Case Report
 

Generalized Bullous Fixed Drug Eruption to Fluconazole with Positive Patch Testing and Confirmed Tolerance to Itraconazole

Generalized Bullous Fixed Drug Eruption to Fluconazole

Abstract

Generalized bullous fixed drug eruption (GBFDE) is a specific variant of fixed drug eruption that belongs to severe cutaneous adverse reactions (SCARs) and its diagnosis is based mainly on clinical course and especially on the reoccurrence of typical bullous lesions in previous and new sites after re-administration of the offending drug. We present a well-documented case of fluconazole-induced GBFDE, with a positive patch test to fluconazole (30% weight/volume preparation) and clinical tolerance to itraconazole proven by negative oral provocation. Even in SCARs, patch testing represents a useful diagnostic tool, while oral provocation remains the gold standard in cases that an alternative but the chemically relevant drug must be administered.

1. Mockenhaupt M. Bullous Drug Reactions. Acta DermVenereol. 2020;100(5):adv00057.
2. Barbaud A, Gonçalo M, Bruynzeel D, Bircher A. European Society of Contact Dermatitis. Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Proposed by the Working party of the ESCD for the study of skin testing in investigating cutaneous adverse drug reactions. Contact Dermatitis. 2001;45(6):321-8.
3. Patel S, John AM, Handler MZ, Schwartz RA. Fixed Drug Eruptions: An Update, Emphasizing the Potentially Lethal Generalized Bullous Fixed Drug Eruption. Am J Clin Dermatol. 2020;21(3):393-9.
4. Dharamsi FM, Michener MD, Dharamsi JW. Bullous fixed drug eruption masquerading as recurrent Stevens Johnson syndrome. J Emerg Med. 2015;48(5):551–4.
5. Andrade P, Brinca A, Gonçalo M. Patch testing in fixed drug eruptions: a 20-year review. Contact Dermatitis. 2011;65(4):195–201.
6. Quint T, Wöhrl S, Kinaciyan T. Fixed drug eruption caused by fluconazole-An underdiagnosed but recurrent problem. Contact Dermatitis. 2018;80(3):172-3.
7. Mithari HS, Gole PV, Kharkar VD, Mahajan SA. Generalized Bullous Fixed Drug Eruption to Fluconazole; with Cross-Reactivity to Tinidazole. Indian J Dermatol. 2019;64(4):335-7.
8. Gaiser CA, Sabatino D. Fluconazole-induced fixed drug eruption. J Clin Aesthet Dermatol. 2013;6(3):44-5.
9. Demir S, Cetin EA, Unal D, Coşkun R, Olgac M, Gelincik A, et al. Generalized Fixed Drug Eruption Induced by Fluconazole Without Cross-Reactivity to Itraconazole: Lymphocyte Transformation Test Confirms the Diagnosis. Drug Saf Case Rep. 2018;5(1):2.
10. Bavbek S, Yilmaz İ, Sözener ZÇ. Fixed drug eruption caused by ornidazole and fluconazole but not isoconazole, itraconazole, ketoconazole and metronidazole. J Dermatol. 2013;40(2):134-5.
Files
IssueVol 20 No 2 (2021) QRcode
SectionCase Report(s)
Published2021-04-17
DOI https://doi.org/10.18502/ijaai.v20i2.6081
Keywords
Cross reactions Drug-related side effects and adverse reactions Fluconazole Patch tests

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Makris M, Fokoloros C, Syrmali A, Tsakiraki Z, Damaskou V, Papadavid E. Generalized Bullous Fixed Drug Eruption to Fluconazole with Positive Patch Testing and Confirmed Tolerance to Itraconazole. Iran J Allergy Asthma Immunol. 20(2):255-259.