rifampin and Hyperpigmentation

Topics: Adult; Dapsone; Drug Therapy, Combination; Female; Hand; Hand Dermatoses; Humans; Hyperpigmentation; Hypesthesia; Leprostatic Agents; Leprosy, Tuberculoid; Rifampin

Various cutaneous side-effects, including, exanthema, pruritus, urticaria and Lyell or Stevens-Johnson syndrome, have been reported with meropenem (carbapenem), a rarely-prescribed antibiotic. Levofloxacin (fluoroquinolone), a more frequently prescribed antibiotic, has similar cutaneous side-effects, as well as photosensitivity. We report a case of cutaneous hyperpigmentation induced by meropenem and levofloxacin.. A 67-year-old male was treated with meropenem (1g×4 daily), levofloxacin (500mg twice daily) and amikacin (500mg daily) for 2 weeks, followed by meropenem, levofloxacin and rifampicin (600mg twice daily) for 4 weeks for osteitis of the fifth metatarsal. Three weeks after initiation of antibiotic therapy, dark hyperpigmentation appeared on the lower limbs, predominantly on the anterior aspects of the legs. Histology revealed dark, perivascular and interstitial deposits throughout the dermis, which stained with both Fontana-Masson and Perls stains. Infrared microspectroscopy revealed meropenem in the dermis of involved skin. After withdrawal of the antibiotics, the pigmentation subsided slowly.. Similar cases of cutaneous hyperpigmentation have been reported after use of minocycline. In these cases, histological examination also showed iron and/or melanin deposits within the dermis, but the nature of the causative pigment remains unclear. In our case, infrared spectroscopy enabled us to identify meropenem in the dermis. Two cases of cutaneous hyperpigmentation have been reported following use of levofloxacin, and the results of histological examination were similar. This is the first case of cutaneous hyperpigmentation induced by meropenem.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Hyperpigmentation; Levofloxacin; Male; Meropenem; Metatarsus; Osteitis; Rifampin

Topics: Anti-Bacterial Agents; Humans; Hyperpigmentation; Leprostatic Agents; Leprosy; Male; Middle Aged; Minocycline; Rifampin; Staining and Labeling

Topics: Clofazimine; Dapsone; Drug Therapy, Combination; Humans; Hyperpigmentation; Leprostatic Agents; Leprosy; Minocycline; New York; Patient Preference; Rifampin

We submit the case of a male patient, suffering from a tuberculous ethiology adrenal primary insufficiency, showing a dermal lesion, in which necrotizing granulomas were found, and from which bacterial culture growth yielded mycobacterium bovis. Given the clinical findings, and awaiting for the bacterial culture result, a triple treatment with tuberculostatics was started, but had to be discontinued because of hepatic toxicity. After culture of cutaneous biopsy yielded micobaterium tuberculosis, treatment with streptomycin, rifampicin and etambutol was restarted. Three weeks later, in spite of increasing hydrocortisone dose to 40 mg, adrenal insufficiency reappeared. Under the circumstances, we chose to continue rifampicin and double hydrocortisone dose. The case is of concern because of the concurrency of three nowadays infrequent disorders: tuberculous ethiology adrenal insufficiency, cutaneous tuberculosis due to mycobacterium bovis and primary adrenal insufficiency due to rifampicin treatment, the latter resolved after increasing hydrocortisone dose.

Topics: Addison Disease; Adrenal Gland Diseases; Aged; Antibiotics, Antitubercular; Humans; Hyperpigmentation; Male; Mycobacterium bovis; Rifampin; Tuberculosis, Cutaneous; Tuberculosis, Endocrine

Topics: Addison Disease; Adult; Antitubercular Agents; Ethambutol; Germany; Humans; Hydrocortisone; Hyperpigmentation; Isoniazid; Male; Pyrazinamide; Rifampin; Tuberculosis, Endocrine