Possible Drug Allergies: Neurological Symptoms and Treatment Options

Suspected drug allergy

Dear Dr.
Jiang,
I have a few questions regarding my condition.
About a month and a half ago, I had a small foreign object penetrate my left foot's fourth toe.
During a skin biopsy at the hospital, I was prescribed a topical ointment called "Shipexin" (ingredients: Neomycin, Bacitracin, Polymyxin).
During this time, I experienced no symptoms.
However, three weeks ago, after the wound had nearly healed, I still felt a prickling sensation due to the foreign object not being removed.
I then applied a hydrophilic ointment prescribed by the clinic called "Ganderson" (ingredients: Betamethasone, Gentamicin) to the affected area (the joint of the left toe).
Within less than an hour, the joint began to swell, become numb, and I was unable to bend it.
I immediately washed off the ointment, but the numbness persisted and worsened the next day, spreading from my toe to my calf and thigh.
I even experienced a limp while walking and had diminished tactile sensation.
I quickly consulted a doctor who prescribed antibiotics and anti-inflammatory pain relief medication, but the numbness continued to increase throughout the day, severely affecting my sleep.
I decided to revert to the original "Shipexin" ointment (ingredients: Neomycin, Bacitracin, Polymyxin), and within about five minutes, the numbness significantly decreased.
However, the joint of my toe remained swollen and unable to bend.
Normally, when I bend all five toes, five small joint bumps appear on the dorsum of my foot, but I only have four, with the fourth toe completely straight.
To confirm whether the symptoms were drug-related, I applied a small amount of the Ganderson ointment to an uninjured area on the back of my left hand.
Within about a minute, I began to feel slight pain and numbness.
I quickly washed it off, but the numb sensation persisted.
I would like to ask the following questions:
1.
I found online that Gentamicin can cause symptoms of neuromuscular paralysis.
Since I experienced numbness after applying the ointment, could this be a drug allergy?
2.
Given that there was a previous wound on my left toe, could the application of the ointment have exacerbated the allergic reaction due to the injury?
3.
Why does the "Shipexin" ointment (ingredients: Neomycin, Bacitracin, Polymyxin) seem to instantly relax my muscles and significantly reduce my numbness?
4.
Are there any medications or ointments that can counteract Gentamicin allergy leading to neuromuscular paralysis symptoms?
5.
Since May 28, after applying the ointment, my left toe joint remains slightly swollen and unable to bend (with no improvement in range of motion).
When standing, I feel weakness in that toe, and forcibly bending the joint with my hand causes a sore, numb sensation (similar to the feeling after a finger sprain).
I am very concerned that this may have caused irreversible nerve or muscle damage (X-rays and blood tests showed no abnormalities).
6.
The doctor suggested that due to the weakness and lingering numbness in this toe, my walking balance has shifted to my right foot, severely affecting my daily life.
Thank you very much for taking the time to respond to my message.

David, 20~29 year old female. Ask Date: 2021/06/13

Dr. Jiang Junyi reply Neurology

Hello David,
Regarding the medication allergy you mentioned, particularly with ointments, it is rarely expressed in a neurological manner.
Your symptoms may suggest lumbar nerve root compression.
A common cause is inflammation resulting from a herniated disc, which can lead to lower back pain that may extend to one or both sides of the buttocks or hips.
If the herniated disc compresses the nerve root, it can result in neuropathic pain (sciatica), with symptoms often located in the posterior thigh, lateral calf, and even the dorsum of the foot and toes.
Additionally, neomycin and gentamicin belong to the same class of medications, so if you are allergic to one, you are likely to be allergic to the other as well.
If you are quite troubled by this, I recommend that you visit a neurology clinic for further evaluation.
However, due to the recent COVID-19 pandemic, it is advisable to wait until the situation stabilizes before going to the hospital for examination.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new pandemic prevention measures before and after your medical visit.
Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2021/06/13

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your recent experiences with topical medications and the associated neurological symptoms. Let's address your questions one by one, while also providing some context about the medications involved and their potential side effects.

1. Possible Drug Allergy: You mentioned that you experienced numbness after applying the Ganderson hydrophilic ointment, which contains Gentamicin. Gentamicin is an aminoglycoside antibiotic known to cause allergic reactions in some individuals, which can manifest as skin irritation, rash, or even more severe symptoms like muscle weakness or numbness. The symptoms you experienced, such as numbness and tingling, could indeed suggest a hypersensitivity reaction to Gentamicin. However, it is essential to note that not all reactions are true allergies; some may be side effects of the medication.

2. Impact of Previous Wound: The presence of a wound can increase the absorption of topical medications, potentially leading to heightened systemic effects. If the skin barrier is compromised, the medication may penetrate more deeply and cause more pronounced reactions. This could explain why your symptoms were more severe after applying the Ganderson ointment to an area with a previous injury.

3. Relief from Neomycin Ointment: The immediate relief you experienced after applying the Neomycin, Bacitracin, and Polymyxin ointment could be due to several factors. These ingredients have antibacterial properties that may help reduce inflammation and promote healing. Additionally, the soothing effect of the ointment itself might have alleviated some of the irritation or inflammation caused by the previous application of the Ganderson ointment.

4. Alternatives for Gentamicin Allergy: If you suspect an allergy to Gentamicin, it is crucial to avoid using products containing this ingredient. Alternatives may include other topical antibiotics that do not belong to the aminoglycoside class, such as mupirocin or clindamycin, depending on the nature of the infection or injury. Always consult with your healthcare provider before switching medications to ensure safety and efficacy.

5. Concerns about Nerve or Muscle Damage: The ongoing symptoms of swelling and inability to bend your toe could indicate a more significant issue, such as inflammation or nerve compression. While your X-rays and blood tests returned normal results, it is essential to monitor your symptoms closely. If the numbness and weakness persist, further evaluation, such as an MRI or nerve conduction studies, may be warranted to assess for any underlying nerve damage or other complications.

6. Impact on Daily Life: Your concerns about how these symptoms affect your daily activities are valid. It is crucial to communicate these issues with your healthcare provider, who may consider referring you to a specialist, such as a neurologist or orthopedic surgeon, for further evaluation and management. They can provide tailored treatment options to address both the neurological symptoms and any musculoskeletal concerns.

In conclusion, it is essential to approach this situation with caution and seek professional medical advice to ensure that you receive appropriate care. Documenting your symptoms and any changes in your condition will be helpful for your healthcare provider in determining the best course of action. Please do not hesitate to reach out to your physician for further evaluation and to discuss your ongoing symptoms.

Wishing you a speedy recovery and improved health.

Best regards.

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