breathing became normal and his rashes disappeared. This time the diagnosis was clear and the history was re-visited. On the fourth day of illness, the boy had received injection ceftriaxone by a local practitioner following which the rash had appeared. He had previously been treated with injection cefotaxime and ampicillin without having any reactions to them. There was history of wheezing without fever in the past and signs of allergic rhinitis and conjunctivitis which were of mild intermittent type. He had received one dose of measles vaccine at ten months of age. There was no family history of allergy. He was observed for further 24 hours during which he was totally asymptomatic and was discharged on oral azithromycin and prednisolone for 5 days. On follow-up a week later, the boy was totally well and asymptomatic.