A Patch Test-Confirmed Mefenamic Acid-Induced Fixed Drug Eruption in a Tunisian Woman (original) (raw)
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Fixed Drug Eruption: Case Report
Britain International of Exact Sciences (BIoEx) Journal, 2020
Drug allergy is characterized by hypersensitivity reactions to pharmacological agents, having an immune mechanism of development. In these reactions antibody and/or activated T cells are directed against medications or their metabolites. This problem is rather urgent for practical healthcare, as over 7% of people suffer from drug allergy. A 54-year old male presented at the emergency room Hospital Zainoel Abidin with redness and swelling of the bodies of a burning sensation, itching pain. In the detailed anamnesis taken from the patient, it was learned that 1 days previously he had consulted a nurse with the fever and 60 min after examination had been prescribed with acid mefenamic. Hypersensitivity immune reactions to medications, according to the present concepts, are divided into immediate reactions (within 1–6 h after starting the preparation manifesting with various forms—from mild to life-threatening symptoms of anaphylaxia), or delayed reactions (several hours to several days...
Drugs Causing Fixed Drug Eruption: A Clinical Study
2011
Objectives: To identify the causative drugs of fixed drug eruption, and to assess drug-related body site distribution of fixed drug eruption. Methods: This study was conducted at Prince Rashid Hospital and Queen Alia Hospital during the period between January 2008 and June 2009. A total of 64 patients who attended the dermatology clinic with fixed drug eruption were asked about the offending drug. Results: Trimethoprim-sulphamethoxazole was the causative agent in 43 cases (70.3%), followed by Furosemide in 5 cases (7.8%), and Tetracyclines in 4 cases (6.3%). Other causative drugs included Diclofenac sodium 3 (4.7%), Ciprofloxacin 3 (4.7%), Ibuprofen 2 (3.1%), Metronidazole 2 (3.1%), Norfloxacin 1 (1.6%), and aspirin 1 (1.6%). The glans penis of the male genitalia was the most commonly involved site (58.0%), followed by the extremities (39.0%), the trunk (20.3%), and the lips (6.3%). The female genitalia (clitoris) was involved only in two patients (3.1%). Only one patient (1.6%) dev...
Mefenamic acid induced Acute Generalized Exanthematous Pustulosis (AGEP): A Case Report
— Acute Generalized Exanthematous Pustulosis (AGEP) is a rare severe cutaneous adverse reaction mainly caused by drugs. It is characterized by an acute pustular eruption over the body along with fever and leukocytosis. It has been known to resolve spontaneously over a period of 2-3 weeks without long term sequelae. However it is of utmost importance for the physicians to clinically identify this condition as to prevent unwanted extensive management. Mefenamic acid is a non-steroidal anti-inflammatory drug (NSAIDs) prescribed over the counter for pain relief. A sixteen year old boy is reported here who developed AGEP after taking mefenamic acid for fever and joint pain. It was diagnosed with the help of history, clinicopathological correlation, AGEP validation score and recovery on withdrawal of the drug. To the best of our knowledge this is the first case report of mefenamic acid causing AGEP in the literature.
Fixed drug eruption represents a drug-related cutaneous reaction which appears in the same place in case of repeated administration of a drug to which the patient shows intolerance. Skin lesions are characterized by erythematous patches or plaques that appear between 30 minutes and 8 hours after the therapy is introduced. The pathogenetic mechanism is represented by the awareness of CD 8 T lymphocytes from the skin, remaining in a sleeping state and reactivating in case of a new administration. This type of after-treatment reaction is most frequently cited in connection with cotrimoxazole, betalactamine and nonsteroidal antiinfl amatory drugs (NSAIDs). We will present eleven clinical cases of fi xed drug eruptions from the casuistry of the Dermatology Clinic from Târgu Mureş. The knowledge of this dermatosis by clinicians and pharmacists leads to full remission and it also helps avoid recurrence of the lesion.
Clinical Profile of Severe Cutaneous Drug Eruptions in a Tertiary Care Hospital
Journal of College of Medical Sciences-Nepal, 2019
Background: An adverse cutaneous reaction caused by a drug is any undesirable change in the structure or function of the skin, its appendages or mucous membranes and it encompass all adverse events related to drug eruption, regardless of the etiology. Methods: This is a retrospective descriptive cross-sectional study done fom April 2017 to March 2019 at dermatology department of Kathmandu Medical College Teaching Hospital. Sample size was calculated as 42 with prevalance of severe cutaneous drug eruption as 3%. After the medication history was taken, all suspected causative drugs were discontinued. For the initial 5 to 7 days, all patients were treated with intravenous corticosteroids and oral antihistamines. Follow up after one week, 2 weeks and one month were suggested for assessment of outcomes. Results: Out of 42 patients, 22 (52.38%) were females and 20 (47.62%) males. Most were in age groups 16-39 & 46-60 counting to 14 (33.33%) in each group. Acute morbilliform eruption was ...
