Polymyxin B-induced skin hyperpigmentation: a rare case report and literature review
Guanhao Zheng1, Li Cao2, Zaiqian Che3
1Department of Pharmacy, Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan, China.
Background:
Polymyxin B (PMB), which is regarded as the ultimate antibacterial treatment against some intractable gram-negative bacteria with its outstanding anti-bacterial activities, inflicts several adverse effects on patients. However, skin hyperpigmentaion (SH) induced by PMB is very rare. Here, we report a case of polymyxin B-induced skin hyperpigmentation (PMB-iSH) in a 21-year-old female. To the best of our knowledge, this is the first case of PMB-iSH in China.
Case Presentation:
A 21-year-old female patient with sepsis received the administration of PMB by intravenous injection for the treatment of multi-drug resistant Klebsiella pneumoniae (MDR-KP) infection. She later suffered from a rare adverse drug reaction (ADR), namely PMB-iSH, after 5-day PMB administration during her treatment. There were multiple red rashes spread on the whole body skin at first. With the rashes fading away, SH with dark round spots appeared, associated with no pain or pruritus. The skin of the head and neck was darkened evidently, and dark brown spots were spread on the skin of trunk and limbs. About a month after her admission, urged by the relatives, the patient was transferred back to the local hospital for further treatment in the end, and her skin color didn't recover to the previous state at that time.
Conclusion:
Both our case and the literature review highlight that PMB can give rise to SH indeed. Clinicians and pharmacists should attach great importance to this rare pigmentary disorder and further investigation is warranted.
Insights
Polymyxin B (PMB) can cause a rare side effect called skin hyperpigmentation (SH). This case report details PMB-induced SH in a young female patient, highlighting the need for clinical awareness of this adverse drug reaction.
Area of Science:
- Pharmacology
- Dermatology
- Infectious Diseases
Background:
- Polymyxin B (PMB) is a critical antibiotic for treating infections caused by multidrug-resistant gram-negative bacteria.
- While effective, PMB is associated with various adverse effects.
- Skin hyperpigmentation (SH) is a rare but documented adverse drug reaction to PMB.
Observation:
- A 21-year-old female with sepsis and multidrug-resistant Klebsiella pneumoniae infection received intravenous PMB.
- After 5 days of treatment, she developed widespread red rashes that resolved, followed by the appearance of dark, non-pruritic spots indicative of SH.
- Hyperpigmentation was most evident on the head and neck, with dark brown spots on the trunk and limbs, persisting for at least a month.
Findings:
- This case represents the first documented instance of Polymyxin B-induced skin hyperpigmentation (PMB-iSH) in China.
- The clinical presentation involved initial rashes followed by persistent dark spot formation.
- The findings confirm that PMB can indeed cause SH, even if rarely.
Implications:
- Clinicians and pharmacists must be vigilant for PMB-iSH as a potential adverse drug reaction.
- Increased awareness of this rare pigmentary disorder is crucial for patient management.
- Further research is warranted to understand the mechanisms and prevalence of PMB-induced SH.
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