Cefixime and ornidazole combination induced fixed drug eruption: a case report

Cefixime, a third generation cephalosporin and ornidazole, a nitroimidazole is used for a wide variety of conditions like urinary tract infections, otitis media, pharyngitis, uncomplicated gonorrhea and anaerobic infections. Fixed drug eruption (FDE) is commonly associated with anticonvulsants, antimicrobials and NSAIDs. Here we report a case of a rare cefixime and ornidazole combination induced fixed drug eruption. A 39 year old male developed hyper-pigmented patches over both forearms and left thigh after consuming fixed dose combination of cefixime and ornidazole tablet for the treatment of urinary tract infection.

Doxycycline induced fixed drug eruption: a case report

Fixed drug eruption (FDE) is an adverse drug reaction seen with various groups of drugs are antibiotics such as trimethoprim -sulphamethoxazle, pencillin, tetracyclines, non steroidal anti- inflammatory drugs like ibuprofen, aspirin etc. Doxycycline belongs to tetracycline groups of antibiotics. We herein present the case of Doxycycline induced fixed drug eruption. A 35-year - old man presented to our hospital, with a 2-day history of itching and hyperpigmentation over the chest. Patient developed skin lesion 2 days after and he started taking Doxycycline 100 mg twice a day for skin infections. Dermatological examination revealed multiple well defined hyperpigmented patches seen over the anterior aspect of the chest. Doxycycline was discontinued immediately, and the skin lesions resolved spontaneously within 2 weeks. Causality assessment by using Naranjo adverse drug reaction probability scale and WHO Uppsala monitoring scale categorize the reaction as Doxycycline was the probable cause for the adverse drug reaction. Severity assessment by using modified Hartwig and Siegel ADR severity assessment scale labelled the reaction as mild-level 2. The causative drug or drugs and cross reactants should be avoided in future to prevent recurrence of similar skin reactions.

Paracetamol-induced fixed drug eruption presenting as eyelid skin necrosis

Fixed drug eruption (FDE) is a type of drug-induced cutaneous disorder that characteristically presents with recurrence of similar lesion at the same skin or mucosal site as a result of systemic exposure to a drug. Paracetamol is commonly prescribed analgesic-antipyretic agent in all age group of patients. FDE due to paracetamol is not very common but it is well reported in literature for all age groups. We report a case of a 7-year-old male with FDE due to paracetamol involving upper eyelid and presenting as an eyelid skin necrosis.

A Study Of Fixed Drug Eruption: Single Center Analysis From Central India

Background: Fixed drug eruption is a common cutaneous adverse drug reaction which is characterised by sharply demarcated skin lesions with recurrences at the same site with each subsequent exposure to the culprit drug. The causative drugs for fixed drug eruption (FDE) in any population changes depend on many factors. The knowledge of peculiar clinical features of FDE helps the treating physician to recognise at early stage and avoidance of mismanagement of such cases. Material and method:In this context, we did a descriptive-analytical study of patients who were diagnosed with FDE in single center between Feb 2013 to Sep 2017 from central India. Results: Ninety seven patients who developed FDE were studied in the study with 65% males and 35% females. Mean age at presentation in males and females were 34.95±16.90 and 37.12±12.98 years, respectively. Multiple lesions were present in 80.4% of patients. Seventy four percent of patients gave the history of prior episodes. In 68% patients, symptoms started and lesions developed within <24 hours of the drug exposure. Mucosal lesions were seen in 46.4% and skin lesions (non-mucosal) were seen in 36.1% and in rest 17.5% patients both mucosal and skin lesions were present. Antibiotics and NSAIDS were the most common group of medications to cause FDE. Thirty two percent of patients were caused by Fixed Dose Combinations of antibiotics and anti-protozoals. Conclusion: In conclusion, FDE is a common acute cutaneous drug eruption that if not diagnosed timely leads not only to recurrences but also causes apprehension and morbidity.

A Case of Sexual Enhancer Induced Fixed Drug Eruption / 대한피부과학회지

Fixed drug eruption is a commonly reported mucocutaneous drug eruption. A 61-year-old male presented to our clinic with a complaint of an itchy round erythematous patch on the left hand dorsum with myalgia. On taking medical history, the patient correlated the episode with the intake of an oral sexual enhancer that he had obtained over the counter. We found the medicine contained tadalafil and sildenafil in combination with herbal ingredients. A short course of oral corticosteroid therapy resulted in the complete resolution of the lesion leaving residual hyperpigmentation of the skin involved. Various sexual enhancers with fancy names and attractive packaging are available without requiring a doctor's prescription. Most contain phosphodiesterase-5 inhibitors in various concentrations, often with herbal additions. These drugs are used erratically by the lay public, and often produce side effects. Herein, we report a case of fixed drug rash related to a sexual enhancer, which we believe to be the first report in Korea.

