Shruti Brahmbhatt, Arpit M Shah
Ventilator-associated pneumonia is a frequent cause of infection that is responsible for high morbidity and mortality, particularly when caused by multidrug-resistant gram-negative organisms. Minocycline is useful for its broad antimicrobial spectrum. Minocycline may cause gastrointestinal upset, dizziness, pruritus, photosensitivity, drug-induced lupus, intracranial hypertension, and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, including rare adverse reactions such as cutaneous manifestations. Here, we report an uncommon case of a 51-year-old male patient admitted to the medical intensive care unit (MICU) due to ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae. The patient developed a generalized maculopapular rash within 12 hours of receiving a single dose of 200 mg of minocycline through the intravenous route. The medication was stopped the next day. The patient received supportive treatment with levocetirizine, and the rash disappeared completely within 48 hours. Causality assessment using the Naranjo Adverse Drug Reaction Probability Scale yielded a score of 6, and the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) scale categorized the event as "probable." This case underlines the need for close monitoring of patients for cutaneous adverse drug reactions during minocycline therapy. Early identification and immediate withdrawal of the drug are essential for rapid recovery.