68-year-old male patient was treated with polymyxin B for multidrug-resistant Klebsiella penumonia. He developed skin pigmentation as an adverse reaction to the drug.
This case study describes polymyxin B-induced skin hyperpigmentation in a 68-year-old male patient. The patient presented with complaints of swelling and pain in his right scrotum. On examination, the patient’s body temperature was 38.4°C. Findings on physical and radiological examinations were consistent with the diagnosis of right epididymitis with an abscess.
He was referred to the urological surgery department. Antibacterial therapy was started for 2 weeks. Treatment included resecting the right epididymis and abscess. However, 24 hours after the procedure, the patient went in septic shock and was transferred to the intensive care unit for treatment. Blood culture was suggestive of Klebsiella pneumoniae infection (KPI). The patient was prescribed cefepime, imipenem, piperacillin-tazobactam, and tigecycline. However, despite treatment, there was no improvement in his symptoms.
Diagnosis and treatment
The diagnosis was of multidrug-resistant Klebsiella pneumonia (KPI). He was administered Polymixin B, meropenem and tigecycline. On the 8th day of the therapy, a red, scattered, dotted and pruritic rash developed on the patient’s trunk and limbs. Similarly, on the 14th day, there was slight improvement in the pruritus, whereas the rash subsided. The patient’s skin colour changed from a normal yellow to slightly black colour. Doctors advised continuing polymyxin-B therapy, despite the adverse events for 17 days. Reason being the effectiveness of the drug against multidrug-resistant KPI. 7 days after the medication was withdrawn, the patient’s face and neck were completely black in colour. In addition, his scalp and feet were desquamated. This lasted for 10 days.
Cod liver oil ointment was being applied on the newly grown epidermis three times a day to lubricate it. The patient was told that the skin would fall off naturally. Moreover, he was advised to not peel it to prevent skin infection.
A nurse was assigned to care for the patient and daily note changes in hyperpigmentation. The patient’s doctor counselled him and his family regarding the psychological effects of the hyperpigmentation. Additionally, 24-days after Polymyxin B was withdrawn, the patient’s eyes and nose began fading significantly, including the whole face and neck. The hyperpigmentation on the face and neck resolved completely after 6 days of withdrawal of polymyxin B.
References
Polymyxin B-Induced Skin Hyperpigmentation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519980/
