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Family Medicine (Expert Forum)
persistent rash after taking Lamictal/Omnicef
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
persistent rash after taking Lamictal/Omnicef
by CarolH, Jul 04, 2003 12:00AM
First off, I had no idea what category to put this in. I don't know if it's allergies or not.
Here's the story: My psychiatrist put me on Lamictal for depression around 6/3/2003 I believe. I started with 25 mgs morning and night and after 2 weeks 50 mgs morning and night. After 3 weeks total, I stopped taking it because I was not comfortable taking a medication that was off-label use for depression, there were alot of other antidepressants I haven't tried. Also I had already read about the Stevens Johnson syndrome and that scared me, even though it is rare.
At the same time I stopped the Lamictal, I was coming down with a sinus infection. I get them about twice a year. This one was a little different, because the sinuses weren't moving at all (usually I cough up 'the green stuff'). I had a fever, headache, and my left gland in my neck was VERY swollen. It even hurt to sleep on that side. Also had a bit of a dry cough. So I went to the doc - diagnosed with sinusitis - and was prescribed Omnicef and told to take Clariten D. One day later I thought I was breaking out in pimples on my face. The next day I woke up with a rash on my upper arms, chest, and face. RAN back to the doctor so paranoid about SJS but they assured me this was a reaction to the Omnicef and prescribed a different antibiotic (Avelox), and told me to take benedryl. Took me off the Clariten D and was told to take sudofed. (why would I get an allergic reaction when I'm already taking an antihistimine, the one in the Clariten D?) Over the next week my temp started going down, but the rash went down alot slower than I thought it would. The rash looks like tiny red prickly bumps. They fade into a pink rash which looks somewhat like poison ivy, no pus whatsoever.
It is now one week later and there are still signs of the rash although it's alot better. Yesterday, Rash is getting less noticeable, (except for a breakout on my right thigh) ... skin is still kind of bumpy.
This morning - I have about 9 red spots down my throat (on the palate) each with a white little knob at the end. It's sore but not unbearable at all. And the beginnings of little blisters on my lips. Nothing that stops me from swallowing or eating.
Should I be worried? Would it have come on alot faster if this was SJS?
What about Mono? I already had mono when I was 15 (I'm now 40).
I still have two doses of Avelox to take. I find it strange to get these spots while I am on an antibiotic.
My temp this morning was 99. My glands are still slightly swollen.
Not sure if this has anything to do with it, but my upper shoulders/neck has been really stiff for a few months now, I've been meaning to go to the chiropractor. However, I've always had very tight muscles in my shoulder/neck.
Do you know what this is? What should I look out for and if it doesn't get better, when should I worry?
Thanks, and Happy 4th of July.
Here's the story: My psychiatrist put me on Lamictal for depression around 6/3/2003 I believe. I started with 25 mgs morning and night and after 2 weeks 50 mgs morning and night. After 3 weeks total, I stopped taking it because I was not comfortable taking a medication that was off-label use for depression, there were alot of other antidepressants I haven't tried. Also I had already read about the Stevens Johnson syndrome and that scared me, even though it is rare.
At the same time I stopped the Lamictal, I was coming down with a sinus infection. I get them about twice a year. This one was a little different, because the sinuses weren't moving at all (usually I cough up 'the green stuff'). I had a fever, headache, and my left gland in my neck was VERY swollen. It even hurt to sleep on that side. Also had a bit of a dry cough. So I went to the doc - diagnosed with sinusitis - and was prescribed Omnicef and told to take Clariten D. One day later I thought I was breaking out in pimples on my face. The next day I woke up with a rash on my upper arms, chest, and face. RAN back to the doctor so paranoid about SJS but they assured me this was a reaction to the Omnicef and prescribed a different antibiotic (Avelox), and told me to take benedryl. Took me off the Clariten D and was told to take sudofed. (why would I get an allergic reaction when I'm already taking an antihistimine, the one in the Clariten D?) Over the next week my temp started going down, but the rash went down alot slower than I thought it would. The rash looks like tiny red prickly bumps. They fade into a pink rash which looks somewhat like poison ivy, no pus whatsoever.
