Pediatric fixed drug eruption: A case report of ofloxacin as the culprit

Abstract

Ofloxacin, a second-generation fluoroquinolone, is a relatively rare but documented cause of fixed drug eruption (FDE). FDE is a localized cutaneous hypersensitivity reaction that is marked by recurrent, welldemarcated erythematous patches or macules, which may develop into blisters upon re-exposure to the offending agent. The underlying mechanism is immune-mediated and involves T-cell activation, cytokine release, and keratinocyte apoptosis. A 5-year-old boy weighing 15 kg was prescribed ofloxacin syrup (7.5 mL twice daily) and paracetamol suspension (5 mL twice daily) for suspected enteric fever. Within 2 days, the patient developed several annular erythematous lesions on his hands and back, which were associated with intense itching, thus raising suspicion of a drug-induced hypersensitivity reaction. Because both medications are potential triggers, a thorough clinical evaluation, including detailed history and, if necessary, patch testing, was considered essential to identify the offending agent. The suspected drug was immediately discontinued, and an alternative antibiotic was selected to manage the infection without intensifying the skin reaction. The management involved symptomatic relief with topical corticosteroids and antihistamines. This case highlights the importance of the early recognition and careful evaluation of adverse cutaneous drug reactions in children. Prompt identification and documentation of such events are critical in ensuring patient safety, guiding future therapy, and enhancing pharmacovigilance practices.