Reactions 1704, p188 - 2 Jun 2018 Bullous fixed drug eruption: case report A 65-year-old man developed bullous fixed drug eruption during treatment with ibuprofen [Gelofen] for toothache. The man was admitted with skin rashes and oral ulcer. Within a week prior to the admission, he was receiving treatment with some other unspecified medications and oral ibuprofen 400mg for toothache. Within 24 hours after the ibuprofen ingestion, he developed burning sensation in the dorsal part of the left fourth finger. Within hours, he developed a well-demarcated bullous lesion at the dorsal surface of the middle and proximal phalanx of the left fourth finger. Similarly, he developed a well-defined painful oral ulcer in the hard palate following initial burning sensation and bulla formation. On admission, a detailed physical examination showed an erythaematous lesion over the upper lip and a painless ulcer in the ventral surface of penile shaft. Additionally, an erythaematous patch measuring 6cm x 8cm was observed in the right lower abdominal wall. Further examination revealed 2cm × 3cm erythematous patch in the left medial malleolus. He did not reveal any evidence of systemic inflammatory diseases or infection. A clinical diagnosis of fixed drug eruption was suspected. Also, a differential diagnosis of Steven-Johnson syndrome was considered in view of extent of the mucocutaneous lesions. The man received an empirical treatment with glucocorticoid, antihistamines and antibiotics for differential diagnoses of Steven-Johnson syndrome. Due to the extensive mucocutaneous lesions, abdominal and malleolar skin biopsies were performed. The microscopic examination of the abdominal skin tissue revealed hyperkeratosis of the epidermis, mild hydropic degeneration of basal layer, mixed inflammatory infiltration in the dermoepidermal junction with eosinophilic predominance, neutrophilic infiltration of blood vessels and melanin incontinence in the papillary dermis. The malleolar skin biopsies showed similar hyperkeratosis and hydropic degeneration. The malleolar skin biopsies also revealed saw tooth appearance, mild spongiosis and lymphocyte-predominant inflammatory infiltration of the dermoepidermal junction. The pathological findings were in line with fixed drug eruption. Following pathological studies and dermatology consultation, a confirmed diagnosis of fixed drug eruption was made. Subsequently, ibuprofen and cefalexin [cephalexin; time of cefalexin initiation and indication not provided in the article] were stopped. The glucocorticoid treatment was switched to fluocinolone acetonide cream and topical moisturising antiseptics including mupirocin cream and rivanol solution. Following the cessation of ibuprofen and cefalexin, and supportive care, he showed a favourable outcome. Within the next few weeks, his skin (mucocutaneous) and oral lesions recovered; however, he exhibited residual hyperpigmentation. At a follow up examination, it was found that he was re- challenged with ibuprofen, which led to development of lesion over the anal mucosa with similar penile involvement. As a result, ibuprofen was confirmed to be the culprit drug in development of the fixed drug eruption. Author comment: "This re-exposure can confirm the causative role of the ibuprofen as the culprit drug for the initial [fixed drug eruption]." "[B]ullous fixed drug eruption (FDE) due to ibuprofen ingestion is an uncommon skin reaction." Fazeli SA, et al. Bullous fixed drug eruption following ibuprofen ingestion. Journal of Research in Pharmacy Practice 7: 51-56, No. 1, Mar 2018. Available from: URL: http://doi.org/10.4103/jrpp.JRPP_17_81 - Iran 803323107 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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