title: Pregabalin- and azithromycin-induced rhabdomyolysis with purpura: An unrecognized interaction: A case report.
abstract: BACKGROUND
  Rhabdomyolysis associated with the use of pregabalin or azithromycin has been demonstrated to be a rare but potentially life-threatening adverse event. Here, we report an extremely rare case of rhabdomyolysis with purpura in a patient who had used pregabalin and azithromycin.
  
  
  METHODS
  We present the case of a 75-year-old woman with a history of fibromyalgia who was admitted with mild limb weakness and lower abdominal purpura. She was prescribed pregabalin (75mg, twice daily) for almost 3 months to treat chronic back pain. Her medical history revealed that 3days before admission, she began experiencing acute bronchitis and was treated with a single dose of azithromycin (500mg). She had developed rapid onset severe myalgia, mild whole body edema, muscle weakness leading to gait instability, abdominal purpura and tender purpura on the lower extremities. Laboratory values included a white blood cell count of 25,400/mL and a creatinine phosphokinase (CPK) concentration of 1250 IU/L. Based on these findings and the patient's clinical history, a diagnosis of pregabalin- and azithromycin-induced rhabdomyolysis was made.
  
  
  CONCLUSIONS
  The long-term use of pregabalin and the initiation azithromycin therapy followed by a rapid onset of rhabdomyolysis is indicative of a drug interaction between pregabalin and azithromycin.
  
  
  CONCLUSIONS
  We report an extremely rare case of rhabdomyolysis with purpura caused by a drug interaction between pregabalin and azithromycin. However, the mechanisms of the interactions between azithromycin on the pregabalin are still unknown.
authors: Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido 078-0343, Japan. Electronic address: pippuclinickato@gold.ocn.ne.jp.
authors: Kazuya
authors: K
authors: Kato
authors: Department of Gastroenterology and Hepatology, Okayama University, 2-5-1 Shikata Town, Okayama City, Okayama 700-8558, Japan.
authors: Yoshiaki
authors: Y
authors: Iwasaki
authors: Department of Surgery, Sapporo Hokuyu Hospital, 5-1, 6-6 Higashi-Sappro, Shiroishi-ku Sapporo City 003-0006, Japan.
authors: Kazuhiko
authors: K
authors: Onodera
authors: Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido 078-0343, Japan.
authors: Mineko
authors: M
authors: Higuchi
authors: Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido 078-0343, Japan.
authors: Kimitaka
authors: K
authors: Kato
authors: Department of Surgery, Pippu Clinic, 2-10, 1 cyome Nakamachi, Pippu Town Kamikawa-gun, Hokkaido 078-0343, Japan.
authors: Yurina
authors: Y
authors: Kato
authors: Department of Dermatology, Tsutsui Clinic, 2-10, Hiraoka 6-2, Kiyota-ku Sappro City, Hokkaido 004-0876, Japan.
authors: Masato
authors: M
authors: Tsutsui
authors: Department of Surgery, Asahikawa Medical University, 1-1, 2-1 Midorigaoka, Asahikawa City, Hokkaido 078-8510, Japan.
authors: Masahiko
authors: M
authors: Taniguchi
authors: Department of Surgery, Asahikawa Medical University, 1-1, 2-1 Midorigaoka, Asahikawa City, Hokkaido 078-8510, Japan.
authors: Hiroyuki
authors: H
authors: Furukawa
keywords: Adverse reaction; Azithromycin; Drug interaction; Pregabalin; Purpura; Rhabdomyolysis