A case of generalized bullous fixed drug eruptions induced by ceftriaxone

Abstract

Fixed drug eruption (FDE) is a delayed-type hypersensitivity reaction to a systemic medication. Generalized bullous fixed drug eruption (GBFDE) is a rare variant involving generalized bullae and erosions across multiple anatomical sites. A 66-year-old female with dialysis-dependent chronic kidney disease presented with fever and chills, and subsequently developed multiple erythematous to bluish annular nodules with central bullae on the hands, feet, tongue, buccal mucosa, and lips after ceftriaxone administration. Clinical examination revealed no prior history of drug allergies. Diagnostic assessments showed elevated serum creatinine and other parameters consistent with renal impairment. The suspected drug was discontinued, and patient treated with oral prednisolone, levocetirizine, topical betamethasone, and fusidic acid. Oral paste and gargles were prescribed for mucosal involvement. This case highlights the importance of recognizing ceftriaxone-induced GBFDE, particularly in patients with chronic kidney disease on haemodialysis. Prompt identification and cessation of the offending drug, along with appropriate therapeutic interventions, are critical for preventing future episodes and ensuring patient safety.