Levofloxacin-induced Fixed Drug Eruption: A Case Report / 대한피부과학회지

Fixed drug eruptions (FDEs) are characterized by the presence of site-specific recurrence of a solitary or multiple, well-circumscribed, erythematous macules or patches that recur with each exposure to a particular medication. Several drugs including non-steroidal anti-inflammatory drugs, non-opioid analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline have been associated with an increased risk of inducing FDE. A 45-year-old woman with known history of levofloxacin use presented with erythematous patches on her face and left forearm. Although a patch test to levofloxacin showed a negative reaction, intradermal tests to assess hypersensitivity to levofloxacin were positive, and she was diagnosed with levofloxacin-induced FDE. Her antibiotic was switched to moxifloxacin, which she tolerated well. Moxifloxacin did not show cross-reactivity. Because of the widespread use of fluoroquinolones, it is important to consider these as possible etiological agents in cases of FDE. We describe a case of FDE diagnosed using positive intradermal tests to detect sensitivity to levofloxacin.

A retrospective analysis of adverse drug reactions in a tertiary care teaching hospital at Dehradun, Uttarakhand.

Background: Adverse drug reactions (ADRs) are one of the major causes of hospital admissions. The objective of this study was to ascertain the various ADRs occurring in a tertiary care teaching hospital at Dehradun, Uttarakhand. Methods: The ADRs were collected from January 2010 to June 2014 by the Department of Pharmacology in Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand. A total of 123 ADRs were collected, analyzed and assessed on WHO causality assessment scale. Results: A total of 123 ADRs were assessed. Male:female ratio was 1.5:1. Age-wise distribution of ADRs was done: 0-15 years had 15 (12.19%), 16-30 had 50 (40.65%), 31-45 showed 25 (20.32%), 46-60 years 22 (17.88%) and >60 years had 11 (8.94%). 112 (91.05%) ADRs were serious, and 11 (8.94%) were non-serious. As per the WHO causality assessment scale, 91 (73.98%) ADRs were probable, 30 (24.39%) were possible, and 2 (1.62%) were certain. Most commonly occurring ADRs were fixed drug eruption in 42 (34.14%) patients, erythematous maculopapular rash in 20 (16.26%) patients and urticarial rash in 15 (12.19%) patients, followed by others. The drugs most frequently associated with ADRs were non-steroidal antiinflammatory drugs (NSAIDs), fluoroquinolones, penicillins, cephalosporins and phenytoin sodium, followed by others. Conclusions: Majority of ADRs were probable according to WHO causality assessment scale. Most common ADR was fixed drug eruption. Most frequent drugs associated with ADRs were NSAIDs. ADRs contribute to increased morbidity and mortality in patients; thereby pose a huge burden on the society.

Reacción adversa a medicamentos (RAM) fija generalizada, debido a gemfibrozilo (GMZ): A propósito de un caso / Case report: generalized fixed drug eruption due to gemfibrozil

El abuso de la ingestión de drogas y la creación de nuevos medicamentos, ha producido un aumento en la aparición de reacción adversa a medicamentos (RAM), los que deben ser siempre informados dada la importancia de su registro. Un tipo de RAM es la erupción fija medicamentosa (EFM). Se revisará un caso de EFM asociada al gemfibrozilo (GMZ) en un paciente chileno de 75 años, quien presentó en dos ocasiones lesiones dermatológicas en la misma localización anatómica, tras la ingestión de GMZ. EFM representa el 5-10% de las RAM y pueden manifestarse en piel y/o mucosas y suelen recurrir en el mismo sitio, cada vez que el paciente consume la droga. Los medicamentos más comunes que producen esta reación son: los antibióticos, analgésicos-anti-inflamatorios no esteroides e hipnóticos. No hemos encontrado publicados casos de EFM a causa de GM. Una EFM ampollar generalizada, es importante diferenciarla clínica e histológicamente del síndrome de Stevens-Johnson o de la necrólisis epidérmica tóxica. Los síntomas, signos, evolución y la histología del caso, nos hace pensar en una EFM bulosa generalizada debido a GMZ.

