Annals of Internal Medicine: Clinical Cases
Fluoroquinolone-Induced Bullous Pseudoporphyria in End-Stage Renal Disease
By Michelle Carrasquel-Alvarez, Ramalakshmi Thulluri, Khaleel Quasem and 2 others.
Abstract
Fluoroquinolones can cause phototoxic cutaneous reactions, including bullous pseudoporphyria, which mimics porphyria cutanea tarda but occurs without porphyrin abnormalities. Patients with end-stage renal disease (ESRD) are at higher risk due to impaired drug clearance. We report a 73-year-old woman on maintenance hemodialysis who developed painful, tense bullae on the dorsal hands within 24 hours of starting levofloxacin. Lesions progressed despite drug withdrawal, becoming hemorrhagic and necrotic. Porphyrin levels were normal, confirming pseudoporphyria. Management included drug cessation, wound care, photoprotection, and hydroxychloroquine, with resolution over 2 weeks. This case emphasizes antibiotic stewardship and recognition of rare fluoroquinolone-associated phototoxicity in ESRD patients.
Keywords
- Open access
Source
Published in Annals of Internal Medicine: Clinical Cases. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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