Eravacycline infusion-related hypoesthesia: A case report.

R Briley Miller, Kinsey M McClure, Robby G Stewart, Stephanie C Shealy, Krishnan Brown, P Brandon Bookstaver

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2022 Jul 08

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Eravacycline (ERV) is often used for drug-resistant gram-negative and nontuberculous mycobacteria (NTM) infections, but infusion site reactions are a potential adverse effect. We report a case of severe hypoesthesia secondary to ERV infusion. A 74-year-old man presented with dyspnea, shortness of breath, and hemoptysis after being treated for community-acquired pneumonia. On the basis of respiratory cultures performed several weeks before the index hospitalization, he was diagnosed with Mycobacterium chelonae pneumonia. On hospital day (HD) 2, the infectious diseases consult team, guided by susceptibilities, initiated a regimen of azithromycin, levofloxacin, and ERV 80 mg (1 mg/kg) intravenously every 12 hours infused over 1 hour in 250 mL of normal saline. Approximately 25 minutes after the ERV infusion began, the patient reported tingling and numbness in his fingers, hands, and mouth, with shooting pain in his head. Symptoms resolved with cessation of the ERV infusion. On HD 3, the same ERV dose and volume was administered with an extended infusion time of 2 hours. The patient experienced the same reaction after 58 minutes, which ceased shortly after the infusion was stopped. Use of ERV was subsequently discontinued. The Naranjo adverse drug reaction probability scale score was 9, indicating a definite reaction. A review of the Food and Drug Administration Adverse Event Reporting System through March 2021 identified 22 ERV-associated events. Among these, 18% appear to be related to ERV infusions. Published results from phase 3 clinical trials did not document any hypoesthesia. It is unknown whether there is a correlation between concentration, dose, or infusion time and associated reactions. This is a unique case of severe hypoesthesia secondary to ERV infusion leading to drug discontinuation. More data are needed to determine effective mitigation strategies. © American Society of Health-System Pharmacists 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Citation

R Briley Miller, Kinsey M McClure, Robby G Stewart, Stephanie C Shealy, Krishnan Brown, P Brandon Bookstaver. Eravacycline infusion-related hypoesthesia: A case report. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2022 Jul 08;79(14):1146-1150