A fixed dose combination of ofloxacin and ornidazole induced fixed drug eruptions
Keywords:Adverse reactions, Drug induced cutaneous disorders, Fixed drug eruptions, Fixed dose combination, Naranjo’s ADR probability scale, Ofloxacin and ornidazole
Fixed drug eruptions (FDEs) may account for 16-21% of all cutaneous drug eruptions. Recent research suggests a cell-mediated process that initiates both the active and quiescent lesions. The major categories of causative agents of fixed drug eruption include antibiotics, antiepileptics, nonsteroidal anti-inflammatory agents, sildenafil, and phenothiazines, although numerous other agents and certain foods such as cashews and licorice have also been reported as causative agents. A 38 year old male presented to the dermatology OPD with hyperpigmented and erythematous macular eruptions on the neck, chest, right arm, left scapular region, left wrist and left knee. The eruptions were associated with burning sensation and itching. He informed having taken medications for gastroenteritis the night before. The medications were Ofloxacin and Ornidazole (FDC), Omeprazole and Domperidone (FDC) and Paracetamol. He gave a history of a similar event, a year ago, with the same antimicrobial combination (Ofloxacin and Ornidazole), although the macular eruptions were restricted to the neck, arm and knee with bleb formation and severe burning sensation. Since the macular eruptions reoccurred, although with extra regions being affected, a diagnosis of FDEs was made. The most probable cause for these FDEs seems to be FDC of Ofloxacin and Ornidazole, because the patient gives history of taking Omeprazole and Paracetamol before without any FDEs. According to Naranjo’s Adverse Drug Reaction Probability Scale, the FDC of Ofloxacin and Ornidazole is a definite cause for the FDEs. (Score = 9).
Mahboob A, Haroon TS. Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol. 1998 Nov;37(11):833-8.
Fathallah N, Ben Salem C, Slim R, Boussofara L, Ghariani N, Bouraoui K. Acetaminophen-induced cellulitis-like fixed drug eruption. Indian J Dermatol. 2011 Mar;56(2):206-8.
Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S. Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 2007;30(5):379-407.
Lee AY. Fixed drug eruptions. Incidence, recognition, and avoidance. Am J Clin Dermatol. 2000 Sep-Oct;1(5):277-85.
Pellicano R, Ciavarella G, Lomuto M, Di Giorgio G. Genetic susceptibility to fixed drug eruption: evidence for a link with HLA-B22. J Am Acad Dermatol. 1994 Jan;30(1):52-4.
Pellicano R, Lomuto M, Ciavarella G, Di Giorgio G, Gasparini P. Fixed drug eruptions with feprazone are linked to HLA-B22. J Am Acad Dermatol. 1997 May;36(5 Pt 1):782-4.
Baird BJ, De Villez RL. Widespread bullous fixed drug eruption mimicking toxic epidermal necrolysis. Int J Dermatol. 1988 Apr;27(3):170-4.
Teraki Y, Shiohara T. IFN-gamma-producing effector CD8+ T cells and IL-10-producing regulatory CD4+ T cells in fixed drug eruption. J Allergy Clin Immunol. 2003 Sep;112(3):609-15.
Mizukawa Y, Shiohara T. Fixed drug eruption: a prototypic disorder mediated by effector memory T cells. Curr Allergy Asthma Rep. 2009 Jan;9(1):71-7.
Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol. 2009 Aug;9(4):316-21.
Weedon D. The lichenoid reaction pattern ('interface dermatitis'). Skin Pathology. 2nd Ed. London, England: Churchill Livingstone; 2002:42-43.
Smoller BR, Luster AD, Krane JF, Krueger J, Gray MH, McNutt NS, et al. Fixed drug eruptions: evidence for a cytokine‐mediated process. Journal of cutaneous pathology. 1991 Feb 1;18(1):13-9.
Hindsen M, Christensen OB, Gruic V, Lofberg H. Fixed drug eruption: an immunohistochemical investigation of the acute and healing phase. Br J Dermatol. 1987 Mar;116(3):351-60.
Shiohara T, Nickoloff BJ, Sagawa Y, Gomi T, Nagashima M. Fixed drug eruption. Expression of epidermal keratinocyte intercellular adhesion molecule-1 (ICAM-1). Arch Dermatol. 1989 Oct;125(10):1371-6.
Bolognia JL, Jorizzo JL, Rapini RP. Fixed drug eruptions. Dermatology. London, England: Mosby; 2003:344-345.
Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI. Fixed drug eruptions. Fitzpatrick’s Dermatology in General Medicine. 6th Ed. New York, NY: McGraw-Hill; 2003:1333.
Sehgal VN, Srivastava G. Fixed drug eruption (FDE): changing scenario of incriminating drugs. Int J Dermatol. 2006 Aug;45(8):897-908.
Choi SY, Suh JH, Park KY, Li K, Kim BJ, Seo SJ, et al. Fixed Drug Eruption Caused by Sildenafil Citrate. Ann Dermatol. 2017 Apr;29(2):247-8.