A CASE OF DRESS IN THE SETTING OF RIFAXIMININDUCED BODILY FLUID DISCOLORATION

Document Type

Conference Proceeding

Publication Date

6-23-2023

Publication Title

J Gen Intern Med

Abstract

CASE: A 59-year-old male with decompensated alcohol-induced liver cirrhosis was transferred to our facility for liver transplant evaluation. At the preceding facility, he presented with acute hepatic encephalopathy and was started on Lactulose 20g tid and Rifaximin 550mg. At our facility, he developed a fever of 101.1F and diffuse erythematous papules with confluence over the bilateral chest, shoulders, neck and head. The patient also developed bright-orange bodily fluid discoloration. CT abdomen/pelvis demonstrated diffuse inflammatory lymphadenopathy. A complete blood count demonstrated absolute eosinophilia. Dermatology performed punch biopsy showing superficial perivascular and interface dermatitis with eosinophils. Rifaximin was discontinued at this time, and Solumedrol 100 mg IV was initiated. Bodily fluid discoloration resolved 3 days after cessation of Rifaximin. On day 15, the rash was entirely resolved and rifaximin was restarted for severe hepatic encephalopathy. Yellow secretions appeared in the next several days and Rifaximin was again discontinued, with resolution of symptoms. IMPACT/DISCUSSION: Hepatic encephalopathy is a neuropsychiatric manifestation of advanced liver disease in result of inadequate hepatic clearance of toxins, namely, hyperammonemia. Pharmacological treatment relies on decreasing production and augmenting ammonia clearance. Rifaximin, a rifamycin derivative, is standard in pharmacological management of hepatic encephalopathy. Since FDA approval for liver disease in 2010, adverse effects of rifaximin use have been largely benign. Mechanistically, rifaximin's negligible systemic absorption likely prevents the side effect profile displayed in other rifamycin products. However, this case describes discoloration of bodily fluids and DRESS syndrome, both of which are well documented complications with rifampin use. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is DRESS secondary to Rifaximin is an exceedingly rare phenomenon. In most patients, symptoms will appear 2-8 weeks after initiation of drug therapy. Systemic symptoms can include fever, lymphadenopathy and rash. CONCLUSION: It is important to identify drug reactions in the hospitalized patient swiftly to avoid iatrogenic complications as the necessary intervention is cessation of inciting agent. Rifamycin antibiotics, such as Rifampin, rarely have been associated with DRESS Syndrome; few, if any, cases have ever been described of Rifaximin inducing DRESS Syndrome.

Volume

38

Issue

Suppl 3

First Page

S373

Last Page

S374

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