Drug-related Rash Caused by Levofloxacin

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

A 55-year-old CM was admitted from the ER with chief complaint of generalized maculopapular rash for 2 days. He was diagnosed with a sinus infection and was prescribed Levaquin (levofloxacin) 2 weeks ago. He has been weak and tired and has had aching pain in his joints especially in fingers and knees. Two days before the admission, he broke out in a rash that started under his arms and in thegluteal fold and then spread to his trunk, back and neck. He has itching but no blisters. He denies any new medications apart from Levaquin, soaps or detergents or any change in food. The patient denies abdominal pain, chest pain, congestion, coryza, diarrhea, dysuria, ear pain and vomiting.

PMH

Hyperlipidemia.

Allergies

Penicillin (rash).

Medications

Lipitor, ASA, MVT, levofloxacin.

Physical examination

VSS.
HEENT: External ears normal. Canals clear. TM's normal. Nasal mucosa normal. No drainage or sinus tenderness. Lips, tongue normal. Oropharynx clear.
Neck: supple, no adenopathy.
CVS: RRR, normal S1/S2, no m/r/g.
Chest: CTA (B).
Extremities: no c/c/e.
Skin: maculopapular rash on neck, back, trunk, arms, and perineal area.

What is the most likely diagnosis?

Drug-related rash caused by levofloxacin.

What test would you order?

CBC+DIFF
CMP
CXR
UA
ESR, CRP

What happened?


Figure 1. Eosinophilia in a drug-related rash.

CBCD showed eosinophilia of 5-6%. The patient's rash resolved spontaneously in 2 days, the rest of the workup was negative and he was discharged home with instructions not to take fluoroquinolone antibiotics.


Figure 2. Development and resolution of eosinophilia in a drug-related rash.

Final diagnosis

Drug-related rash caused by levofloxacin.

References

Adverse Reactions to Drugs: A Short Review. V. Dimov. Clinical Notes in Allergy and Immunology.
Practical Aspects of Choosing an Antibiotic for Patients with a Reported Allergy to an Antibiotic. Joan L. Robinson, Tahir Hameed, and Stuart Carr. Clinical Infectious Diseases 2002;35:26–31.

Multiple choice questions

Chapter 57: Drug Allergy. Allergy and Immunology Review Corner: Chapter 57 of Pediatric Allergy: Principles & Practices, edited by Donald Y.M. Leung, et al.

Published: 09/17/2007
Updated: 07/17/2009