A 64-year-old male patient with right lung adenocarcinoma developed im-mune-mediated liver injury after treated with chemotherapy and pembrolizumab for 2 cycles and was hospitalized. While in hospital, the patient took amoxicillin capsule 0.5 g once every 8 hours to treat lung infection. After about 10 hours of medication, the patient developed maculopapular drug erup-tion without treatment. In the 2nd morning, The rash spread to the trunk and upper limbs and the color darkened. Amoxicillin capsule were discontinued which was considered to be related to macu-lopapular drug eruption and diphenhydramine 20 mg intramuscularly and cetirizine hydrochloride 10 mg orally once daily was given. On the 3rd day, the rashes on both upper limbs disappeared, and the rashes on the trunk partly subsided, and the color faded. on the 6th day, the rashes disappeared to-tally. The patient taken amoxicillin many times in the past had not developed an allergic reaction. It was considered that the maculopapular drug eruption induced by amoxicillin in this case was related with activation of immune status after pembrolizumab.

1.国家药品不良反应监测中心. 药品不良反应术语使用指南[S]. 2016, 68.

2.Haanen J, Carbonnel F, Robert C, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2018, 29(Suppl 4): v264-v266. DOI: 10.1093/annonc/mdx225.

3.Adam J, Pichler WJ, Yerly D. Delayed drug hypersensitivity: models of T-cell stimulation[J]. Br J Clin Pharmacol, 2011, 71(5): 701-707. DOI: 10.1111/j.1365-2125.2010.03764.x.

4.Pullen H, Wright N, Murdoch JM. Hypersensitivity reactions to antibacterial drugs in infectious mono-nucleosis[J]. Lancet, 1967, 2(7527): 1176-1178. DOI: 10.1016/s0140-6736(67)91893-4.

5.Stokes SC, Tankersley MS. HIV: practical implications for the practicing allergist-immunologist[J]. Ann Allergy Asthma Immunol, 2011, 107(1): 1-9; quiz 9-11. DOI: 10.1016/j.anai.2011.05.004.

6.Watanabe Y, Yamaguchi Y. Drug allergy and autoimmune diseases[J]. Allergol Int, 2022, 71(2): 179-184. DOI: 10.1016/j.alit.2022.02.001.

7.Thompson DF, Ramos CL. Antibiotic-induced rash in patients with infectious mononucleosis[J]. Ann Pharmacother, 2017, 51(2): 154-162. DOI: 10.1177/10600 28016669525.

8.Lozano AX, Chaudhuri AA, Nene A, et al. T cell characteristics associated with toxicity to immune checkpoint blockade in patients with melanoma[J]. Nat Med, 2022, 28(2): 353-362. DOI: 10.1038/s41591-021-01623-z.

9.Utsunomiya A, Oyama N, Iino S, et al. A case of erythema multiforme major developed after sequential use of two immune checkpoint inhibitors, nivolumab and ipilimumab, for advanced melanoma: possible implication of synergistic and/or complementary immunomodulatory effects[J]. Case Rep Dermatol, 2018, 10(1): 1-6. DOI: 10.1159/000485910.

10.吴迪. 帕博利珠单抗致严重免疫相关皮肤不良反应的文献分析[J]. 中国医院药学杂志, 2022, 42(21): 2282-2287. [Wu D. Literature analysis of severe immune-related skin adverse reactions induced by pabolizumab[J]. Chinese Journal of Hospital Pharmacy, 2022, 42(21): 2282-2287.] DOI: 10.13286/j.1001-5213.2022.21.15.

11.BircherAJ. Uncomplicated drug-induced disseminated exanthemas[J]. Chem Immunol Allergy, 2012, 97: 79-97. DOI: 10.1159/000335617.

12.Tadicherla S, Ross K, Shenefelt PD, et al. Topical corticosteroids in dermatology[J]. J Drugs Dermatol, 2009, 8(12): 1093-1105. https://pubmed.ncbi.nlm.nih.gov/20027937/.

13.Schneck J, Fagot JP, Sekula P, et al. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective study on patients included in the prospective EuroSCAR Study[J]. J Am Acad Dermatol, 2008, 58(1): 33-40. DOI: 10.1016/j.jaad.2007.08.039.