Eruptions in focus: cefadroxil and the uncommon realm of fixed-drug reactions: a case report

Palak Agrawal; Rahul Kunkulol; Kartik Dhananjay Ghodke

doi:10.18203/2319-2003.ijbcp20240996

Authors

Palak Agrawal Department of Pharmacology, Dr. BVVP Rural Medical College, Pravara Institute of Medical Sciences (Deemed to be University), Loni, Ahmednagar, Maharashtra, India
Rahul Kunkulol Department of Pharmacology, Dr. BVVP Rural Medical College, Pravara Institute of Medical Sciences (Deemed to be University), Loni, Ahmednagar, Maharashtra, India
Kartik Dhananjay Ghodke Dr. BVVP Rural Medical College, Pravara Institute of Medical Sciences (Deemed to be University), Loni, Ahmednagar Maharashtra, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20240996

Keywords:

Cefadroxil, Immunological cutaneous adverse reaction, CD8 memory T cells, Cytokine production, CD4 regulatory T cells, Naranjo algorithm, Pharmacovigilance

Abstract

This case report explores a rare case of localized fixed-drug eruption (FDE) induced by cefadroxil, a first-generation cephalosporin. FDE, characterized by recurrent lichenoid lesions at specific sites upon drug exposure, is an immunological cutaneous adverse reaction. The incidence of FDE due to cephalosporins is infrequently reported, making this case noteworthy. We present a 51-year-old male who developed brownish-black patches and painful blisters on his extremities after initiating treatment with Cefadroxil for a minor toe injury. The patient's symptoms, clinical course, and subsequent recovery are detailed. Treatment involved corticosteroids, antibiotics, and topical agents. The report also provides immunological insights into FDE pathogenesis, involving CD8+ memory T cells, cytokine production, and the role of CD4+ regulatory T cells. While the exact pathogenesis of FDE remains elusive, this report sheds light on the mechanisms contributing to the self-limited nature of these eruptions. Causality assessment using the Naranjo algorithm categorized the association between cefadroxil and FDE as probable. This case report contributes to the limited literature on FDE caused by cephalosporins and underscores the importance of recognizing and managing such dermatological reactions. The broader implications of understanding FDE pathogenesis and the rarity of cephalosporin-induced cases provides valuable insights for clinicians and researchers.

Metrics

Metrics Loading ...

References

Burgdorf WH, Plewig G, Wolff HH, Landthaler M, editors. 3rd ed. Berlin: Springer-Verlag. Braun Falco's Dermatology. 2009;460-2.

Kanwar AJ, Bharija SC, Belhaj MS. Fixed drug eruptions in children: a series of 23 cases with provocative tests. Dermatologica. 1986;172(6):315-8.

Pai V, Kikkeri N, Athanikar S, Bhandari P, Shukla P, Rai V. Retrospective analysis of fixed drug eruptions among patients attending a tertiary care center in Southern India. Indian J Dermatol Venereol Leprol. 2014;80(2):194.

Zaouak A, Ben Salem F, Ben Jannet S, Hammami H, Fenniche S. Bullous fixed drug eruption: A potential diagnostic pitfall: A study of 18 cases. Therapies. 2019;74(5):527-30.

Sehgal VN, Srivastava G. Fixed drug eruption (FDE): Changing scenario of incriminating drugs. Int J Dermatol. 2006;45(8):897-908.

Flowers H, Brodell R, Brents M, Wyatt JP. Fixed drug eruptions: presentation, diagnosis, and management. South Med J. 2014;107(11):724-7.

Mizukawa Y, Yamazaki Y, Shiohara T. In vivo dynamics of intraepidermal CD8+ T cells and CD4+ T cells during the evolution of fixed drug eruption. Br J Dermatol. 2008;158(6):1230-38.

Mizukawa Y, Yamazaki Y, Teraki Y, Hayakawa J, Hayakawa K, Nuriya H, et al. Direct Evidence for Interferon-Production by Effector-Memory-Type Intraepidermal T Cells Residing at an Effector Site of Immunopathology in Fixed Drug Eruption. Am J Pathol. 2002;161(4):1337-47.

Teraki Y, Shiohara T. IFN-producing effector CD8+ T cells and IL-10-producing regulatory CD4+ T cells in fixed drug eruption. J Allergy Clin Immunol. 2003;112(3):609-15.

Sánchez-Morillas L, Rojas Pérez-Ezquerra P, González Morales ML, Mayorga C, González-Mendiola R, Laguna Martínez JJ. Fixed drug eruption due to norfloxacin and cross reactivity with other quinolones. Allergol Immunopathol. 2013;41(1):60-1.

Ungureanu A, Zlatian O, Mitroi G, Drocaş A, Ţîrcă T, Călina D, et al. Staphylococcus aureus colonisation in patients from a primary regional hospital. Mol Med Rep. 2017;16(6):8771-780.

Ozkaya E, Mirzoyeva L, Jhaish MS. Ceftriaxone induced fixed drug eruption: first report. Am J Clin Dermatol. 2008;9(5):345-7.

Kim EJ, Kim JE, Ro YS, Ko JY. Cefaclor-Induced Generalized Fixed Drug Eruption. Ann Dermatol. 2015;27(4):465-6.

Jung JW, Cho SH, Kim KH, Min KU, Kang HR. Clinical Features of fixed Drug Eruption at a Tertiary Hospital in Korea. Allergy Asthma Immunol Res. 2014;6(5):415-20.