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Levofloxacin/piroxicam Erythema multiforme: case report A 29-year-old woman developed erythema multiforme after oral challenge tests with piroxicam and levofloxacin [dosages not stated]. The woman had a history of pruritic skin eruptions and vesicles on the interphalangeal areas of her hands, palms and soles, and oedema on her tongue and oropharynx, after receiving cotrimoxazole [trimethoprim/sulfamethoxazole], ciprofloxacin, methenamine anhydromethylene citrate, piroxicam, azithromycin and ceftriaxone. Her mother had a history of a similar reaction after receiving cotrimoxazole. The woman had a history of recurrent urinary system infections and had been receiving oral antibacterials frequently. She was hospitalised for testing to be carried out. HLA typing for both her and her mother revealed common groups of HLA-A24, HLA-A18, HLA-C03, DRB1*11 and DQB1*03. Skin prick and intradermal tests with ampicillins, benzylpenicillin [penicillin G], amoxicillins and ceftriaxone were all negative. She had no reaction to an IM challenge with ceftriaxone. Oral challenge tests with phenoxymethylpenicillin [penicillin V], methenamine anhydromethylene citrate and clarithromycin were all negative. An oral challenge test with piroxicam was positive. She developed circular, hyperaemic lesions on her palm 21/2 hours after administration of piroxicam. The following day, she had bullous lesions on her tongue, oropharynx, palms and soles. The woman received methylprednisolone and short-acting antihistamines. A biopsy from a palm lesion revealed an erythema multiforme-type drug eruption. One week after the eruption, an oral challenge test was performed with levofloxacin to identify a safe alternative antibacterial. However, her healing erythema multiforme lesions were aggravated [time to reaction onset not stated]. As her history showed that she could use flurbiprofen, diclofenac and paracetamol [acetaminophen] safely, she was advised to use these drugs when she required NSAIDs or analgesics [patient outcome not stated]. Isik SR, et al. Multidrug-induced erythema multiforme. Journal of Investigational Allergology and Clinical Immunology 17: 196-198, No. 3, 2007 801092519 Turkey

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Reactions 1 Sep 2007 No. 1167