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A cachectic man developed widespread blistering skin lesions after norfloxacin use. This case highlights potential severe cutaneous adverse reactions to fluoroquinolones.

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Area of Science:

  • Dermatology
  • Internal Medicine
  • Clinical Pharmacology

Background:

  • A 60-year-old male presented with a 2-month history of cachexia, fever, diarrhea, and vomiting.
  • The patient had recently taken norfloxacin for diarrhea prior to the onset of dermatological symptoms.

Observation:

  • Physical examination revealed pallor, significant lymphadenopathy, and a low body mass index (17.67).
  • Generalized, bizarre-shaped vesicles and bullae were present on erythematous skin, with a characteristic "string of pearls morphology" on the trunk.
  • Extensive skin peeling, erosions, and a positive Nikolsky sign were noted, indicating a severe blistering process.

Findings:

  • Tzanck smear showed neutrophils and eosinophils, excluding acantholytic cells.
  • Moderate hepatomegaly was also observed.
  • The clinical presentation and history suggest a severe cutaneous drug reaction, possibly Stevens-Johnson syndrome/toxic epidermal necrolysis spectrum, triggered by norfloxacin.

Implications:

  • This case underscores the importance of considering fluoroquinolones as a potential cause of severe blistering skin reactions.
  • Early recognition and discontinuation of the offending drug are crucial for managing such adverse events.
  • Further investigation into the specific immunopathogenic mechanisms of norfloxacin-induced severe cutaneous adverse reactions is warranted.