Levofloxacin-induced fixed drug eruption

Fixed drug eruption is a distinctive cutaneous adverse drug reaction characterised by the recurrence of well-demarcated lesions at the same anatomical site following re-exposure to the offending drug, with residual hyperpigmentation after resolution. Antimicrobials are common triggers, although fluoroquinolones are less frequently implicated. A man in his 30s developed multiple well-defined hyperpigmented patches involving the upper lip, upper limbs and foot within 24 hours of receiving levofloxacin for a lower respiratory tract infection. The lesions were pruritic, non-tender and recurrent at previously affected sites. Clinical findings and a clear temporal relationship supported the diagnosis of fixed drug eruption. Withdrawal of levofloxacin and symptomatic treatment resulted in gradual resolution with post-inflammatory hyperpigmentation. Causality assessment using the Naranjo scale suggested a probable association. This case highlights the importance of recognising fixed drug eruption caused by commonly prescribed antibiotics and the role of careful drug history taking and adverse drug reaction reporting.