A case of fixed drug eruption secondary to quinine in tonic water presenting to a sexual health clinic

Abstract

Fixed drug eruption (FDE) is a cutaneous drug reaction which occurs repeatedly at a given mucocutaneous site after exposure to the causative agent. Lesions typically occur on extremities, oral mucosa and genital skin. Quinine is a common food additive and is recognised as a rare cause of FDE. We report a case of FDE with oral and genital lesions presenting to a sexual health clinic due to quinine contained in tonic water.

Cutaneous Adverse Drug Reactions with Antimalarials and Allergological Skin Tests

“…- About 10 cases of fixed drug eruption to AM were reported only with Qu contained in tonic water [20,21,22,23,24,25,26,27]. …”

Fixed food eruption caused by quinine in a 54‐year‐old female patient

“…By defi nition, fi xed food eruption (FFE) is a localized macular or plaque-like skin eruption that occurs within 24 to 48 hours after the consumption of certain foods [ 1 ] . Clinically, it is characterized by a single or a few sharply demarcated, red or livid lesions (2-5 cm in size), which recur in the same spot after repeated consumption of the same food [ 1,2 ] . Apart from potentially causing pruritus or pain, the lesions may also show central blistering.…”

“…Apart from potentially causing pruritus or pain, the lesions may also show central blistering. Lesional resolution is usually associated with postinfl ammatory hyperpigmentation [ 2,3 ] .…”

“…First reported by Kelso in 1996, FFE was fi rst described in a 66-year-old woman who had recurrently developed erythematous, hyperpigmented macules on the left buttock after consuming strawberries [ 1 ] . Since then, only about 20 other cases of FFE have been published in the international literature, the most common trigger apparently being quinine [ 2,3 ] . Other triggers include cashews [ 5 ] , asparagus [ 6 ] , lentils [ 7 ] , lactose [ 8 ] , fi sh [ 9,10 ] , seafood [ 9 ] , and food dyes [ 11 ] .…”

Highlights from this issue

“…Lonsdale-Eccles et al report this month a case of fixed drug reaction related to consumption of impressive quantities of gin and tonic 4. We like our clinical articles to go beyond the guidelines, and address issues where there is real uncertainty and difficulty in our practice.…”