Abstract
The incidence of febrile neutropenia secondary to high-dose methotrexate is not an uncommon adverse reaction in hematology patients. However, acute kidney injury (AKI) following the combination of piperacillin and vancomycin in pediatric patientsis a relatively uncommon adverse drug reaction. In this report, an 11-year-old male patient in the pediatric hematologydepartment presented with febrile neutropenia and mucositis postchemotherapywith high dose methotrexate for B-ALL (acute lymphoblastic leukemia) as induction therapy. For that, he was treated with a combination (piperacillin-tazobactam + vancomycincombination) of antibiotics along with supportive treatment. Two days after theinitiation of this combination, the patient presented with derangement of renal parameters and serumpotassium levelsand developedacute kidney injury. After the combination of antibiotics was stopped andthe antibiotics were switched to teicoplanin and cefoperazone-sulbactam combination, the patient’s renal parameters recovered in the subsequent 3—4 days, and the patient was discharged with a normal hematological and renal profile in stable condition. This case report highlights the incidence of acute kidney failure with hyperkalemia as an adverse drug reaction secondary to combination antibiotic therapy consisting of piperacillin-tazobactam + vancomycin. This adverse drug reaction can be considered “possible” according to the WHO casualty assessment.