Clindamycin-Induced Lip and Nasal Passage Swelling

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Abstract
OBJECTIVE: To report a severe case of clindamycin-induced lip and nasal passage swelling. DESIGN: Single case report. SETTING: Six hundred eighty-four-bed community hospital. CASE SUMMARY: A 34-year-old, insulin-dependent diabetic white man with worsening cellulitis and osteomyelitis of the left great toe was admitted for treatment with intravenous antibiotics. Intravenous clindamycin was the first agent administered. Within 5 minutes after initiating the drug (600-mg dose) the patient began to sneeze and his eyes began to tear and itch. Within 10 minutes, his lips and nasal passages began to swell. By the end of the infusion (approximately 20 min), the patient's lips were severely swollen and his nasal passages were completely closed off secondary to the swelling. The patient did not have difficulty breathing through his mouth and denied any shortness of breath. He did not develop a rash. His vital signs remained stable and no pharmacologic agents were administered for this reaction. No subsequent doses of clindamycin were given and complete resolution of all symptoms occurred within 24 hours. CONCLUSIONS: Severe lip and nasal passage swelling is an uncommon adverse reaction associated with the use of intravenous clindamycin. We believe this to be the first published case of nasal passage swelling and only the second case reporting lip edema associated with the intravenous form of this agent. Clinicians should be aware of this uncommon but potentially severe reaction.

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