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Multiple fixed drug eruption due to drug combination
1Department of Dermatology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173-0032, Japan. ayoko@med.nihon-u.ac.jp
Contact Dermatitis
|June 4, 2005
Summary
A rare case of multiple fixed drug eruption (FDE) occurred after taking piroxicam (PL) and levofloxacin together. Standard tests were negative, but a combination challenge provoked the FDE, highlighting drug combinations as a potential cause.
Area of Science:
- Dermatology
- Clinical Pharmacology
Background:
- Fixed drug eruption (FDE) is a rare adverse drug reaction characterized by the recurrence of skin lesions at the same site(s) upon re-exposure to the causative agent.
- Drug-induced skin reactions are common, but FDE specifically linked to drug combinations is exceptionally rare.
Observation:
- A patient developed multiple fixed drug eruptions (FDE) after simultaneous administration of piroxicam (PL) and levofloxacin.
- Standard diagnostic tests including patch tests, lymphocytic stimulation tests, and monotherapy oral provocation tests with PL or levofloxacin were negative.
- Re-challenge with a fraction of the combined PL-levofloxacin dose successfully provoked the characteristic erythematous plaques in the previously affected areas.
Findings:
- This case presents the first documented instance of multiple FDE caused by the combination of piroxicam and levofloxacin.
- Diagnostic challenges were noted, as individual drug testing did not predict the reaction to the combination therapy.
Implications:
- The findings suggest that drug combinations, even when individual components are non-reactive in standard tests, can trigger FDE.
- Clinicians should consider drug combinations as potential culprits in FDE, especially when monotherapy testing is inconclusive.
- Further research into the mechanisms of FDE induced by drug combinations is warranted.