Publication date: Available online 12 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): E. Garval, V. Vuiblet, A. Durlach, G. Perceau, D. Anuset, P. Bernard
IntroductionLe méropénème (carbapénème) est un antibiotique rarement prescrit. Des effets secondaires cutanés ont été rapportés à type d'exanthème, de prurit, d'urticaire et de syndromes de Lyell ou de Stevens–Johnson. La lévofloxacine (fluoroquinolone), antibiotique largement prescrit, partage les mêmes effets secondaires cutanés, auxquels s'ajoute une action photosensibilisante. Nous rapportons un cas d'hyperpigmentation cutanée noirâtre induite par l'association de méropénème et de lévofloxacine.ObservationUn homme de 67 ans était traité par méropénème (1g×4/j), lévofloxacine (500mg×2/j) et amikacine (500mg/j) pendant 2 semaines, puis méropénème, lévofloxacine et rifampicine (600mg×2/j) pendant 4 semaines, pour une ostéite du cinquième métatarsien. Trois semaines après le début de l'antibiothérapie, une pigmentation noirâtre apparaissait, prédominant à la face antérieure des jambes. La biopsie cutanée révélait un dépôt noirâtre du derme superficiel et moyen, périvasculaire et interstitiel, coloré par les colorations de Fontana et de Perls. L'étude en microspectroscopie infrarouge permettait d'identifier la molécule de méropénème dans le derme. Après arrêt des antibiotiques, la pigmentation régressait lentement.DiscussionDes cas similaires d'hyperpigmentation cutanée noirâtre ont été rapportés après utilisation de minocycline. Dans ces cas, l'analyse histologique montrait également des dépôts dermiques de fer et/ou de mélanine, mais la nature du pigment responsable restait incertaine. Dans notre cas, l'analyse en spectroscopie infrarouge a permis de localiser le méropénème dans le derme. Deux cas d'hyperpigmentation cutanée ont été rapportés après utilisation de la lévofloxacine, avec une analyse histologique similaire.BackgroundVarious cutaneous side–effects, including, exanthema, pruritus, urticaria and Lyell or Stevens–Johnson syndrome, have been reported with meropenem (carbapenem), a rarely-prescribed antibiotic. Levofloxacin (fluoroquinolone), a more frequently prescribed antibiotic, has similar cutaneous side–effects, as well as photosensitivity. We report a case of cutaneous hyperpigmentation induced by meropenem and levofloxacin.Patients and methodsA 67-year-old male was treated with meropenem (1g×4 daily), levofloxacin (500mg twice daily) and amikacin (500mg daily) for 2 weeks, followed by meropenem, levofloxacin and rifampicin (600mg twice daily) for 4 weeks for osteitis of the fifth metatarsal. Three weeks after initiation of antibiotic therapy, dark hyperpigmentation appeared on the lower limbs, predominantly on the anterior aspects of the legs. Histology revealed dark, perivascular and interstitial deposits throughout the dermis, which stained with both Fontana–Masson and Perls stains. Infrared microspectroscopy revealed meropenem in the dermis of involved skin. After withdrawal of the antibiotics, the pigmentation subsided slowly.DiscussionSimilar cases of cutaneous hyperpigmentation have been reported after use of minocycline. In these cases, histological examination also showed iron and/or melanin deposits within the dermis, but the nature of the causative pigment remains unclear. In our case, infrared spectroscopy enabled us to identify meropenem in the dermis. Two cases of cutaneous hyperpigmentation have been reported following use of levofloxacin, and the results of histological examination were similar. This is the first case of cutaneous hyperpigmentation induced by meropenem.
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Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com
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Πέμπτη 12 Οκτωβρίου 2017
Hyperpigmentation cutanée induite par le méropénème et la lévofloxacine
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- Editorial board
- Impacts of ozone air pollution and temperature ext...
- Temporal multiscaling characteristics of particula...
- Characterization of atmospheric black carbon and c...
- Observations of biomass burning tracers in PM2.5 a...
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- Oral surgery: The drug holiday
- NHS FP17 form printing error
- Dental radiography: Short roots
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- Top 5 most talked-about BDJ articles of the year
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- Book Review: Evidence-Based Caries Prevention
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