Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Fixed drug eruption (FDE) is a unique dermatological drug reaction known for its recurrence in identical locations upon re-exposure to the causal drug. Acute FDE typically manifests a single or a small number of dusky red or violaceous plaques that, once resolved, leave post-inflammatory hyperpigmentation.
The case we present involves a patient with maculopapular bullous rash on his back, chest, and extremities. The rash was initially misdiagnosed as Chickenpox, yet a skin biopsy indicated Bullous Drug Eruption as a more likely diagnosis. This case is novel as the patient’s medical history did not reveal any previous intake of drugs most frequently associated with FDE, but the histopathology evidence confirmed the diagnosis of FDE and the final diagnosis was made.
Case Presentation: Patient is a 58-year-old male with a history of hyperlipidemia and thyroid disease who presented to the Emergency Department (ED) with chest pain and left upper extremity weakness. The patient presented with a day of 6/10 anterior chest pain “unlike anything he has ever felt before”. radiating to the back, associated with shortness of breath without aggravating or precipitating factors. The patient also reported two days of bilateral upper extremity weakness and generalized fatigue requiring a cane for ambulation . He reported poor appetite, cough, nausea, vomiting at home and a new “itchy”, non-painful maculopapular rash on his back. His temperature was 38.9C, heart rate 134 bpm, respiratory rate 22, blood pressure 144/77mmHg, white blood cell count 17 × 109/L, lactic acid 1.9 mmol/L, fulfilling the systemic inflammatory response syndrome (SIRS) criteria. He was diagnosed with Sepsis and started on a Sepsis treatment protocol including fluids and IV antibiotics. Chest x-ray was unrevealing, EKG demonstrated sinus tachycardia and high-sensitivity cardiac troponin (hs-cTn) was 133 ng/L which was trending down on subsequent serial evaluations and subsequent cardiac studies were also unrevealing. He had negative sputum and blood cultures and negative CMV, EBV, HIV testing. Neurology was consulted for his upper extremity weakness. Neuroimaging revealed cervical canal narrowing and mediastinal lymphadenopathy.
Infectious disease was consulted regarding rash and lymphadenopathy. At tentative diagnosis was chicken pox and acyclovir was initiated. However, the rash worsened into a maculopapular bullous rash on the patient’s back, chest and upper extremities and lymphadenopathy. Dermatology was consulted and a biopsy was performed indicating Bullous Drug Eruption. Following this diagnosis, acyclovir was discontinued, and the patient was started on prednisone oral, and the patient’s rash improved significantly following the initiation of this treatment.
Conclusions: Generalized bullous fixed drug eruption, a rare variant of FDE, may present with atypical features, mimic other skin diseases. Histological examination of a skin biopsy is instrumental to establish a diagnosis in cases with unusual clinical features. Management primarily involves the discontinuation of the offending agent, if identified, and symptomatic treatment. This case serves to discuss a novel presentation of an FDE variant and contribute to the current clinical understanding of the disease.
Academic/Professional Position
Medical Student
Academic/Professional Position (Other)
MS3
Recommended Citation
Reid-Gordon, Christopher; Gatiganti, Aishwarya; and Campo Maldonado, Jose E., "Unmasking the Chameleon: A Rare Case of Generalized Bullous Fixed Drug Eruption" (2024). Research Symposium. 12.
https://scholarworks.utrgv.edu/somrs/2023/posters/12
Included in
Unmasking the Chameleon: A Rare Case of Generalized Bullous Fixed Drug Eruption
Background: Fixed drug eruption (FDE) is a unique dermatological drug reaction known for its recurrence in identical locations upon re-exposure to the causal drug. Acute FDE typically manifests a single or a small number of dusky red or violaceous plaques that, once resolved, leave post-inflammatory hyperpigmentation.
The case we present involves a patient with maculopapular bullous rash on his back, chest, and extremities. The rash was initially misdiagnosed as Chickenpox, yet a skin biopsy indicated Bullous Drug Eruption as a more likely diagnosis. This case is novel as the patient’s medical history did not reveal any previous intake of drugs most frequently associated with FDE, but the histopathology evidence confirmed the diagnosis of FDE and the final diagnosis was made.
Case Presentation: Patient is a 58-year-old male with a history of hyperlipidemia and thyroid disease who presented to the Emergency Department (ED) with chest pain and left upper extremity weakness. The patient presented with a day of 6/10 anterior chest pain “unlike anything he has ever felt before”. radiating to the back, associated with shortness of breath without aggravating or precipitating factors. The patient also reported two days of bilateral upper extremity weakness and generalized fatigue requiring a cane for ambulation . He reported poor appetite, cough, nausea, vomiting at home and a new “itchy”, non-painful maculopapular rash on his back. His temperature was 38.9C, heart rate 134 bpm, respiratory rate 22, blood pressure 144/77mmHg, white blood cell count 17 × 109/L, lactic acid 1.9 mmol/L, fulfilling the systemic inflammatory response syndrome (SIRS) criteria. He was diagnosed with Sepsis and started on a Sepsis treatment protocol including fluids and IV antibiotics. Chest x-ray was unrevealing, EKG demonstrated sinus tachycardia and high-sensitivity cardiac troponin (hs-cTn) was 133 ng/L which was trending down on subsequent serial evaluations and subsequent cardiac studies were also unrevealing. He had negative sputum and blood cultures and negative CMV, EBV, HIV testing. Neurology was consulted for his upper extremity weakness. Neuroimaging revealed cervical canal narrowing and mediastinal lymphadenopathy.
Infectious disease was consulted regarding rash and lymphadenopathy. At tentative diagnosis was chicken pox and acyclovir was initiated. However, the rash worsened into a maculopapular bullous rash on the patient’s back, chest and upper extremities and lymphadenopathy. Dermatology was consulted and a biopsy was performed indicating Bullous Drug Eruption. Following this diagnosis, acyclovir was discontinued, and the patient was started on prednisone oral, and the patient’s rash improved significantly following the initiation of this treatment.
Conclusions: Generalized bullous fixed drug eruption, a rare variant of FDE, may present with atypical features, mimic other skin diseases. Histological examination of a skin biopsy is instrumental to establish a diagnosis in cases with unusual clinical features. Management primarily involves the discontinuation of the offending agent, if identified, and symptomatic treatment. This case serves to discuss a novel presentation of an FDE variant and contribute to the current clinical understanding of the disease.