Non-steroidal, anti-inflammatory drugs, followed by antibiotics, are the main
causes of fixed drug eruption. They provoke one or several round erythematous or
bullous lesions that recur in the same place after taking the causative
medication. A positive patch test on residual, lesional skin can replace
satisfactorily oral reintroduction. We describe the case of a 74-year-old woman
with numerous, rounded, erythematous lesions on the trunk and recurrent
blistering on the fifth right-hand finger, which developed a few hours after
taking etoricoxib. Lesional patch testing with etoricoxib was positive and
reproduced the typical pattern of a fixed drug eruption upon histopathology. We
emphasize the specific reactivity of the etoricoxib patch test, and the capacity
to reproduce the histologic pattern of the reaction.
Severe cutaneous drug reactions include a wide spectrum of clinical manifestations
ranging from mild morbilliform cutaneous rash, to severe forms of hypersensitivity.
Special attention is given in this report to the acute generalized exanthematous
pustulosis (AGEP), induced in 90% of cases by the use of systemic drugs, especially
aminopenicillins and macrolides. The incidence of the disease is low, 1-5 cases per
million patients / year. The main differential diagnosis is Von Zumbusch's Pustular
Psoriasis. The prognosis is generally good and the disease self limited, after
withdrawal of the triggering drug. In this report the authors describe a case of
AGEP, triggered by ceftriaxone in a patient with psoriasis vulgaris.
A male full‐term infant, who had been exclusively breast‐fed since birth, at 2 months of age developed an erythematous, scaling eruption involving the face (in a periorificial distribution, i.e. mouth, nose, ears, and eyes), hands, and feet, which did not respond to treatment with topical corticosteroids and oral antimicrobials. He was first seen at our institution at 5 months of age (Figs 1 and 2). He had been irritable for the last 2 weeks, but had no diarrhea, alopecia, or anogenital lesions. A clinical diagnosis of acrodermatitis enteropathica was confirmed with a serum zinc level of 41.2 µg/dL (normal, 70–120 µg/dL). His mother had low–normal serum (70.5 µg/dL; normal, 70–120 µg/dL) and normal milk (0.43 µg/mL; normal, 0.2–0.72 µg/mL) zinc concentrations. Within 7 days of starting therapy with zinc sulfate, 10 mg/kg/day, all cutaneous lesions had resolved (Fig. 3).
1
Infant at 5 months of age showing an erythematous, scaling eruption involving the face (periorificial distribution, i.e. mouth, nose, and eyes) and hands
2
Infant with dermatophytosis‐like lesions
3
Infant at 6 months of age after starting oral zinc supplementation. The lesions have resolved
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