Slow desensitization to fluconazole in woman with maculopapular exanthema

Abstract

Introduction: Desensitisation is a procedure that modifies the immune response to a pharmaceutical agent, thereby creating a transient tolerance to the drug in question. This allows the patient with an allergic reaction to continue receiving the requisite treatment without interruption. Once the desensitization process is terminated, the patient's hypersensitivity to the drug resumes. This case study presents the case of a 53-year-old woman with a personal history of kidney transplant who presents to the hospital with a lesion on the hallux of the left foot at the starting point of onychocryptosis, with a positive culture for cryptococci. The presumptive diagnosis is disseminated disease due to compatible lesions in the lungs, as indicated by computed tomography. Therefore, long-term treatment with fluconazole is recommended. During the administration of the antifungal agent, the patient developed a maculopapular rash with pruritus, which was diagnosed as a hypersensitivity reaction to the drug. Consequently, a slow desensitization procedure was performed to ensure the patient's safety and efficacy of treatment. Objectives: Describe a slow desensitization protocol in a patient with a non-IgE-mediated maculopapular reaction. Additionally, the medical history and clinical history of the patient, as well as the time of onset of symptoms after administration of the drug, were analyzed. Furthermore, a literature review on similar allergic reactions was conducted, and the medical and pharmacological interventions used were specified. Material and methods: We observed desensitization protocols in patients with a history of allergy and their subsequent monitoring. A desensitization protocol comprising 15 consecutive steps was implemented, adapted from a protocol for oral TMS in patients with HIV infection and a history of allergy to the antibiotic in question. Results: The procedure was straigtfoward and efficacious, and thus the patient proceeded with the recommended dosage for the infectious condition. Conclusion: It was determined that the desensitization procedure is safe when conducted by trained medical professionals in a controlled setting.