Generalized rash, intense itching, and mild fever after two days of antibiotic treatment for recurrent pyelonephritis

Abstract

A 26-year-old woman with no significant comorbidities, came to the emergency room with fever, low back pain, and dysuria of two days' duration. The patient has a history of recurrent pyelonephritis with several episodes in the last three years, successfully treated with various antibiotics. On this occasion, acute pyelonephritis was diagnosed by urine analysis that showed pyuria and bacteriuria. Empirical treatment was started with trimethoprim-sulfamethoxazole (TMP-SMX) due to its efficacy and its adequate spectrum of activity. However, two days after starting treatment, the patient developed an acute adverse reaction, characterized by diffuse maculopapular skin rash, intense itching, and mild fever (37.6 ° C). She has no history of allergies to medications, nor a family history of severe allergic reactions. She lives alone and has no children. She does not report having consulted a doctor in the last three years. She does not take other medications or have a history of recent viral infections. The patient reports not having had similar reactions in the past, including during previous episodes of pyelonephritis treated with other antibiotics. antibiotics.