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[Hypersensitivity to fluindione (Previscan). Positive skin patch tests].

E Frouin¹, B Roth, A Grange

¹Service de Dermatologie, Hôpital Pasteur, Centre Hospitalier de Colmar.

Annales De Dermatologie Et De Venereologie

|February 1, 2006

Summary

Fluindione (Previscan), a vitamin K antagonist, can cause severe hypersensitivity reactions, including rash, hepatitis, and kidney failure. Patch testing confirmed fluindione as the cause in a patient experiencing these symptoms.

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Area of Science:

Pharmacology
Immunology
Dermatology

Background:

Fluindione (Previscan) is a widely prescribed oral anticoagulant in France, belonging to the vitamin K antagonist class.
While bleeding is a known complication, severe immunoallergic reactions are less common.
This report details a case of drug-induced hypersensitivity syndrome attributed to fluindione.

Observation:

A 75-year-old woman presented with a diffuse erythematous papular rash and facial edema 3 weeks after starting fluindione, allopurinol, and perindopril.
Laboratory findings revealed hyperleukocytosis, mixed hepatitis, and moderate renal failure, indicative of a drug reaction.
Eosinophilia, hepatic cytolysis with cholestasis, and acute renal failure were noted. Symptoms recurred upon fluindione reintroduction and resolved upon its withdrawal.

Findings:

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The clinical presentation and laboratory results strongly suggested drug-induced hypersensitivity syndrome.
Positive skin patch tests confirmed fluindione as the causative agent, while allopurinol and perindopril were ruled out.
This case highlights the potential for severe immunoallergic reactions to fluindione, even when skin involvement is not the primary feature.

Implications:

Drug-induced hypersensitivity syndrome (DRESS) associated with fluindione, though rarely reported, necessitates clinical awareness.
Physicians should consider fluindione as a potential cause of DRESS, characterized by fever, hepatitis, and acute tubular interstitial nephritis.
Skin patch testing is a valuable diagnostic tool for identifying the specific drug responsible for hypersensitivity reactions.