A case report on angioedema induced by levofloxacin: an unexpected occurrence

Abstract

Angioedema is an abrupt swelling of the skin, mucous membrane, or both. It can be either food or drug induced. Drug induced Angioedema (allergic or non-allergic) is known with ACE inhibitors, NSAIDs, Beta-lactams. Levofloxacin is a well-tolerated, broad-spectrum fluoroquinolone commonly prescribed for urinary or respiratory tract infections. Common side effects with levofloxacin involve gastrointestinal tract. However, reports on Levofloxacin induced Angioedema are scarce. Hence, we report two cases of Levofloxacin induced Angioedema. In both the cases, patients developed swelling of face following ingestion of Tab. Levofloxacin 500 mg orally BD on previous day. Drug was prescribed for urinary or respiratory infection. After a provisional diagnosis of Levofloxacin induced Angioedema by the dermatologist, both the patients were asked to withdraw the drug immediately. The reaction was treated with Inj. Avil (Pheniramine maleate) 1 cc i.v. stat and Inj. Dexona (Dexamethasone) 2 cc i.v. stat in one patient whereas oral corticosteroid (Tab. Prednisolone 10mg orally OD with tapering dose) was used in second patient. Oral antihistaminics were also prescribed as per the necessity. Both patients recovered within 4-7 days. Both ADRs were uploaded via Vigiflow under Pharmacovigilance Programme of India (PvPI) with likely relationship between suspected drug and ADR. Incidence of Drug induced cutaneous ADRs (CADRs) in India is 2.85%. Instances of hypersensitivity or anaphylactic reactions with fluoroquinolones are much lesser and milder than with NSAIDs or Beta-lactams. These reactions are associated with quinolone-specific Ig E. Existence of cross reactivity with quinolones is also high. This property is due to a similar ring (4-oxo-1, 4-dihydroquinoline ring) possessed by all fluoroquinolones. This allergic angioedema confined to the skin can be treated with antihistaminics or glucocorticoids.