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Vyshnavi Biradavolu*, Sreekeerthi Nethi, Sai Charitha Sreeram and N. Surendra Reddy


Hepatic encephalopathy is a neuropsychiatry manifestation and complication of hepatic cirrhosis ranging from mild confusion to severe coma and it also occur when the systemic circulation is overwhelmed by gut-derived neurotoxins, particularly ammonia, in patients with impaired liver function, portal-systemic bypass, or cirrhosis and portal hypertension. Rifaximin is a non absorbable antibiotic with antimicrobial effects on a broad spectrum of gut bacteria. Rifaximin has little effect on the normal gut flora, and resistance is infrequent. Here, we report a case of Rifaximin induced erythematous Maculopapular rash. A 37yrs male patient was admitted or presented to the general medicine department of SVRRGGH, Tirupati with complaints of rash over abdomen on 3rd day. Patient had Decompensated Chronic Liver Disease (DCLD) since one month, for which he was on therapy with Rifaximin. He was treated with T.Cetrizine 5mg twice daily for rashes occurred in the chest side, while continuing T.Rifaximin 550mg twice daily to treat hepatic encephalopathy. On the next day, patient was referred to dermatology and was diagnosed as having Erythematous Maculopapular rash over abdomen for which Betamethasone ointment on night time and T.CPM (Chlorpheniramine Maleate OD) were prescribed. Clinicians and pharmacists should understand that drug induced rashes can occur acutely or chronic after drug exposure. Lactulose is effective secondary therapeutic agent for prevention of recurrence of Hepatic Encephalopathy (HE) in patients with cirrhosis.

Keywords: Hepatic encephalopathy, Rifaximin, Maculopapular rash, Secondary therapeutic agent.

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