Multiple drugs

Abstract

Clostridium difficile diarrhoea, skin disorders and off-label use: 2 case reportsIn a study (Poland) involving 441 patients, who were diagnosed with Covid-19 between 15 March 2020 and 15 June 2020, two patients (1 man and 1 woman), aged 83-86 years were described, of whom an 83-year-old man developed Clostridium difficile infection (CDI) diarrhoea following treatment with ceftazidime, chloroquine and azithromycin, and developed erythematous rash, macular rash and pruritus following off-label treatment with chloroquine and azithromycin while an 86-year-old woman developed CDI diarrhoea following treatment with azithromycin (off-label), chloroquine (off-label), lopinavir/ritonavir (off-label), piperacillin/ tazobactam, ciprofloxacin and imipenem/cilastatin, and developed erythematous rash, macular rash, skin oedema and dermatitis exfoliative during treatment with azithromycin, chloroquine and lopinavir/ritonavir [dosages and times to reactions onsets not stated; not all routes and outcomes stated].An 83-year-old man was hospitalised with exacerbation of chronic obstructive pulmonary disease and SARS-CoV-2 infection. On admission, no dermal lesions was noted. On day 4 after introducing ceftazidime (because of fever and the picture of ground glass opacity visible in the CT of the chest), he developed diffuse erythematous infiltrated lesions within the trunk and limbs with the greatest severity on the back and buttocks. The dermal lesions were accompanied by pruritus. The use of clemastine [clemastinum] and clobetasol, and the discontinuation of ceftazidime in further treatment resulted in the marked reduction of dermal lesions and pruritus. Histopathological investigation revealed lesions within the epidermis, characterised by local acanthosis and atrophy. Hyperkeratotic lesions were noted on the surface of the mass and while elastosis or the features of skin atrophy were seen in the stromal layer. Numerous thin-walled vessels and perivascular inflammatory infiltrations of mononuclear cells and eosinophils were present subepidermally. The microscopic picture was suggestive of atrophic lesions, which may have been drug-induced. He was taking an unspecified proton pump inhibitor (PPI) due to dyspepsia. During his hospital stay, he was taking off-label chloroquine and off-label azithromycin for SARS-CoV-2 infection from the start of his hospitalisation. He developed diarrhoea (defined as >3 loose bowel movements) on day 3 of hospitalisation, and was diagnosed with CDI. CDI risk factors included age, hospitalisation, presence of comorbidities, proton pump inhibitor and antibiotic therapy. Vancomycin treatment was started. He had developed CDI diarrhoea due to ceftazidime, chloroquine and azithromycin, and erythematous rash, macular rash and pruritus due to chloroquine and azithromycin.An 86-year-old woman had hypertension, brain injury of vascular origin and two myocardial infarctions. She was admitted with confirmed SARS-CoV-2 infection, and the symptoms of an urinary tract infection. On admission she presented no der...