Penicillin hypersensitivity with eosinophilia. A case report with immunologic studies

A case of penicillin hypersensitivity with marked eosinophilia and a transient skin rash is presented. The patient continued to receive large doses of penicillin intravenously for treatment of subacute bacterial endocarditis, and underwent successful open-heart surgery with replacement of the mitral valve. By means of the passive hemagglutination technic, direct skin tests and Schultz-Dale technic using unheated, heated and mercaptoethanol-treated serum, it was possible to demonstrate antibodies to penicillin in both IgG and IgM immunoglobulins during the first three months of the illness. At the thirtieth week only skin-sensitizing antibodies (probably IgA) to penicillin were demonstrable by these technics. The peripheral lymphocytes in a five day culture were stimulated and showed blast cell transformation when either penicillin G or penicilloyl polylysine was added. Direct Schultz-Dale experiments with the patient's cardiac muscle showed a contraction when penicillin G was added. This finding indicates the presence of anti-bodies fixed to the heart muscle. A strong contraction was observed with both the patient's and a control cardiac muscle when bradykinin, serotonin and epinephrine were added to the bath, but these tissues seem to be relatively insensitive to the action of histamine.