SHM Converge Scientific Abstract ePoster Gallery-A Unique Case of Proton Pump Inhibitors Induced Drug Reaction

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This case describes a rare suspected omeprazole-induced hypersensitivity reaction in a 45-year-old man with HIV who developed painful oral and genital skin/mucosal lesions shortly after starting treatment for H. pylori. His regimen included nitazoxanide, doxycycline, levofloxacin, and omeprazole. Symptoms began within days of starting the medications and worsened despite an ED visit where he was initially treated for presumed oral candidiasis with fluconazole.<br /><br />On exam, he had a bright red, mildly swollen tongue with erosions and white non-adherent exudates, erosions of the lower lip mucosa, and erythematous edematous lesions involving the penis, scrotum, and anus. Vital signs were stable and infectious workup was largely negative, including tests for chlamydia, gonorrhea, trichomonas, herpes simplex virus, mononucleosis, and strep. His RPR remained positive but had improved from prior levels, suggesting response to syphilis treatment rather than new infection.<br /><br />Clinicians suspected a drug hypersensitivity reaction to one of the recently started medications, with omeprazole considered the most likely cause because proton pump inhibitors (PPIs) are known to cause cutaneous hypersensitivity reactions. He was advised to stop all four drugs and was discharged on supportive therapy: dexamethasone swish-and-spit and hydrocortisone ointment for affected genital and perianal areas.<br /><br />The report emphasizes that PPI-related skin reactions, though uncommon, can range from mild eruptions to severe conditions such as DRESS or toxic epidermal necrolysis. Because these reactions may occur anywhere from days to years after exposure, clinicians should maintain a high index of suspicion when new dermatologic findings appear after PPI initiation.

Asset Subtitle

Hemang Shah

Meta Tag

Author List Hemang Shah, Willie Smith Jr.

Category Clinical Vignettes

Concept Proton Pump Inhibitor

Concept Drug Hypersensitivity

Concept Medication-Induced Rash

Concept Discontinuation

Concept Omeprazole

Distinguished Non-Finalist

Presenter Organization Emory University Hospital Midtown

Presenting Author Hemang Shah

Track Adult

Keywords

omeprazole

hypersensitivity reaction

proton pump inhibitor

oral lesions

genital lesions

H. pylori treatment

drug eruption

HIV patient

cutaneous adverse reaction

DRESS syndrome

Proton Pump Inhibitor

Drug Hypersensitivity

Medication-Induced Rash

Discontinuation

Omeprazole