Cotrimoxazole-induced generalized bullous fixed drug eruption mimicking stevens-johnson syndrome: a case report

Authors: Marie Len A. Camaclang, MD, Eileen Liesl A. Cubillan, MD, FPDS

Abstract

Introduction: Generalized bullous fixed drug eruption (GBFDE) is characterized by generalized erythema and appearance of multifocal ill-defined hyperpigmentation, and flaccid bullae which easily rupture and exhibit epidermal detachment. It may be clinically indistinguishable from stevens-johnson syndrome (SJS), especially on initial presentation.

Case Summary: This is a case of a 71-year-old Filipino female who presented with one-day history of generalized erythema associated with pain, pruritus and undocumented fever, after intake of co-trimoxazole for urinary tract infection. There was eventual development of dusky patches and multiple bullae on the trunk and extremities. She allegedly had a previous hospitalization for a similar condition, and was assessed to have cutaneous drug reaction from co-trimoxazole. On physical examination, there was generalized ill-defined erythema, with tenderness on palpation, and areas of denuded skin and flaccid bullae. Nikolsky sign was positive. There were no mucosal involvement. The patient was initially assessed with stevens-johnson syndrome (SJS) prior to dermatologic referral, admitted in an intensive care unit, and managed with intravenous corticosteroids. Skin biopsy revealed subepidermal split with numerous dermal melanophages consistent with GBFDE. The patient was eventually transferred to a regular room and discharged improved.

Conclusion: This case highlights the importance of differentiating GBFDE from SJS, with implications in management. A consistent clinical absence of mucosal involvement, and histopathologic confirmation, support the diagnosis of GBFDE. This case also illustrates a favorable prognosis for GBFDE.

 

Citation

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Keywords

bullous fixed drug eruption, stevens-johnson, cotrimoxazole

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