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Metformin-Induced Generalized Fixed Drug Eruption With Cutaneous Hemophagocytosis
Jose Luis Ramírez-Bellver1, Joaquin Lopez, Elena Macias
1Departments of *Dermatology, and †Pathology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
The American Journal of Dermatopathology
|December 2, 2016
Summary
Fixed drug eruption (FDE) is a skin reaction that recurs in the same location when exposed to a drug. This case report details the first instance of cutaneous hemophagocytosis in a generalized metformin-induced FDE.
Area of Science:
- Dermatology
- Pathology
Background:
- Fixed drug eruption (FDE) is characterized by recurrent skin lesions upon re-exposure to an offending drug.
- Metformin is an uncommon cause of FDE, with only two prior cases reported.
- Cutaneous hemophagocytosis, a rare finding in dermatological conditions, has not been previously associated with FDE.
Observation:
- An 86-year-old male presented with a generalized, pruritic, macular eruption.
- Histopathological examination revealed interface dermatitis with features typical of FDE.
- Hemophagocytosis by histiocytes was observed in the deep dermis, with immunohistochemistry identifying the engulfed cells as lymphocytes.
Findings:
- This case represents the first documented instance of cutaneous hemophagocytosis in the context of a metformin-induced generalized FDE.
- The hemophagocytosis was a localized histopathological finding without systemic implications for the patient.
Implications:
- This finding expands the histopathological spectrum of FDE.
- It highlights the importance of thorough histopathological evaluation in drug-induced eruptions.
- While hemophagocytosis was present, it did not indicate systemic hemophagocytic lymphohistiocytosis in this FDE case.
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