A case of entecavir-associated bullous fixed drug eruption and a review of literature

Abstract

Fixed drug eruption (FDE) is a type of drug reaction characterized by localized erythema, hyperpigmentation, and bullous at the same site(s), generally observed following every intake of a causative drug. Delayed-type cellular hypersensitivity (Type IVC) is considered to play a role in FDE etiology. Several antibiotics, barbiturates, oral contraceptives, nonsteroidal anti-inflammatory drugs, laxative-containing phenolphthalein, metronidazole, and quinine are known to be the primary drugs responsible for FDE. Bullous FDE, on the other hand, is a relatively rare form of FDE. Hepatitis B is a significant worldwide health problem, and entecavir is a common nucleoside (deoxyguanosine) analog used for treating hepatitis B; however, it has various side effects, such as lactic acidosis, myalgia, azotemia, hypophosphatemia, headache, diarrhea, pancreatitis, and neuropathy, and, in rare cases, cutaneous drug eruption. Our aim is to present a case of entecavir-associated bullous drug reaction, which has not been reported in the literature. Furthermore, we performed a review of literature to compile previously reported entecavir-associated drug reactions.

Hypopigmented penile fixed drug eruption

“…Nevertheless, this additional information suggested differentials of either FDE or herpes genitalis. He was told to stop taking co‐trimoxazole and to continue with his ARV drugs since co‐trimoxazole is one of the most commonly prescribed medications in Nigeria connected with FDE and herpes genitalis infection had earlier been ruled out 2,3 . We observed that the ulcers healed over 3 months (Figure 4) and did not re‐occur for the next 8 months of follow‐up of the patient.…”

“…It is a relatively common form of cutaneous adverse drug reaction that has been associated with over 100 medications worldwide. [1][2][3] In Nigeria, sulphonamides, particularly sulfadoxine/pyrimethamine and trimethoprim/sulfamethoxazole (co-trimoxazole), are the dominant etiological drugs of FDE. 4,5 The pathophysiological mechanism of FDE involves a type IV hypersensitivity reaction, mediated by CD8+ memory T lymphocytes of the stratum basale.…”

“…Fixed drug eruption (FDE) is diagnosed clinically by linking exposure to a drug with the occurrence of fixed exanthematous reactions. It is a relatively common form of cutaneous adverse drug reaction that has been associated with over 100 medications worldwide 1–3 . In Nigeria, sulphonamides, particularly sulfadoxine/pyrimethamine and trimethoprim/sulfamethoxazole (co‐trimoxazole), are the dominant etiological drugs of FDE 4,5 .…”

“…Classically, FDE requires a few days to 2 weeks to develop after initial exposure and within 48 h for subsequent exposures 6 . Typically, FDE is described as single, well demarcated, red to violaceous, round to oval, patches or plaques that heal with residual hyperpigmentation 1–6 . There have been several reports of non‐pigmenting FDE 7 .…”

“…7 Atypical presentations may include multiple/generalized, vesicles/bullae, that rupture into erosions or shallow ulcers that have been misdiagnosed as erythema multiforme, herpes genitalis, Steven-Johnson syndrome, contact dermatitis, and lichen planus. [1][2][3]6,7 FDE can occur on any skin surface; however, oral mucosa, genitals, and perianal region have received the most attention. 6 We report a patient with FDE who presented with a prolonged time between re-exposure to co-trimoxazole and the onset of symptoms.…”