Ciprofloxacin induced fixed drug eruption.

Fixed drug eruption (FDE) is a clinical entity occurring in the same site or sites each time the drug is administered. Acute lesions appear as sharply marginated erythematous plaques, which are usually found on lips, genitalia, abdomen, and legs. The eruptions usually occur within hours of administration of the offending agent and resolves spontaneously without scarring after few weeks of onset. Most common drugs causing FDE are sulfonamides, tetracyclines, salicylates, barbiturates, doxycycline, fluconazole, clarithromycin, etc. Ciprofloxacin, a widely used fluoroquinolone antimicrobial, induces cutaneous adverse drug reactions (ADRs) in about 1-2% of treated patients. Urticaria, angioedema, maculopapular exanthems, and photosensitivity are the most frequently documented cutaneous adverse reactions. In this case report, the patient soon after taking ciprofloxacin tablets, developed itching in the lips, palms and in scrotal region. On continuing the treatment, the next day he developed fluid filled lesions over palm, knuckle, and hyperpigmentation. He gives a history of severe itching and rashes in scrotal region. He gives a history of similar complaints in the previous month after taking ciprofloxacin medication. There was no history of intake of any other medication. On examination, bullous lesions and pustules in finger webs, hyperpigmentation on knuckles, and scrotal erosions were seen. In the present case report, the patient presented with FDE immediately after oral administration of ciprofloxacin and got completely cured after stopping the drug and taking adequate treatment. According to the Naranjo’s ADR probability scale (score=8), this ADR is categorized as a “probable” reaction to the drug.

Drug-induced cutaneous adverse drug reactions in dermatology in Dr. B.R. Ambedkar Medical College.

Background: Cutaneous adverse drug reactions (ADRs) affect 2-3% of hospitalized patients. The severity varies from mild itching to life-threatening Stevens-Johnson syndrome (SJS). Hence, this study was undertaken to emphasize the need to report ADRs. Methods: The study was carried out in the Department of Dermatology in Dr. B.R Ambedkar Medical College Hospital from June to December 2012. Naranjo’s algorithm was used to determine the causality of an ADR. Informed consent was obtained from each patient, and thorough clinical examination was conducted. All the information was carefully recorded in a pre-designed proforma. To establish the etiologic agent for a particular type of reaction, attention was paid to the drug history, temporal correlation with the drug, duration of the reaction, morphology of the reaction, associated mucosal or systemic involvement, improvement of lesions on withdrawal of the drug. Results: In the present study, all the age groups were affected with cutaneous ADRs, with a higher incidence in age group between 31 and 40 years, non-steroidal anti-inflammatory drugs (NSAIDs) (41.66%) were most commonly observed drug, followed by anti-microbials (25%) and anti-convulsants (21.66%). Fixed drug eruptions (FDE) (46.66%) most commonly observed cutaneous reaction, followed by SJS (16.66%), erythema multiformae (16.66%) most commonly observed ADRs. Conclusions: ADRs are potentially avoidable causes for seeking medical care. FDE was most common ADR and NSAIDs were most common causative agents in our study. ADRs can be prevented by avoiding polypharmacy, obtaining history of any previous skin reaction and the causative agent.

Clinical Features of Fixed Drug Eruption at a Tertiary Hospital in Korea

PURPOSE: Fixed drug eruption (FDE) is characterized by a well-defined erythematous patch, plaque, or bullous eruption that recurs at the same site as the result of systemic exposure to a causative drug, and resolves with or without hyperpigmentation. This study was carried out to identify the common causative drugs and clinical features of FDE in Korea. METHODS: We reviewed electronic medical records of all patients diagnosed with FDE from January 2000 to December 2010 at a tertiary hospital in Korea. RESULTS: A total of 134 cases were diagnosed as FDE. The mean age was 35.9 years (range, 0-82 years) and 69 (51.5%) of the patients were male. The mean duration from the first event to attending hospital was 1.9 years (range, 1-20 years). The mean number of recurrences was 2.6 (1-10), and 72.6% of patients sought medical care after experiencing symptoms twice or more. Four patients (3.1%) needed hospitalization. The most common sites were the upper extremities (47.7%), followed by the lower extremities, face, abdomen, chest, buttocks and perineum. Clear documentation on the causative drugs was available for 38 patients (28.4%), and among these, non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen accounted for 71.1% of cases, and antibiotics accounted for 15.8%. Eighty patients (59.7%) underwent active treatment for FDE, and topical steroids were most frequently prescribed (43.3%), with systemic steroids used in 11.2% of patients. CONCLUSIONS: NSAIDs and acetaminophen were the main causative agents of FDE, however, the causative agents were not assessed in 25% of patients.

