Methods: An observed graded challenge to intravenous ceftriaxone.
Results: Our patient is a healthy 13 year-old boy with a known peanut allergy who presented at the emergency department of the Montreal Children’s Hospital with pre-auricular cellulitis and fever. His blood tests revealed no leukocytosis but an elevated C-reactive protein and erythrocyte sedimentation rate. He was treated with 2g of ceftriaxone intravenously. Within 5 minutes, he developed a 3 cm elevated lesion superior to the left orbit that resolved within 1 hour of appearance. On subsequent visit, a graded challenge was performed. The patient tolerated well 10% of the total dose; however, within 30 minutes after receiving 90% of the dose, the patient developed the same reaction at the same location. The lesion resolved within 1 hour. The patient was challenged to oral cephalexin the following day with no reaction, and was prescribed oral cephalexin to complete the treatment.
Conclusions: The patient’s history and challenge are consistent with a FDE. To the best of our knowledge, this is the first case report on FDE to ceftriaxone in children. Given increased use of ceftriaxone, clinicians should be aware of the possible development of FDE to ceftriaxone. A graded drug challenge is useful in establishing the diagnosis of FDE to ceftriaxone.