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Adverse drug reactions
Secondary haemophagocytic lymphohistiocytosis associated with metronidazole
  1. Kazuki Iio1,
  2. Yuta Ariyama1,
  3. Hirofumi Tomita2,
  4. Hiroshi Sakakibara1,
  5. Hiroshi Hataya1
  1. 1 General Pediatrics, Tokyo Metropolitan Children’s Medical Center, Fuchu-shi, Japan
  2. 2 Surgery, Tokyo Metropolitan Children’s Medical Center, Fuchu-shi, Japan
  1. Correspondence to Dr Kazuki Iio, General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan; kazuki_iio{at}tmhp.jp

http://dx.doi.org/10.1136/postgradmedj-2019-136512

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    A lower grade elementary schoolgirl was hospitalised for the treatment of a perforated appendicitis complicated by a pelvic abscess. Although her fever and abdominal pain subsided after conservative treatment with ampicillin/sulbactam and cefotaxim, her pain accompanying defecation failed to improve. On hospitalisation day 10, a follow-up abdominal ultrasonography revealed an enlarged abscess in the pouch of Douglas and ampicillin/sulbactum was switched to metronidazole. Her fever recurred after this change, and a transrectal drainage of the abscess was performed on day 15. Despite good control of the abscess after the drainage, her fever did not abate.

    On day 18, small, scattered erythemas of 1–2 mm in diameter appeared on her limbs. She vomited several times, and her body temperature was 40.1°C. On blood analysis, …

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    Footnotes

    • Contributors KI cared for the patient and wrote the first draft of the manuscript. YA and HT cared for the patient and helped draft the manuscript. HS assisted with the patient’s care and reviewed the paper. HH supervised the writing of the report. All the authors have read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.