Ciprofloxacin-associated Pruritic Erythematous Cutaneous Eruption in a Young Adult with Bilateral Epididymo-orchitis: A Case Report
Sriram Thirunavukkarasu *
Department of Pharmacy Practice, P.G.P College of Pharmaceutical Science and Research Institute Affiliated with The Tamil Nadu Dr. M.G.R. Medical University, Namakkal, Tamil Nadu, India.
*Author to whom correspondence should be addressed.
Abstract
Aims: To describe a suspected ciprofloxacin-associated pruritic erythematous cutaneous adverse drug reaction in a young adult with bilateral epididymo-orchitis and to assess the probability of a causal relationship using the Naranjo Adverse Drug Reaction Probability Scale, while highlighting the importance of pharmacovigilance and antimicrobial susceptibility-guided therapy.
Presentation of Case: A 22-year-old male presented with fever, bilateral testicular swelling and scrotal pain, and was diagnosed with bilateral epididymo-orchitis. Laboratory evaluation showed leukocytosis (15.6 × 10³/µL; neutrophils 81%), and urine culture isolated Escherichia coli resistant to ciprofloxacin/ofloxacin. During hospitalisation, intravenous ciprofloxacin 200 mg twice daily was administered with other antimicrobial and supportive therapy. On day 6 of ciprofloxacin exposure, the patient developed pruritus with an erythematous skin eruption. The clinical photograph demonstrated erythematous changes without clearly identifiable wheals; hence, the reaction was characterised as a pruritic erythematous cutaneous eruption rather than definitive urticaria or fixed drug eruption. The Naranjo Adverse Drug Reaction Probability Scale yielded a score of 7, indicating a probable adverse drug reaction.
Discussion: The case illustrates the diagnostic challenge of accurately classifying drug-related skin reactions based on clinical morphology and incomplete documentation of latency and isolated dechallenge. The concurrent isolation of ciprofloxacin-resistant E. coli adds an important antimicrobial-stewardship dimension, highlighting the need for culture-guided reassessment of antimicrobial therapy alongside suspected adverse reactions.
Conclusion: This case highlights the value of precise cutaneous reaction characterisation, structured causality assessment, pharmacovigilance and culture-guided antimicrobial review. Comprehensive ADR documentation may help prevent inappropriate re-exposure, support safer antimicrobial prescribing, and improve medication safety.
Keywords: Ciprofloxacin, cutaneous adverse drug reaction, pruritus, antimicrobial resistance, pharmacovigilance