Pneumococcal Vaccination-Induced Localized Cutaneous Toxic Reaction Mimicking Fixed Drug Eruption on a Nearby Vaccination Injection Site in an Infant / 대한피부과학회지

Pneumococcus is a very important pathogen for children and elderly people, and causes considerable morbidity and mortality in these groups. Pneumococcal vaccination is relatively safe, and is being increasingly used for the prevention of pneumococcal disease, such as meningitis, pneumonia, otitis media, and bacteremia. Mild adverse reactions of pneumococcal vaccination are relatively common, and include erythema, pain, fever, myalgia, and headaches. However, adverse skin reactions are very rare. Here, we present a case of pneumococcal vaccination-induced localized toxic reaction mimicking fixed drug eruption on a nearby vaccination injection site in an infant, which has not previously been documented in Korea.

Fixed Drug Eruption Caused by Levocetirizine / 대한피부과학회지

No abstract available.

Fixed drug eruption due to paracetamol.

Fixed drug eruption is a common type of drug eruption seen in dermatology OPD’s. Usually it is seen with sulphonamides, salicylates, tetracyclines, oxyphenbutazones, dapsone, barbiturates, phenolphthalein, morphine, codeine, quinine, phenacetin, erythromycin, griseofulvin, mebendazole etc. We hereby report a case of fixed drug eruption due to single dose of oral paracetamol in an otherwise healthy male after one hour of consuming it. A provisional diagnosis of Paracetamol induced fixed drug eruption was made. Paracetamol was stopped and patient advised never to take Paracetamol in future. Patient was managed with prednisolone 10mg /day, cetirizine 10 mg/day, and amoxicillin 500 mg twice a day and mometasone + fusidic acid cream to be applied over the lesions.

Úlcera vulvar en una paciente de 15 años: ¿se puede reconocer la alergia a fármacos? / Vulvar ulcer in a 15-year-old girl: can we recognize adverse drug reactions?

Introducción. Los pediatras consideran la úlcera vulvar como una patología poco común. Sin embargo, los médicos que se especializan en la atención de adolescentes y niñas con patología vulvar consideran las úlceras vulvares como un motivo de consulta frecuente. Caso clínico. Se trató de un paciente femenino de 15 años con cuadro de fiebre y dolor faríngeo diagnosticado como faringitis bacteriana. Recibió tratamiento con trimetoprima-sulfametoxazol. Dos días después cursó con aparición de placas hiperpigmentadas de centro ampolloso, que evolucionaron a una úlcera de aproximadamente 4 cm de diámetro. Inicialmente se consideró un origen infeccioso de la lesión y se manejó con fluconazol tópico; posteriormente, amoxicilina clavulanato. No presentó mejoría y, tras la valoración por el dermatólogo, se diagnosticó eritema pigmentado fijo con base en la morfología de lesión inicial. Recibió tratamiento con betametasona y loratadina oral, así como hidrocortisona tópica al 1%. Evolucionó con resolución de las lesiones. Conclusiones. En la práctica del pediatra es trascendental conservar en mente no solo la patología de origen infeccioso y venéreo en las pacientes adolescentes con úlcera vulvar, sino también las reacciones de alergia a fármacos.

Background. Pediatricians consider vulvar ulcer as an uncommon pathology. However, clinicians specialized in the care of young girls and teenagers with vulvar pathology actually consider vulvar ulcer not to be an infrequent primary complaint. Case report. We report the case of a 15-year-old girl who presented fever and sore throat for which she was treated with trimethoprim-sulfamethoxazol. Two days after taking the drug she presented hyperpigmented patches with a bullous center that developed into an ulcer of ~4 cm in diameter. First considered infectious in origin, she received treatment with topical fluconazol and afterwards with amoxicillin clavulanate without any improvement. She was then assessed by a dermatologist, and the diagnosis of fixed drug eruption was established on the basis of the initial morphology of the lesion. She was treated with betamethasone and loratadine as well as topical 1% hydrocortisone. The lesions evolved to complete resolution. Conclusions. In pediatric practice, it is important for the pediatrician to consider not only infectious and venereal causes in teenage girls with vulvar ulcer, but also allergic drug reactions.

