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[Skin pigmentation induced by meropenem and levofloxacin]
E Garval1, V Vuiblet2, A Durlach3
1Service de dermatologie, hôpital Robert-Debré, CHU de Reims, avenue du Général-Kœnig, 51092 Reims cedex, France.
Background:
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.
Patients And Methods:
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.
Discussion:
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.
Insights
This case study reports cutaneous hyperpigmentation in a patient treated with meropenem and levofloxacin antibiotics. Infrared spectroscopy identified meropenem in the dermis, suggesting it as a cause of the skin discoloration.
Area of Science:
- Dermatology
- Pharmacology
- Infectious Diseases
Background:
- Cutaneous side-effects are known for antibiotics like meropenem (carbapenem) and levofloxacin (fluoroquinolone).
- Reported side-effects include exanthema, pruritus, urticaria, and severe conditions like Lyell or Stevens-Johnson syndrome.
- Levofloxacin also carries a risk of photosensitivity.
Observation:
- A 67-year-old male developed dark hyperpigmentation on his lower limbs after two weeks of antibiotic therapy for osteitis.
- The patient was treated with meropenem, levofloxacin, and amikacin, followed by meropenem, levofloxacin, and rifampicin.
- Histology showed dark deposits in the dermis, and infrared microspectroscopy identified meropenem within the skin.
Findings:
- This is the first reported case of cutaneous hyperpigmentation induced by meropenem.
- Infrared spectroscopy confirmed the presence of meropenem in the dermis of the affected skin.
- The pigmentation slowly subsided after the withdrawal of the antibiotics.
Implications:
- This case highlights a rare but identifiable side-effect of meropenem and levofloxacin combination therapy.
- Understanding the causative agent through techniques like infrared spectroscopy is crucial for diagnosis and management.
- Further research may elucidate the exact mechanism of pigment deposition in the dermis.