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

Abstract

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.

Spectrum of skin diseases presented at LAUTECH Teaching Hospital, Osogbo, southwest Nigeria

“…The frequency of keloids and hypertrophic scars (1.1%) remains within the previous range of 0.5-3.7%; the lowest of these prevalences was reported by Shrank and Harman 3 and the highest by Nnoruka. 30,31 The ACTDs, predominantly lupus erythematosus, have been increasing slowly in prevalence, as previous studies have noted. 8,18 Skin malignancies remain rare and were not reported in the studies performed in Ibadan and Enugu.…”

“…However, recently published literature suggests that provocative agents may include antibiotics consumed within livestock and fish, and nonsteroidal agents hidden in balms, ointments, and herbal preparations. 30,31 The ACTDs, predominantly lupus erythematosus, have been increasing slowly in prevalence, as previous studies have noted. 5 Prevalences in SW Nigeria have increased gradually from the 1.2% reported by Shrank and Harman 3 to 2.5% by Ogunbiyi et al, 5 and 2.9% in the present study.…”

Fixed drug eruption caused by antibiotics contained in food?

“…Because of the thermostability of these antibiotics, cooking may not fully eliminate the residual drugs. FDE resulting from residual antibiotics containing food has been reported previously . Based on this patient's medical history, the antibiotics contained in meat may have been responsible for his FDE, along with his consumption of alcohol.…”

Fixed Drug Eruption to Trimethoprim-Sulfamethoxazole and Doxycycline

“…It is also important to consider alternative forms of exposure. This was highlighted by a case report that hypothesized that consumption of antibiotics found in cooked meat caused a woman’s lesions [ 11 ]. When there are multiple suspected agents, additional testing can be done through patch testing or with drug challenge [ 1 ].…”