Eritema pigmentar fixo simulando herpes labial relacionado ao uso de fluconazol / Fixed drug eruption simulating herpes labialis related to fluconazole

O eritema pigmentar fixo geralmente representa uma reação cutânea adversa a medicamentos caracterizada pelo surgimento de lesões eritematosas arredondadas ou ovais que recorrem no mesmo sítio em minutos a horas após uma nova exposição ao medicamento previamente utilizado. As lesões podem ser únicas ou múltiplas e esmaecem em poucos dias deixando pigmentação hipercrômica residual, sendo os anti-inflamatórios e antibióticos, frequentes causadores. Já o herpes labial é causado principalmente pelo HSV1 e se manifesta com vesículas agrupadas sobre base eritematosa com posterior evolução para crostas e pode ser desencadeado por estresse, trauma etc. O objetivo do presente trabalho é demonstrar um caso de eritema pigmentar fixo simulando herpes labial, relacionado ao uso de fluconazol, visto que existem relativamente poucos relatos desta associação na literatura médica...

A Case of Generalized Bullous Fixed Drug Eruption / 대한피부과학회지

No abstract available.

A Case of Fixed Drug Eruption Due to Doxycycline and Erythromycin Present in Food

A fixed drug eruption (FDE) is not difficult to diagnose, given its clinical characteristics. However, the causative agent can be difficult to identify, particularly when the patient denies ingestion of any drugs. To the best of our knowledge, we present herein the first reported case of an FDE caused by antibiotics taken in food; doxycycline and erythromycin contained in pork and fish. A 57-year-old female experienced repeated episodes of well-demarcated erythematous patches covering her entire body. She denied taking any medications, but she thought that the lesions appeared after consuming pork and/or fish. An oral provocation test showed positive results for doxycycline and erythromycin, commonly used antibiotics in live-stock farming and in the fishing industry. Because of the antibiotics' thermostability, cooking does not guarantee the elimination of residual drugs. From the patient's history, we concluded that doxycycline and erythromycin contained in the pork and fish that she ate were the cause of the FDE.

A case of levocetirizine-induced fixed drug eruption and cross-reaction with piperazine derivatives

Fixed drug eruption is an uncommon adverse drug reaction caused by delayed cell-mediated hypersensitivity. Levocetirizine is an active (R)-enatiomer of cetirizine and there have been a few reports of fixed drug eruption related to these antihistamines. We experienced a case of levocetirizine-induced fixed drug eruption and cross-reaction with other piperazine derivatives confirmed by patch test. A 73-year-old female patient presented with recurrent generalized itching, cutaneous bullae formation, rash and multiple pigmentation at fixed sites after taking drugs for common cold. She took bepotastine besilate (Talion®) and levocetirizine (Xyzal®) as antihistamine. She took acetaminophen, pseudoephedrine 60 mg / triprolidine 2.5 mg (Actifed®), dihydrocodeinebitartrate 5 mg / di-methylephedrine hydrochloride 17.5 mg / chlorpheniramine maleate 1.5 mg / guaifenesin 50 mg (Codening®) and aluminium hydroxide 200 mg / magnesium carbonate 120 mg (Antad®) at the same time. Patch test was done with suspected drugs and the result was positive with levocetirizine. We additionally performed patch test for other antihistamines such as cetirizine, hydroxyzine, fexofenadine and loratadine. Piperazine derivatives (cetirizine and hydroxyzine) were positive, but piperidine derivatives (fexofenadine and loratadine) were negative to patch test. There was no adverse drug reaction when she was challenged with fexofenadine. We report a case of levocetirizine-induced fixed drug eruption confirmed by patch test. Cross-reactions were only observed in the piperazine derivatives and piperidine antihistamine was tolerant to the patient.

Fixed Drug Eruption due to Ciprofloxacin / 대한피부과학회지

Fixed drug eruption is a pattern of a drug-induced cutaneous reaction. It is characterized by skin erythematous plaques that recur at the same site each time the drug is administered. Now, we report the case of a 26-year-old woman who presented with 2 ill-defined erythematous patches on her back with itching sensation. The patient had a history of ciprofloxacin medication. The patch test with suspected drugs showed negative reactions, but intradermal tests were positive reactions. The patient was diagnosed with fixed-drug eruption due to ciprofloxacin.