Fixed Drug Eruption Associated with Nonsteroidal Anti-Inflammatory Drugs for Menstrual Pain: A Case Report

Fixed drug eruption (FDE) is a type of drug reaction in which cutaneous or mucocutaneous lesions recur at the same site due to repeated administration of the causative drug. The most reported FDE-inducing drugs are nonsteroidal anti-inflammatory drugs (NSAIDs). We report a case of FDE associated with the use of NSAIDs for menstrual pain. A 33-year-old woman was referred to our department with blisters and soreness on her lips, tongue, and labial mucosa. The results of blood examination helped rule out herpes simplex virus infection, pemphigus, and pemphigoid. An FDE was suspected because these symptoms coincided with the use of NSAIDs for menstrual pain. Thus, the patient was advised not to use these NSAIDs but to use acetaminophen instead. No recurrence has been observed since the patient began avoiding these NSAIDs.

Immediate and Delayed Hypersensitivity Reactions to Antibiotics: Aminoglycosides, Clindamycin, Linezolid, and Metronidazole

Hypersensitivity reactions including IgE-mediated and delayed cell-mediated reactions to aminoglycosides, clindamycin, linezolid, and metronidazole are rare. For aminoglycosides, allergic contact dermatitis is the most frequent reaction for which patch testing can be a useful step in evaluation. For clindamycin, delayed maculopapular exanthems are the most common reactions. There are case reports of clindamycin associated with drug rash with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), acute febrile neutrophilic dermatosis, and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). For linezolid, cases of hypersensitivity were exceedingly rare and included urticaria, angioedema, anaphylaxis, delayed rashes, and DRESS. For metronidazole, only rare cases were found across a broad spectrum of reactions including allergic contact dermatitis, fixed drug eruption, angioedema, anaphylaxis, serum sickness-like reaction, SJS/TEN, AGEP, SDRIFE, and a possible case of DRESS. IgE-mediated reactions and anaphylaxis to these types of antibiotics are uncommon, and reports of skin testing concentrations and desensitization protocols are largely limited to case reports and series. Non-irritating skin testing concentrations have been reported for gentamycin, tobramycin, and clindamycin. Published desensitization protocols for intravenous and inhaled tobramycin, oral clindamycin, intravenous linezolid, and oral and intravenous metronidazole have also been reported and are reviewed.

Mucosal Fixed Drug Eruption to Levetiracetam with Early Positive Patch Test on Non-Lesional Skin

Levetiracetam (LEV) is a second-generation antiepileptic drug (AED) that is well tolerated, has a broad spectrum of action, low protein binding, and minimal hepatic metabolism. The incidence of hypersensitivity to LEV in children and adults is 0.6%. This is the first reported fixed drug eruption (FDE) identified using a patch test in a pediatric case associated with LEV