A Case of Midazolam Induced Drug Hypersensitivity Syndrome

Lee, Ki Yeol; Hong, Jin Woo; Lee, Chae Young; Kim, Ki Ho; Kim, Young Hun

Abstract

Drug hypersensitivity syndrome is defined by various combinations of severe skin eruption and systemic signs. The symptoms of this syndrome usually begin in two to six weeks after the exposure to the offending drug, but if a patient is re-challenged with the drug, then the symptoms occur within a day. Midazolam is a short-acting benzodiazepine that,s commonly used for conscious sedation for a variety of procedures and also for premedication. Midazolam is capable of causing adverse effects such as nausea, vomiting, difficulty of breathing, cardiac arrest and signs of an allergic reaction. A 56-year-old man was prescribed Midazolam to prepare him for colonoscopy. Shortly after, he developed diffuse erythematous macules and patches with an itching sensation on all the skin of his body. The laboratory studies showed leukocytosis with eosinophilia and abnormal liver transaminase values. The skin biopsy showed vacuolar degeneration in the basal layer and a perivascular lymphocytic infiltration with eosinophils in the upper dermis. He was diagnosed as suffering with Midazolam-induced drug hypersensitivity syndrome and he was treated with systemic steroid and antihistamines for 2 weeks. This resulted in an improvement of the skin lesions and normalization of the liver transaminase values. To the best of our knowledge, no case of drug hypersensitivity syndrome associated with Midazolam has ever been published. Herein, we report that Midazolam, which is a widely used drug, may induce drug hypersensitivity syndrome.