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Ciprofloxacin is a broad spectrum quinolone antibiotic which is used for treating a wide variety of infections. It inhibits cell division by inhibiting DNA gyrase and topoisomerase IV enzymes. The most common adverse reactions are mild nausea, vomiting and/or abdominal discomfort in 3% to 17% of patients, mild headache and dizziness in 0.9% to 11% of patients. Rashes including photosensitivity can also occur. We report a case of 62 years old male, admitted in the hospital with the history of itching, redness and raised multiple dark skin lesion over the chest, back and oral cavity, bilateral palms and upper limbs since 2 days. On examination, multiple well- defined hyperpigmented patches with peripheral erythema seen over chest, abdomen, and back. Hyperpigmentation of lips along with the erosion of buccal mucosa and angle of mouth; erythematous plaque and exfoliation were seen in the scrotal region. Palms and scalp were spared. The patient was then treated successfully with antihistamines and steroids. The Naranjo and WHO-Uppsala monitoring center scale showed as a

Fluindione an oral vitamin K antagonist is associated with various hemorrhagic and immunoallergic effects. This drug is also prone to produce various drug interactions, which if not taken into consideration while prescribing, might lead to increased incidence of adverse drug reactions for the patients. We report a case of drug interaction between fluindione and cefixime leading to cutaneous bleeding manifestations and raised PT-INR. Our patient was a 59 year old lady, a known case of rheumatic heart disease and mitral valve replacement, on tablet fluindione 20 mg for past 11 years. She was prescribed tablet cefixime 200 mg two times a day for three days for treatment of upper respiratory tract infection, following which she developed cutaneous bleeding manifestations like ecchymosis and purpura in left upper and lower limbs. She also had a rise in PT-INR level to 4.2, predisposing the patient to life threatening bleeding manifestations. Hence, caution is warranted while prescribing antibiotics to patients on oral anticoagulant therapy. Antibiotics that do not cause drug interaction with the anticoagulants must be selected in these patients. Also, periodic monitoring of PT INR in patients on anticoagulants especially when a new drug is co-prescribed is essential to curb the hazards of potential adverse drug interaction.