Moxifloxacin
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Skin rash: case report A woman in her early 60’s developed a skin rash during treatment with moxifloxacin for pulmonary disease due to Mycobacterium intracellulare. The woman presented in 2004, at the age of 49 years, with an initial symptom of dry cough. Her cough became productive 2 years later, involving haemoptysis. Later, in 2007, her productive cough persisted, and bronchiectasis was detected in the medial segment of the right middle lobe, which was subsequently resected. Thereafter, she became asymptomatic for several months. She was diagnosed with tuberculosis in 2008, in view of the finding of granuloma in the resected surgical section. Therefore, she started receiving the 2RHEZ4R2H2 regimen, involving daily administration of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months, followed by isoniazid and rifampicin, twice a week for 4 months. However, in spite of appropriate therapy, test results did not become negative for tuberculosis, and 5 years later, she re-presented with persistent cough, involving purulent and haemoptoic sputum. Analysis of her sputum revealed 2+ acid-alcohol fast bacilli; hence, she started receiving the 2RHEZ4R2H2 scheme again, but without becoming negative. This was declared as a treatment failure, and the possibility of multidrug-resistant (MDR) tuberculosis was considered. Cultures performed in 2013 identified Mycobacterium intracellulare. In 2014, she was treated with isoniazid, rifampicin, clarithromycin and ethambutol; however, the treatment was discontinued after the first dose because of a severe headache and tremor [aetiology not stated]. In 2015, she again consulted, and was treated with moxifloxacin [route and dosage not stated] and azithromycin, followed by ethambutol 2 weeks later. In 2016, she was diagnosed with depression, for which she started receiving amitriptyline. She also received omeprazole and cinitapride for severe gastrooesophageal reflux disease (GERD) symptoms, apart from non-pharmacological therapy, involving lifestyle modification (including a strict diet). During month 3 of therapy, three of her sputum tests were found to be negative for acid-fast bacilli. After 8 months of treatment, her cough subsided; hence, the treatment was discontinued. However, over the subsequent 18 months, her cough progressed and became productive, and she lost 3kg of weight. She developed mild haemoptysis; a new sputum test was found positive for acid-fast bacilli. Tests revealed lesions compatible with bronchiectasis and nodules. Therefore, in 2017, she resumed therapy for depression and GERD, and received the same regimen for Mycobacterium intracellulare. After 1 month of therapy, she gained 1kg, her cough decreased in severity and frequency, and her symptoms of depression subsided. However, she developed a skin rash due to moxifloxacin [duration of treatment to reaction onset not clearly stated]. Therefore, moxifloxacin was discontinued and replaced with amikacin. The woman’s rash resolved. By month 4 of therapy, she reported only a single episode of cou
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