A prospective observational study on drug induced cutaneous eruptions in a tertiary care hospital
2018
Article History: Received 20 Sep 2017 Revised 05 Dec 2017 Accepted 11 Dec 2017 Aims: To study the clinical pattern of drug-induced cutaneous eruptions, associate the causality relationship between the suspected drug and the cutaneous reaction observed, also to assess the severity and the preventability criteria of cutaneous reaction. Subject & Methodology: A hospital-based Prospective, the Observational study was carried out in patients presenting to Department of Dermatology at Osmania General Hospital. Data collection form was designed according to the need of our study. Naranjo scale, Modified Hartwig and Siegal scale, Schumock and Thornton scale was used in the study to assess the causality, severity and the preventability criteria of the observed reactions respectively. After inclusion and exclusion criteria, 147 cases were enrolled in the study. Results: A total of 147 cutaneous eruptions were identified in which female predominance was observed. The most common clinical patte...
A study of cutaneous adverse drug eruptions in dermatologic practice
Cutaneous adverse drug reactions (CADR) are a major problem in drug therapy and is one of the leading causes of morbidity and mortality in health care. Objectives: 1) To study the diverse clinical spectrum of CADR. 2) To assess the causality and identify the offending drug. Materials and Methods: Present study was an 18 months prospective, hospital based study conducted, recording a total of 100 patients with various cutaneous ADR. The diagnosis of cutaneous drug reactions was made mainly based on detail history and correlation between the intake of probable offending drug and the onset of rash. Results: The most common type of CADR patterns recorded among the 100 cases in the present study were Maculopapular rash (30%), Fixed drug eruption & bullous variant (19%), Acute urticaria (18%), Acneiform eruptions (6%), Erythema multiforme & Stevens – Johnson syndrome (SJS) in (5%), Exfoliative dermatitis & Photosenstivity in (4%), Angioedema, Vasculitis & Hyperpigmentation in (2%), Toxic epidermal necrolysis (TEN), Drug hypersensitivity syndrome & Pruritus in (1%) each. The drugs most often implicated were Antimicrobials(40%), NSAIDs (30%), and Anticonvulsants (11%). Antimicrobials were implicated in (43.3%) of Maculopapular rash followed by NSAIDs (33.3%). Antimicrobials (52.6%) and NSAIDs (42.1%) in FDE. Urticarial reaction was caused mainly by NSAIDs (44.3%). Life threatening severe cutaneous adverse drug reactions (SCARs) such as SJS, TEN & Drug hypersensitivity syndrome (DHS) were seen 7% of total cases. Conclusion: Although it was a monocentric study, this study revealed a high frequency of cutaneous drug reactions with different clinical presentations, induced by frequently used antibiotics, analgesics and anticonvulsants as and when used giving an interesting data with respect to onset, severity and clinical presentation.
The dermatopathology of drug eruptions
Current Problems in Dermatology, 2002
Cutaneous drug eruptions are among the most common adverse reactions to drug therapy, the etiology of which reflects immunologic and/or nonimmunologic mechanisms, the former encompassing all of the classic immune mechanisms of Gell and Combs. The latter reflect cumulative and synergistic effects of drugs including interactions of pharmacokinetic and pharmacodynamic factors such as the alteration by one agent of the effective serum concentration of another and the molecular interactions of drugs and their metabolites. It has recently been observed that concurrent infection with lymphotropic viruses may enhance drug effects by promoting lymphoid blast transformation and lymphocyte survival. Drug reactions may also be dramatically affected by intercurrent systemic connective tissue disease syndromes that promote enhanced lymphocyte longevity and the acquisition of progressively broadening autoantibody specificities, a phenomenon that is also of import in drug-induced lupus erythematosus. To confirm the relationship between drug intake and the provocation of a cutaneous eruption in any given patient, ideally one should establish that (1) the onset of the eruption correlates temporally with drug ingestion, resolves with discontinuation of the suspect agent, and recurs following rechallenge; (2) the suspect drug is established to provoke the adverse effect seen in the patient; and (3) an alternate explanation is unlikely.
Linear immunoglobulin A bullous dermatosis possibly induced by mefenamic acid
The Journal of dermatology, 2010
Dear Editor, Linear immunoglobulin A bullous dermatosis (LABD) is a relatively rare autoimmune blistering disease characterized clinically by the presence of small tense blisters and immunologically by the presence of immunoglobulin (Ig)A at the dermal-epidermal junction. Idiopathic, systemic disease-related and drugrelated types of this disorder have been described so far. 1,2 We report the first case of LABD possibly associated with mefenamic acid, which is well known to induce commonly fixed drug eruptions.