Blue-gray discoloration of the skin after levofloxacin exposure in a 44-year-old man with pulmonary tuberculosis

IntroductionHuman tuberculosis (TB) is primarily caused by Mycobacterium tuberculosis. Pulmonary disease occurs in 70-90% of the patients being the most commonly affected sites. The standard therapeutic regimen for TB as recommended by World Health Organization (WHO), consists of two months of the intensive phase, and four months of the continuation phase. The intensive-phase drugs include isoniazid (H) 5 mg/kg, rifampin (R) 10 mg/kg, ethambutol (E) 15 mg/kg, and pyrazinamide (Z) 25 mg/kg. Then isoniazid and rifampin are continued for the next four months. In the cases of resistance to isoniazid, treatment with a combination of rifampin, ethambutol, pyrazinamide, and a quinolone antibiotic such as levofloxacin (Lfx) is performed for a total of six months [1-3]. Drug-induced hepatitis is the most well-known complication of anti-TB treatment. Other adverse events include anorexia, vomiting, abdominal pain, peripheral neuropathy, thrombocytopenia, renal reactions, and skin rashes [4]. Here, we reported a rare complication of levofloxacin which was used as a second-line agent for TB treatment.