Multidrug-induced erythema multiforme

Area of Science:

• Dermatology
• Pharmacology

Background:

• Adverse skin reactions to medications are frequent, affecting over 1% of patients for many common drugs.
• Drug-induced skin reactions necessitate careful identification of causative agents for patient safety.

Observation:

• A 29-year-old woman presented with pruritus, rash, vesicles on extremities, and oropharyngeal edema after exposure to multiple medications.
• Skin biopsy confirmed erythema multiforme (EM), with subsequent oral challenges implicating piroxicam and levofloxacin.

Findings:

• Piroxicam was identified as a cause of erythema multiforme (EM) through oral challenge.
• Levofloxacin was also identified as a potential trigger for EM, a rare association.

Implications:

• This case highlights the importance of considering less common drugs like piroxicam and levofloxacin in the differential diagnosis of drug-induced erythema multiforme.
• Identifying specific drug triggers is crucial for preventing recurrent severe cutaneous adverse reactions.