Naslov
Consider fixed drug reaction before conducting unnecessary diagnostic tests

Autori
Špoljar Sanja, Ferara Nikola, Pedić Lovre, Haralović Vanda, Perović Judita, Kilić Paula, Lampalo Marina

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
2nd Symposium of the International Contact Dermatitis Research Group (ICDRG) in cooperation with Croatian Dermatovenereological Society of the Croatian Medical Association / - , 2023, 42-42

Skup
2nd Symposium of the International Contact Dermatitis Research Group (ICDRG) in cooperation with Croatian Dermatovenereological Society of the Croatian Medical Association

Mjesto i datum
Split, Hrvatska, 31.03.2023. - 02.04.2023

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
fixed drug eruption, drug reaction, differential diagnosis

Sažetak
Introduction: Fixed drug reaction (FDR) is a distinctive immunological cutaneous adverse reaction characterized by sharply defined lichenoid lesion(s) that appear at the same location every time there is exposure to the offending agent. Most typically it presents as one or more, round to oval, erythematous or livid plaque on acral localization (hands, feet, lips, genitals) or mucous membrane. The most common offending agents are antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). Although FDR seems typical, physicians often conduct unnecessary diagnostics before suspecting it. Here, we present a patient in which FDR was mistaken for other diagnoses. Case report: A 45- year old female patient presented with several recurrent, sharply defined, erythematous and livid patches on the skin of extremities, palms and soles, along with similar lesions on oral mucosa and lip edema. Lesions would show partial to total regression after systemic corticosteroids and antihistamines administration, but reoccurred on the second day of each menstrual cycle. Notable conditions from patient’s history were microcytic anemia treated with iron supplementation and bilateral oophorectomy after acute oophoritis. Differential diagnoses were erythema multiforme (EM) and progesteron hypersensitivity , with the latter being excluded after laboratory tests and examination by endocrinologist. Skin biopsy and histopathologic analysis of the lesion on upper leg revealed dens lymphocytic and eosinophilic infiltrate and pigmentophages in the dermis, pointing to drug-induced dermatitis. Thorough questioning revealed that patient has been taking naproxen and ibuprofen regularly in the beginning of each menstrual cycle to treat period pain. After cessation of the offending agents lesions have not reappeared, but some hyperpigmentations lingered. Conclusion: FDR may seem easy to diagnose due to a typical presentation and patient’s awareness of the offending drug. However, when typical aspects are missing and patient can’t think of the offending drug, there is substantial number of differential diagnosis, such as EM, herpes simplex, pemphigus vulgaris, Behcet's disease, lichen planus and other. Thorough interview with the patient can steer the suspicion and prevent unnecessary diagnostic tests and treatments.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA