title: Cutaneous adverse reaction to ciprofloxacin: demonstration of specific lymphocyte proliferation and cross-reactivity to ofloxacin in vitro.
abstract: Ciprofloxacin (CPFX) is a widely used fluoroquinolone antibiotic, inducing cutaneous adverse drug reactions in about 1 to 2% of the treated patients. Conclusive diagnosis of drug allergy, however, still remains a major problem in daily clinical practice. Here, we present 2 patients with drug allergy to CPFX. In both cases the clinical suspicion for CPFX as the causative agent was confirmed in vitro by means of the lymphocyte transformation test, whereas epicutaneous patch tests remained negative. In vivo, a small percentage of the drug is biotransformed to the three major metabolites desethylene-, sulfo- and oxociprofloxacin. Though structurally closely related to their mother compound, these metabolites failed to induce in vitro lymphocyte proliferation in both patients. On the other hand, in vitro crossreactivity to ofloxacin, another fluorinated quinolone, could be demonstrated, which to our knowledge has not previously been reported.
authors.affiliation: Medical Institute of Environmental Hygiene at Heinrich-Heine-University, Department of Dermatology, Duesseldorf, Germany.
authors.forename: A C
authors.initials: AC
authors.lastname: Rönnau
authors.forename: B
authors.initials: B
authors.lastname: Sachs
authors.forename: S
authors.initials: S
authors.lastname: von Schmiedeberg
authors.forename: N
authors.initials: N
authors.lastname: Hunzelmann
authors.forename: T
authors.initials: T
authors.lastname: Ruzicka
authors.forename: E
authors.initials: E
authors.lastname: Gleichmann
authors.forename: H C
authors.initials: HC
authors.lastname: Schuppe
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000009:adverse effects*; D002939:Ciprofloxacin / Q000009:adverse effects* / Q000493:pharmacokinetics; D003429:Cross Reactions; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D004342:Drug Hypersensitivity; D005260:Female; D006801:Humans; D008213:Lymphocyte Activation / Q000187:drug effects*; D008875:Middle Aged; D015242:Ofloxacin / Q000009:adverse effects* / Q000493:pharmacokinetics; D010328:Patch Tests
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D015242:Ofloxacin