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Letter to the Editor DOI: 10.7241/ourd.20132.59 PETECHIAE - ADVERSE REACTIONS TO CIPROFLOXACIN Anca Chiriac 1 , Anca E. Chiriac 2 , Tudor Pinteala 3 , Liliana Foia 2 , Caius Solovan 4 , Piotr Brzezinski 5 Source of Support: Nil Competing Interests: None 1 Nicolina Medical Center, Department of Dermatology, Iasi-Romania 2 University of Medicine, Gr T Popa, Iasi-Romania 3 Imperial College London, UK 4 University of Medicine, V Babes Timisoara, Romania 5 Dermatological Clinic, 6th Military Support Unit, Ustka, Poland Corresponding author: Anca Chiriac, MD PhD ancachiriac@yahoo.com Our Dermatol Online. 2013; 4(2): 241-242 Date of submission: 30.12.2012 / acceptance: 01.02.2013 Cite this article: Anca Chiriac, Anca E. Chiriac, Tudor Pinteala, Liliana Foia, Caius Solovan, Piotr Brzezinski: Petechiae - adverse reactions to Ciprofloxacin. Our Dermatol Online. 2013; 4(2): 241-242. Sir There are many dermatological adverse reactions to Ciprofloxacin reported in the literature: allergic reaction, pruritus, urticaria, photosensitivity/phototoxicity reaction, flushing, fever, chills, angioedema, edema of the face, neck, lips, conjunctivae or hands, cutaneous candidiasis, hyperpigmentation, erythema nodosum, sweating [1-5]. We report a case of petechiae appeared 24 hours after the initiation of Ciprofloxacin treatment for urinary infection,with long lasting evolution, despite the immediate withdrawal of the medication.The petechiae were present on the lower limbs, with intense pruritus, no systemic reactions. Case presentation A 65-year-old woman, with a history of chronic urinary infections, for the first time treated with Ciprofloxacine 500mg twice daily, presented to our Department for the sudden onset (24 hours before the admission to the hospital) of a petechial rash on the lower limbs (Fig. 1a, 1b). No fever, no gastro-intestinal symptoms, just a slight pruritus on the site of the lesions. She was in good health state and she reported the first cutaneous manifestations after the second intake of the drug. All the laboratory parameters were within normal range (no thrombocytopenia). The medication was stopped and the patient was under observation and a short course of antihistamines, with wonderful results, but only after 21 days after the withdrawal of Ciprofloxacine therapy. Figure 1 a,b. Petechiae on the lower limbs www.odermatol.com © Our Dermatol Online 2.2013 241
Discussions Ciprofloxacin is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with ciprofloxacin are rare with an incidence of 0.6% (Tabl. I). It is well known that Fluoroquinolones can induce drugdependent, platelet-reactive antibodies causing complementmediated destruction of platelets and thrombocytopenia [1], but it was the case of our patient who had a normal number of platelets. Also there have been reported a few cases of photo exposed purpuric eruptions during treatment with Ciprofloxacine [2], but our patient denied any exposure to sun or UV light and it was winter when the diagnosis of petechias induced by Ciprofloxacine was made [5]. There are few reports on petechial adverse reaction to Ciprofloxacine therapy and we want to aware clinicians about this possible side effect of this widely use medication. Adverse reaction (L Mandell 2002) Range of incidence (%) Gastrointestinal (diarrhea, vomiting) 0.8 - 6.8 Central nervous system (dizziness, headache) 0.9 - 11 Skin (rashes) 0.4 - 2.1 Blood disorders 0.5 - 5.3 Cardiovascular (palpitations) 0.5 - 2.0 Musculoskeletal 0.5 - 2.0 Phototoxicity or photoallergy 0.5 - 2.1 Serious reactions, eg, hemolytic uremic syndrome, Stevens Johnson syndrome
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Volume 4, Number 2, April 2013 ISSN
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Editorial Board: Abdel-Naser Mohame
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CONTENTS E d i t o r i a l O r i g
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Original Article DOI: 10.7241/ourd.
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Figure 1. Survival time of HIV/TB-
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Figure 3. A. melanocytic naevus on
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82% of the children belonged to the
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Comment to the article DOI: 10.7241
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The skin around body openings such
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Figure 1. Finger nail dystrophy in
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Comment to the article DOI: 10.7241
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Similar type of rash was also prese
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13. Mastaglia FL, Ojeda VJ: Inflamm
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Figure 1. Atrophic areas on left up
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5. Brocard A, Quereux G, Moyse D, D
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Figure 1. Macroglossia Figure 2. Ma
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Case Report DOI: 10.7241/ourd.20132
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Figure 4a, b. Skin biopsy shows hyp
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Discussion Poikiloderma of Civatte
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Page 50 and 51: Comment to the article DOI: 10.7241
Page 52 and 53: Case Report A 56 year old Caucasian
Page 54 and 55: Using a battery of neurotoxic agent
Page 56 and 57: Figure 1. Multiple lesions on the u
Page 58 and 59: Case Report DOI: 10.7241/ourd.20132
Page 60 and 61: Figure 1. a PAS positive accentuati
Page 62 and 63: The patient was put on melanocyl 0.
Page 66 and 67: The type of treatment prescribed by
Page 68 and 69: On the basis of these clinical find
Page 70 and 71: Surgery has been reported to be the
Page 72 and 73: Figure 1. Histological section show
Page 76 and 77: Discussion The breast location of t
Page 78 and 79: Figure 2. The epithelial nests show
Page 82 and 83: Discussion SCACP is one of the cuta
Page 84 and 85: Figure 1. Tumor of the nasal colume
Page 86 and 87: Figure 2. Vesicles and crusts aroun
Page 88 and 89: Outbreaks have occurred recently in
Page 90 and 91: Clasificación En base al epitelio
Page 92 and 93: - Microcefalia, hipoplasia mediofac
Page 94 and 95: Caso Nº 3: · Niña, edad desconoc
Page 96 and 97: Clinical Images DOI: 10.7241/ourd.2
Page 98 and 99: Figure 7. Fixed cutaneous sporotric
Page 102 and 103: Historical Article DOI: 10.7241/our
Page 104 and 105: Figure 6. Henri Mondor (1885-1962).
Page 108 and 109: Figure 5. Alfred Guido Miescher (18
Page 112 and 113: Names of ''Lines'', in dermatology
Page 114 and 115: Figure 1. Erik Adolf von Willebrand
Page 116 and 117: THOMAS INMAN English physician, 182
Page 118 and 119: There are three type of tinea capit
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