Polymyxin B-induced skin hyperpigmentation: a rare case report and literature review

Abstract

BackgroundPolymyxin B (PMB), which is regarded as the ultimate antibacterial treatment against some intractable gram-negative bacteria with its outstanding anti-bacterial activities, inflicts several adverse effects on patients. However, skin hyperpigmentaion (SH) induced by PMB is very rare. Here, we report a case of polymyxin B-induced skin hyperpigmentation (PMB-iSH) in a 21-year-old female. To the best of our knowledge, this is the first case of PMB-iSH in China.Case presentationA 21-year-old female patient with sepsis received the administration of PMB by intravenous injection for the treatment of multi-drug resistant Klebsiella pneumoniae (MDR-KP) infection. She later suffered from a rare adverse drug reaction (ADR), namely PMB-iSH, after 5-day PMB administration during her treatment. There were multiple red rashes spread on the whole body skin at first. With the rashes fading away, SH with dark round spots appeared, associated with no pain or pruritus. The skin of the head and neck was darkened evidently, and dark brown spots were spread on the skin of trunk and limbs. About a month after her admission, urged by the relatives, the patient was transferred back to the local hospital for further treatment in the end, and her skin color didn’t recover to the previous state at that time.ConclusionBoth our case and the literature review highlight that PMB can give rise to SH indeed. Clinicians and pharmacists should attach great importance to this rare pigmentary disorder and further investigation is warranted.

An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

“…The non-infectious causes of hyperpigmentation include drug associated reactions. Some drugs could be involved here, including the antiretro viral drug, interferon alfa, non steroidal anti inflammatory drugs, anti hypertensive, antimalarial drugs, and antibiotics [47][48][49][50]. .Some forms of postinflammatory hyperpigmentation are more obvious in people with darker skin colors [17].…”

“…All patients with Koplik's spot had positive anti-measles Ig M. This spot was not sensitive because many participants in our study came while rashes had already spread all over their bodies. The Koplik's spots are usually seen since 1-2 days before until 1-2 days after the onset of the first rash [11,15,35,50]. Other researches found that only 47.4% of the total participants had Koplik's spots, with a specificity of 86.1% [62].…”

Cutaneous Hyperpigmentation Secondary to High-Dose Tigecycline: A Case Report

“…Other concomitant medications such as omeprazole and colistin have been reported to induce skin discolorations. 12 , 13 However, their continuation during the evident improvement in skin color lessens their likelihood of involvement in the observed hyperpigmentation. An unreported drug–drug interaction developing at high levels of tigecycline could be another explanation of the cutaneous discoloration in our patient.…”

Skin Hyperpigmentation in Coronavirus Disease 2019 Patients: Is Polymyxin B the Culprit?

“…Healthcare workers should be aware of this rare adverse event, and skin color changes should be monitored frequently. Higher concentration of polymyxin B may be relevant to skin darkening in some studies (Zheng et al, 2018). Once polymyxin B induced skin hyperpigmentation was observed, it was crucial to make dose adjustment or replace it with an alternative medication regimen.…”

“…Reports of polymyxin B associated skin hyperpigmentation in adults were rare, unlike in neonates ( Zavascki et al., 2015 ; Gothwal et al., 2016 ). Polymyxin B is mainly excreted through the kidney, dosage adjustment is required in patients with lower creatinine clearance ( Zheng et al., 2018 ). The cumulation of polymyxin B might be a possible reason for skin hyperpigmentation in neonates due to their immature kidney function ( Gothwal et al., 2016 ; Li et al., 2020 ).…”