Authors
Yifei Peng, Rui Peng
Published in
Frontiers in medicine. Volume 13. Pages 1863232. Epub Jun 30, 2026.
Abstract
Managing complex infections after immunotherapy in patients with advanced head and neck cancer is clinically challenging, especially when severe adverse drug reactions like carbapenem hypersensitivity and tigecycline-associated coagulopathy further limit treatment options. This case demonstrates the potential contribution of clinical pharmacists in such difficult scenarios.
A 74-year-old man with oral squamous cell carcinoma developed severe sepsis after one cycle of PD-1 inhibitor (penpulimab) plus EGFR inhibitor (cetuximab). The clinical pharmacist sequentially recommended escalation to meropenem, switch to piperacillin-tazobactam, and addition of vancomycin. Later, the pharmacist recognized possible imipenem-related central nervous system effects, leading to discontinuation of all carbapenems due to possible cross-hypersensitivity. Subsequently, tigecycline was initiated, its associated coagulopathy was managed, and a switch to doxycycline was made.
The patient's fever resolved, and coagulation substantially improved; the infection was finally controlled. Causality was assessed using the Naranjo scale (imipenem 7, meropenem 5) and the RUCAM scale (penpulimab 6).
In this case, the clinical pharmacist's dynamic assessment and use of quantitative adverse reaction tools (Naranjo and RUCAM scales) contributed to successful infection control and management of drug toxicity.
PMID:
42454128
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.
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