Ciprofloxacin-induced Stevens-Johnson Syndrome with Grapefruit Juice Consumption: A Case Report
| Autor: | Nathan Sherman, Matthew G Cravens, Jennifer Sawaya |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
food.ingredient medicine.drug_class Urology Antibiotics Dermatology 030204 cardiovascular system & hematology Grapefruit juice 03 medical and health sciences 0302 clinical medicine food ciprofloxacin Medicine Antibiotic prophylaxis Body surface area CYP3A4 business.industry General Engineering Vasectomy food and beverages Stevens johnson Ciprofloxacin stomatognathic diseases cytochrome p450 sjs stevens-johnson syndrome business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | We describe the case of a 49-year-old, otherwise healthy, Hispanic male who underwent an uncomplicated vasectomy and was treated prophylactically with a one-week course of ciprofloxacin. Two days after completing the antibiotic course, he developed a pruritic, blistering rash that covered 90% of his body surface area. Punch biopsy of the skin lesions confirmed the diagnosis of Stevens-Johnson syndrome (SJS). Upon further questioning, it was revealed that the patient had consumed approximately 32 ounces of grapefruit juice each of the seven days following his vasectomy. We hypothesized that the cytochrome P450 inhibitory effect of grapefruit juice had dramatically elevated systemic levels of ciprofloxacin, increasing the risk of developing SJS. Literature review revealed that ciprofloxacin is metabolized primarily by CYP1A2 with partial CYP3A4 metabolism, while grapefruit juice is strictly an enterocyte CYP3A4 inhibitor. To the authors' knowledge, consumption of grapefruit juice has never been demonstrated to increase systemic levels of ciprofloxacin or of other fluoroquinolones. We conclude that either this is the first reported case of a grapefruit juice-ciprofloxacin interaction causing SJS, or that this is simply ciprofloxacin-induced SJS. Importantly, ciprofloxacin is not recommended by the American Urological Association for a routine vasectomy without risk factors for infection. We remind clinicians that inappropriately prescribed antibiotic prophylaxis for routine procedures can cause serious morbidity, including SJS, and should only be prescribed when indicated. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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