Azithromycin-induced allergic reaction – A rare case report and review of literature

Introduction

Macrolides are commonly prescribed antibiotics with rare adverse effects. We report the case of a 30-year-old female patient with bronchial asthma who developed azithromycin-induced allergic reaction.

Case report

A 30-year-old female patient with bronchial asthma presented to our hospital with a one week history of cough, low-grade fever with chills, myalgia, and fatigue. Vital signs showed a low grade fever; other parameters were normal. Chest auscultation revealed crackles over the left posterior chest with a few scattered wheezes. Her complete blood count was unremarkable. A clinical diagnosis of community-acquired pneumonia was made, and she was prescribed azithromycin 500 mg once daily for three days. Within an hour of taking the first dose, the patient had developed pruritus, swelling of the lips, and eyelid, but she did not experience any difficulty breathing or swallowing. Soon after the development of these symptoms, she had discontinued azithromycin on her own and visited our hospital the following day. On evaluation, she was clinically stable but had persistent pruritus and facial swelling. Pruritus was relieved with diphenhydramine, and the patient was monitored and subsequently discharged with instructions on danger signs. At her follow-up visit within a week, all symptoms had resolved.

Discussion

Azithromycin-induced allergic reactions can occur in rare circumstances. These reactions range from mild cutaneous reactions to life-threatening anaphylaxis, with immediate-type skin reactions and angioedema being the most commonly reported. To date, only a few successful cases of macrolide desensitization have been reported.

Conclusion

While azithromycin is one of the commonly prescribed antibiotics with rare adverse effects, clinicians should be vigilant, as serious reactions may still occur.