Blue-Black Pigmentation of Legs and Arms in a 68-Year-Old Woman—Quiz

López-Pestaña, A.; Tuneu, Anna; Lobo, Carmen; Zubizarreta, J.; Eguino, Patricia

doi:10.1001/archderm.143.11.1441-b

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…The mechanisms responsible for this hyperpigmentation include drug metabolite deposits, precipitation of intracellular iron chelate complexes within macrophages, and increased intracellular melanin production [ 4 , 6 , 8 ]. A review of the medical literature via PubMed revealed only four reported cases of levofloxacin-induced cutaneous hyperpigmentation—all confirmed by biopsy [ 2 – 5 ]. On review of these cases, three patients were on oral levofloxacin therapy for more than four weeks [ 2 , 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Levofloxacin-Induced Acute Hyperpigmentation Changes in a Chronic Kidney Disease Patient

Patil

Campbell

et al. 2020

Case Reports in Medicine

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Medication-induced cutaneous hyperpigmentation has variable clinical presentations and is dependent on the specific drug involved. Most commonly, an attentive patient observes such changes early in the course; when missed by the patient, such changes are usually noted by an observant clinician. Clinical diagnosis can be challenging if the patient is on multiple medications because other causes must be excluded. This condition occurs via multiple mechanisms. Frequently, the pigmentary change is reversible with discontinuation of the drug. Causative medications include nonsteroidal; anti-inflammatory agents, antimalarials, antibiotics, psychotropics, amiodarone, and chemotherapeutic agents. The; antimicrobials responsible for hyperpigmentation are antimalarials, tetracyclines, tigecycline, dapsone, rifampicin, and antiretrovirals such as zidovudine. Sunlight exposure can worsen the pigmentation seen with some of the above antimicrobials (e.g., dapsone). Here, we describe an older adult white woman presenting with acute cutaneous; hyperpigmentation of the bilateral lower extremities while on levofloxacin therapy. Hyperpigmentation resolved after cessation of the agent. Our case highlights this unique acute presentation after only a few days of oral levofloxacin.

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Section: Discussionmentioning

confidence: 99%

“…Although uncommon, skin reactions typically include rashes [ 1 ]. Upon review of the medical literature in PubMed, only four cases of levofloxacin-induced cutaneous hyperpigmentation have been reported [ 2 – 5 ]. In most of these cases, the duration of levofloxacin was more than one week, and typically on the order of months.…”

Section: Introductionmentioning

confidence: 99%

Levofloxacin-Induced Acute Hyperpigmentation Changes in a Chronic Kidney Disease Patient

Patil

Campbell

et al. 2020

Case Reports in Medicine

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“…Literature reviews have shown that 10-20 % of cases of cutaneous hyperpigmentation are related to adverse drug effects. Such agents include gyrase inhibitors for which, however, only individual case reports are available [1][2][3][4][5][6][7][8] . Cutaneous discoloration has frequently been described in association with minocycline treatment [ 3,8,9 ] , which is commonly characterized by irreversible blackening of the skin, teeth, or sclera due to oxidation.…”

mentioning

confidence: 99%

“…There are only few individual reports of levofl oxacin-associated cutaneous hyperpigmentation in the published literature. López-Pestaña et al reported on a 68-year-old female patient who had developed hyperpigmentation starting on the lower legs one month after initiation of levofl oxacin therapy; following treatment cessation, the hyperpigmentation spontaneously resolved [ 1 ] . Likewise, Lorente et al published hyperpigmentation occur during treatment of a bacterial infection, the regimen should be switched according to antibiogram results.…”

mentioning

confidence: 99%