Antituberculosis Drug-Induced Fixed Drug Eruption: A Case Report.

Fixed drug eruption (FDE) was caused by fixed-dose combination (FDC) of antituberculosis drugs in the form of tablet Forecox® (rifampicin [rifampin] 225 mg + isoniazid 150 mg + pyrazinamide 750 mg + ethambutol 400 mg) in a 40-year-old male patient with a history of drug allergy. The patient developed FDE after taking the third dose of tablet Forecox® for pulmonary tuberculosis. Tablet Forecox® was withdrawn and the patient recovered from the reaction after 15 days of treatment for FDE. As per World Health Organization-Uppsala Monitoring Centre (WHO-UMC) and Naranjo causality assessment criteria, the association between the reaction and tablet Forecox® was possible and probable, respectively. The reaction was moderately (Level 4b) severe according to the Modified Hartwig and Siegel scale. As there is an increased risk of allergic reaction in patients with a history of drug allergy, FDCs should not be used in order to avoid complexity in identifying the culprit drug.

Cyclophosphamide and/or Anthracyclines Induced Epiphora in Breast Cancer Patients: A Rare Side-effect.

BACKGROUND: Two female breast cancer patients developed epiphora after administration of cyclophosphamide and/or anthracyclines based 2-day chemotherapy regimen. An ophthalmologist was consulted and no apparent cause was found. CASE DESCRIPTION: Patients were managed by ciprofloxacin eye drops. Chemotherapy induced ocular complications are not uncommon, but under reported. Although epiphora is a mild reaction, if severe however, it can interfere with daily activities. Patients having chemotherapy induced ocular toxicity should go for ophthalmic examination to pick up ocular adverse effects of anticancer drugs and treat them at an early stage.

Cephalosporins Associated Pseudomembraneous Colitis in an Elderly Male Patient - A Case Report.

INTRODUCTION: Incidence of antibiotic- associated diarrhoea is a common (10-30%) but pseudomembranous colitis (PMC) is less frequent (1-5%). Fluoroquinolones, clindamycin, penicillins, cephalosporins (mostly third generation) are commonly associated with PMC. The association between cephalosporins and PMC is now well established. CASE PRESENTATION: A 78 year old male patient developed pseudomembraneous colitis after administration of Ceftriaxone and Cefazoline for the treatment of pleural effusion. The reaction was confirmed by ultrasonography and CT scan. Causative agents were stopped and patient was managed by systemic therapy. Patient was expired due to respiratory complications as there was complexity in management of disease due to development of pseudomembraneous colitis. CONCLUSION: Increase awareness of prescribers for high-risk drugs, close monitoring, with immediate withdrawal of the culprit drug can reduce the complexity of management that occur due to development of such adverse drug reaction.

Metronidazole and Norfloxacin induced Generalized Fixed Drug Eruptions in an adult male patient - A Case Report.

INTRODUCTION: Fluoroquinolones are most widely used for empirical treatment of gastrointestinal disease due to emergence of drug resistant strains to other antimicrobials. They are also indulged in cutaneous adverse drug reactions with varying form of severity. CASE PRESENTATION: A 43 year old male patient developed fixed drug eruptions after administration of tablet norfloxacin and metronidazole for treatment of colicky abdominal pain with diarrhoea. Erythematous rashes involved whole body including buccal mucosa. Causative drugs were stopped and patient was managed by local as well as systemic therapy and was recovered after 20 days. CONCLUSION: Awareness among healthcare professionals regarding FDEs and its management is essential to prevent mortality and morbidity and counsel patient regarding future use of drugs causing reactions with physician's advice.

Steroid Induced Bilateral Avascular Necrosis of Head of Femur in an Adult Male Patient - A Case Report.

A 28 year old male patient, known case of pemphigus vulgaris was on dexamethasone pulse therapy. Total 7 pulses were given after that he developed avascular necrosis of head of femur on both sides, which was confirmed by digital X- ray and MRI. Avascular necrosis is a disabling and progressive condition in young patients gradually leads to femoral head collapse and eventual total hip arthroplasty. As per WHO-UMC causality assessment criteria, the association between reaction and drug was possible, Naranjo's score was 7. According to Modified Schumock and Thornton's criteria, this reaction was not preventable. The Modified Hartwig and Siegel's scale showed that the reaction was severe (level 6). Here we present a case where the use of steroid for pemphigus vulgaris resulting in the development of bilateral avascular necrosis of head of femur.