It is now one week later and there are still signs of the rash although it's alot better. Yesterday, Rash is getting less noticeable, (except for a breakout on my right thigh) ... skin is still kind of bumpy.
This morning - I have about 9 red spots down my throat (on the palate) each with a white little knob at the end. It's sore but not unbearable at all. And the beginnings of little blisters on my lips. Nothing that stops me from swallowing or eating.
Should I be worried? Would it have come on alot faster if this was SJS?
What about Mono? I already had mono when I was 15 (I'm now 40).
I still have two doses of Avelox to take. I find it strange to get these spots while I am on an antibiotic.
My temp this morning was 99. My glands are still slightly swollen.
Not sure if this has anything to do with it, but my upper shoulders/neck has been really stiff for a few months now, I've been meaning to go to the chiropractor. However, I've always had very tight muscles in my shoulder/neck.
Do you know what this is? What should I look out for and if it doesn't get better, when should I worry?
Thanks, and Happy 4th of July.
Doctor's Answer
by Kevin Pho, MD, Jul 04, 2003 12:00AM
, Jul 04, 2003 12:00AM
Hello - thanks for asking your question.
Without seeing the lesions myself, it is impossible to say what you have.
It is possible that it is a drug eruption, since it occured after you took several antibiotics. SJS is an unlikely possibility, but this should definitely be confirmed by your personal physician who can see the lesions. There is typically no diagnositic tests for SJS - diagnosis is typically made by looking at the characteristic lesions. If there is still confusion, a biopsy can be made.
As for the bumps in your throat - there are several possibilities. Obvious tests that should be done are a Strep test and monospot test (for mononucleosis). There are a variety of viruses that present with bumps in the throat. Coxsackieviruses and echoviruses come to mind. Most viruses resolve on their own, but if they continue there are medications that can be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Without seeing the lesions myself, it is impossible to say what you have.
It is possible that it is a drug eruption, since it occured after you took several antibiotics. SJS is an unlikely possibility, but this should definitely be confirmed by your personal physician who can see the lesions. There is typically no diagnositic tests for SJS - diagnosis is typically made by looking at the characteristic lesions. If there is still confusion, a biopsy can be made.
As for the bumps in your throat - there are several possibilities. Obvious tests that should be done are a Strep test and monospot test (for mononucleosis). There are a variety of viruses that present with bumps in the throat. Coxsackieviruses and echoviruses come to mind. Most viruses resolve on their own, but if they continue there are medications that can be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
This afternoon I ended up going back to the clinic which first treated my sinus infection then saw the rash a week ago.
The doc assured me it was not sjs. Because of the rash (not sure if I'd call them lesions however I am not familiar with exactly what that means. They are red pimply raised small dots) ... anyway he gave me a shot of cortisone and gave me a one week (or 5 days?) prednisone pack ... I hate taking prednisone but he said it should calm the rash. I have taken prednisone in the past for polymyositis for 3 years.
Also I have read on the web that usually the rashes come right back after you stop the prednisone. He said not necessarily so. So much conflicting information.
Also, because my glands are still swollen and I think my sinus infection is still present (the stuff in my nose is dried out and icky - probably dry from all the darn benedryl I was taking). Anyway I convinced him to give me another round of antibiotics, this time Biaxin, which I have always taken in the past.
I wanted to ask about the possibility of mono but forgot. Darn!
Thanks again for the quick reply.
I still don't understand how a reaction to a drug could still be occuring over a week after taking the drug.
Tegretyol(sp),,did same thing & ended up in the e/r...allegeric rxn which most often happens very quickly as with Lamitcal...
Hypersensitivity Reactions: Hypersensitivity reactions, some fatal or life threatening, have also occurred. It is important to note that early manifestations of hypersensitivity (e.g., fever,lymphadenopathy: abnormally enlarged lymph nodes or "swollen glands," sore throat, dry, intermittent cough) may be present even though a rash is not evident though rash does occur frequently with this syndrome). If such signs or symptoms are present, the patient should be evaluated immediately. LAMICTAL should be discontinued if an alternative etiology for the signs or symptoms cannot be established.
Prior to initiation of treatment with LAMICTAL, the patient should be instructed that a rash