Advances in Research

Background: Periorbital edema can be a manifestation of IgE-mediated drug hypersensitivity reactions (DHRs) to beta-lactam antibiotics. Amoxicillin-clavulanic acid is frequently implicated in immediate hypersensitivity reactions, including angioedema and periorbital edema.

Case Summary: A 38-year-old primigravida at 39 weeks and 2 days of gestation underwent delivery and was administered intravenous amoxicillin-clavulanic acid (1.2 grams) and drotaverine hydrochloride post-delivery. She experienced acute bilateral periorbital edema without systemic impairment shortly after administration. There was no history of comorbidities or allergies. Due to the rapid onset and the absence of fever, proptosis, or limited ocular movements, infectious etiologies such as orbital or preseptal cellulitis were ruled out. Following the administration of an intravenous antihistamine (pheniramine), the reaction resolved.

Causality and Severity Assessment: Naranjo scale was used to evaluate the causal relationship between amoxicillin-clavulanic acid and periorbital edema; it indicated a "PROBABLE" association. Severity was assessed using the Modified Hartwig and Siegel Scale and was classified as "Moderate (Level 3)." Based on the clinical presentation and course, the reaction was considered predictable.

Conclusion: These findings highlight the importance of early recognition of antibiotic-induced hypersensitivity reactions in obstetric care settings. They also underscore the need for systematic causality assessment to ensure accurate diagnosis and safe medication use.