Localized bullous drug reaction to cefotaxime leading to wet gangrene in a neonate: A case report

Abstract

Background

Bullous drug eruptions are rare but serious adverse reactions in neonates. Cefotaxime, a commonly used third-generation cephalosporin in neonatal intensive care, can rarely cause severe cutaneous adverse reactions.

Results

We report a case of a term, large-for-gestational-age male neonate who developed bullous drug eruption following intravenous cefotaxime administration on Day 3 of life. The patient was initially admitted for decreased urine output and received prophylactic cefotaxime for suspected sepsis. Immediately after the fifth dose of intravenous cefotaxime, blister formation occurred over all five left toes distal to the IV cannula site. This progressed to gangrenous changes involving all five toes with erythematous discoloration extending to the metacarpophalangeal joints. Conservative management, including antibiotics and local wound care, resulted in gradual improvement, characterized by the formation of demarcation lines and the resolution of inflammation.

Conclusion

This case highlights a rare but serious complication of cefotaxime use in neonates. Healthcare providers should be aware of this potential severe cutaneous adverse reaction, particularly when cefotaxime is administered via peripheral intravenous access. Early recognition and immediate discontinuation of the offending drug, along with conservative management, can lead to favorable outcomes.