SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), a rare inflammatory disorder, is an association of distinct skin disorders with pustules with osteoarticular inflammation. Its etiology remains unclear, and various treatment regimens frequently fail to control the disease. An 18-year-old male patient presented to the outpatient department with severe nodulocystic acne on the face with pain at both the wrists and lower back associated with high-grade fever and chills. On physical examination, he had severe tenderness at both wrist joints and lower back, along with swelling of right wrist. Magnetic resonance imaging revealed osteitis of the distal end of the right radius. Technetium-99m-MDP Whole Body Bone Scan revealed increased metaphyseal uptake in distal radius on both sides and prominent uptake at the sacroiliac joints, vertebral end plate, left 7th costo-vertebral joint and bilateral sternoclavicular joints and manubrium sternum (resulting in “bull's head” sign, which is characteristic of SAPHO syndrome). He responded very well to a combination therapy of nonsteroid anti-inflammatory drugs, antibiotics, colchicine, and isotretinoin over a 12-week period.

Ofloxacin is a second-generation fluoroquinolone and is highly effective against a wide range of bacterial infections. Fluoroquinolones are well-tolerated drugs with mild-to-moderate adverse effects such as gastrointestinal disturbances, skin reactions, and neurological reactions. These are widely used antimicrobials, which can cause cutaneous ADRs in about 1%–2% of patients. Hypersensitivity reactions due to ofloxacin are found rarely, ranging in frequency from 0.4% to 2%, respectively. This case report highlights one such event of cutaneous ADR by the use of ofloxacin injection causing Injection site reaction after a few minutes of Ofloxacin infusion. Based on history and clinical examination patient was diagnosed as ofloxacin induced hypersensitivity reaction and was successfully treated with antihistamines and corticosteroids. General management of ADR includes withdrawal/suspension, dose reduction of the suspected drug, and administration of supportive therapy. In this case, the suspected drugs were withdrawn and the patient was treated symptomatically. Pharmacovigilance should be a part of patient care to reduce the occurrence of adverse drug reactions and also encourage practitioners in reporting to gather more and more data regarding adverse drug reactions. Due to the rarity of Ofloxacin induced ADRs this article sheds light on one of such cases to help in pharmacovigilance