Unusual fixed drug eruption due to rifampicin

Abstract

Cutaneous reactions due to rifampicin (RPM) are uncommon and amongst these fixed drug eruption (FDE) is especially rare. There have been only three reports of FDE to RPM in the literature so far. 1-3 In 1985, Naik et al. first repOlted a peculiar urticarial type of FDE due to RFM . Here, we describe a second such case with a similar unusual cutaneous drug eruption. Case reportA 24-year-old soldier suffering from borderline tuberculoid leprosy (BT) was admitted to the Leprosy Center, Base Hospital, Lucknow for supervised institutional therapy. He was put on cap RPM 600 mg once a month and dapsone 100 mg daily. The patient developed a solitary itchy erythematous urticarial lesion of 3.5 cm diameter with typical peau d'orange appear ance (Figure 1), on the right side of the chest wall about 1 h after the second monthly dose of RFM. The lesion subsided on its own within 1 h without any residual hyperpigmentation. A similar lesion at the same site was observed following the third monthly dose of RPM which also subsided within 1 h without treatment. At this stage, a clinical diagnosis of FDE was made and all drugs were discontinued. Two days later, the patient was subjected to a provocation test with 600 mg of RFM, following which he developed an urticarial lesion at the same site. The provocation test to dapsone did not evoke any cutaneous reaction. Skin biopsy of the lesion revealed slight dermal oedema and sparse eosinophilic infiltration. Interestingly, this cutaneous response to RFM ceased after the fifth dose of RPM.In our patient, recurrence of a wheal at exactly the same site following administration of RPM is highly suggestive of FDE. Though FDE can be urticarial, the residual hyper pigmentation that follows a classical FDE was not seen. Moreover, the histopathology was

Fixed drug eruption (FDE): changing scenario of incriminating drugs

“…recorded FDE exclusively localized to site of bacillus Calmette–Guérin (BCG) vaccination. This interesting localization and predilection for certain sites has been recorded by several workers 71–77 . The interval between the original trauma and the initial onset of FDE lesions may range up to several years and may represent a form of recall phenomenon 69 .…”

“…The clinical expression of classic FDE is sufficiently distinctive to form a diagnosis (see above); however, the unusual expression of FDE may be overlooked unless there is a high degree of suspicion 71–77 . There are reports of localized bullous pemphigoid resembling bullous FDE, 212 or FDE masquerading as herpes (simplex) labialis 213 or discoid lupus erythematosus 214 .…”

“…This interesting localization and predilection for certain sites has been recorded by several workers. [71][72][73][74][75][76][77] The interval between the original trauma and the initial onset of FDE lesions may range up to several years and may represent a form of recall phenomenon. 69 Familial occurrence of FDE is unusual, but there are reports describing such a situation.…”

“…The clinical expression of classic FDE is sufficiently distinctive to form a diagnosis (see above); however, the unusual expression of FDE may be overlooked unless there is a high degree of suspicion. [71][72][73][74][75][76][77] There are reports of localized bullous pemphigoid resembling bullous FDE, 212 or FDE masquerading as herpes (simplex) labialis 213 or discoid lupus erythematosus. 214 Similarly, NFDE, where a tendency to resolve completely after the attack is apparent, [26][27][28][29][30][48][49][50] must be considered in the differential diagnosis.…”