SYMMETRIC DRUG-RELATED INTERTRIGINOUS AND FLEXURAL EXANTHEMA (SDRIFE) INDUCED BY CIPROFLOXACIN

Abstract

<h3>Introduction</h3> Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) describes a symmetrical erythematous rash seen on gluteal and intertriginous areas after first or repeated exposure to systemic drugs. Although beta-lactam antibiotics are the most common causative agents, fluoroquinolones and topical medications have only rarely been implicated in SDRIFE. Here we describe a case of SDRIFE to ciprofloxacin. <h3>Case Description</h3> A 19-year-old male with microtia was treated for otitis externa. He had no prior history of reactions to antibiotics. He received one week of ciprofloxacin otic drops followed by the addition of oral amoxicillin and ciprofloxacin. After one dose of oral ciprofloxacin, he developed pruritus on his neck, chest, and ear and was subsequently admitted for intravenous (IV) sulfamethoxazole-trimethoprim and ciprofloxacin along with otic ciprofloxacin due to worsening otitis. After 2 doses of IV antibiotics, he developed a maculopapular pruritic rash over the decolletage and back with symmetrical eczematous plaques to bilateral axillae, posterior auricular folds, and neck. Despite discontinuing IV antibiotics, the rash initially worsened but rapidly improved after stopping otic ciprofloxacin. <h3>Discussion</h3> We report one of the few cases of flouroquinolone induced SDRIFE previously described only in patients receiving systemic therapy. In this case, exposure to topical fluoroquinolones continued to drive the hypersensitivity reaction despite discontinuing all systemic fluoroquinolones. Although fluoroquinolones and topically administered drugs remain less recognized culprits of SDRIFE, this case highlights the importance of avoidance of all forms of a culprit drug in patients with drug hypersensitivity.