Potential Pharmacogenomics (PGx), Human Leukocyte Antigen (HLA) Antiviral to Cephalosporin Crossover Reaction.
Michael J Schuh, Lydia Halim Girgis
✦ AI-curated · Sources linked
Case in brief
A 43-year-old man with type 2 diabetes and HLA-B*57:01 positivity received intravenous cefepime for pubic symphysis osteomyelitis associated with Pseudomonas. After three weeks, he developed fever, aches, agranulocytosis, thrombocytopenia, and rash, suspected to be cefepime-related. Cefepime was replaced with piperacillin-tazobactam, and the symptoms resolved. The report raises the question of whether HLA-B*57:01 positivity and abacavir sensitivity may be relevant to a possible cefepime-associated reaction; it does not establish a pharmacogenomic cross-reaction.
What made this case unusual
The case raises a possible HLA-B*57:01-associated crossover reaction between abacavir sensitivity and cefepime toxicity, but the abstract presents this as an unresolved question rather than a demonstrated association.
Diagnostic / clinical pearl
When cytopenias and rash develop during cefepime therapy, consider a suspected drug reaction; symptom resolution after cefepime withdrawal supports suspicion but does not establish an HLA-mediated mechanism.