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Polymyxin B-Induced Diffuse Cutaneous Hyperpigmentation
Sandeep Lahiry1, Shouvik Choudhury2, Ayan Mukherjee2
1Post Graduate Trainee, Department of Pharmacology, Institute of Post Graduate Medical Education and Research , Kolkata, West Bengal, India.
Abstract:
Polymyxin B is a polypeptide-antibiotic, primarily used for resistant Gram-negative infections, first obtained from bacterium Bacillus polymyxa in the late 1940s. Antibiotic spectrum are restricted to mainly gram negative bacterias like Enterobacter, E. coli, Klebsiella, Salmonella, Pasteurella, Bordetella, Shigella; and particularly organisms like Pseudomonas aeruginosa and Acinetobacter baumannii, which are extremely potent to acquire antibiotic resistance. Side effects include neurotoxicity and acute renal tubular necrosis. Here, we present a rare case of skin hyper-pigmentation in a 65-year-old elderly male of Indian origin, diagnosed as a case of Multi-Drug Resistant (MDR) Klebsiella pneumonia, treated with intravenous antibiotics. The manifestations were observed after 4 days of Polymyxin B therapy initiation. All other concomitant drugs, infections, or immunologic disorders that, could have caused this symptom, were carefully excluded. An objective causality assessment reveals that, the cutaneous hyperpigmentation was possibly associated with Polymyxin B therapy, though further studies may be needed to explain the underlying mechanism.
Insights
Polymyxin B, an antibiotic for resistant Gram-negative infections, may cause skin hyperpigmentation. This rare side effect was observed in a patient treated for Multi-Drug Resistant Klebsiella pneumoniae.
Area of Science:
- Pharmacology
- Dermatology
- Infectious Diseases
Background:
- Polymyxin B is a critical antibiotic for treating infections caused by multidrug-resistant Gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii.
- Its use is limited by potential toxicities, such as neurotoxicity and nephrotoxicity.
Observation:
- A rare case of cutaneous hyperpigmentation is presented in a 65-year-old male of Indian origin.
- The patient was being treated with intravenous antibiotics for Multi-Drug Resistant Klebsiella pneumoniae infection.
Findings:
- The skin hyperpigmentation manifested after four days of initiating Polymyxin B therapy.
- Other potential causes for the hyperpigmentation, including concomitant medications, infections, and immunological disorders, were systematically excluded.
- Causality assessment suggests a possible association between Polymyxin B therapy and the observed cutaneous hyperpigmentation.
Implications:
- This case highlights a rare but notable adverse effect of Polymyxin B therapy.
- Further research is warranted to elucidate the underlying mechanisms of Polymyxin B-induced hyperpigmentation.
- Clinicians should be aware of this potential side effect when prescribing Polymyxin B, especially for extended durations.