Ciprofloxacin-induced erythema multiforme
A 40-year-old female patient reported to our clinic with complaints of painful ulcers, hemorrhagic crusts on the lips and fever. Patient also reported with conjunctival soreness and multiple, erythematous, discrete, confluent blanchable macules and papules all over the body since four days. Because patient had the history of urinary tract infection, she had been using ciprofloxacin. The presentations of the patient were strongly correlated with the intake of ciprofloxacin, as the signs and symptoms have started appearing four days after intake of ciprofloxacin. The patient was advised to discontinue ciprofloxacin. Two days after discontinuation of the drug, the patient developed bullous lesions and bullae on lips, which subsequently ruptured to leave large raw painful areas followed by crustations of lips []. The patient's family history was non-contributory. The hemoglobin estimation, total and differential WBC count, ESR, chest X-ray, and blood sugar were all within normal limits. The patient was advised tab. prednisone 20 mg two times daily and tab paracetamol 500 mg three times daily for 1 week. After 1 week steroid dose was tapered and patient was recalled. After 15 days of prescription, there was complete resolution of swelling and crustations on the lips []. The patient was kept under observation for 2 months; in this period there was no recurrence. Naranjo algorithm theory explains and scales the adverse drug reactions associated with the drugs. In this case, Naranjo score is 6 in association with the drug ciprofloxacin.[]