Fixed Drug Eruption: A Rare Case of Polysensitivity between Two Unrelated Fixed Dose Combination Preparations - A Case Report

Authors

  • Jessica Kaushal Government Medical College, Amritsar; Baba Farid University of Health Sciences, Faridkot, Punjab, India
  • Abhimanyu Rakesh Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar; Baba Farid University of Health Sciences, Faridkot, Punjab, India

DOI:

https://doi.org/10.5195/ijms.2020.646

Keywords:

Drug Eruptions, Delated Hypersensitivity, Gliptins, Antimicrobial Agents, Titanium dioxide

Abstract

Background: A fixed drug eruption is a type IV hypersensitivity reaction to a medication that characteristically re-emerges on the same site each time the specific drug is taken. Antimicrobials (including fixed dose combinations) are frequently implicated in fixed drug eruption while gliptins (as separate drugs or as combined preparations) on the other hand are infrequent triggers. Drugs belonging to similar classification and having similar chemical structures can show cross reactivity, but here we describe a case of cross reactivity between unrelated drug classes, also known as polysensitivity.

The Case: A 58-year-old man presented with painful, burning, and pruritic blisters with ulcerations on the oral mucosa of lips, hard palate, and tip of the tongue. The patient had been on vildagliptin - metformin fixed dose combination tablets for one year. He was asked to stop the drug and lesions started improving thereafter. A week later he suffered from gastroenteritis for which he took a combined preparation of ofloxacin and ornidazole and lesions re-appeared at the same site as before with severe itching and burning.

Conclusion: This case highlights polysensitivity amongst chemically unrelated drugs, especially available in fixed-dose combination. It is an extremely rare occurrence (less than 0.2%). Moreover, there have only been a few cases of such delayed reactions occurring to gliptins, especially vildagliptin. A clinician must keep a high index of suspicion to identify this phenomenon.

Author Biographies

Jessica Kaushal, Government Medical College, Amritsar; Baba Farid University of Health Sciences, Faridkot, Punjab, India

MBBS, Intern.

Jessica Kaushal is an intern rotating at Guru Nanak Dev Hospital, Amritsar, Punjab, India. She has presented a paper at a national conference organized by Junior World Congress. She rotated at Cardiology department, Unicardio, Florida International University, Miami this year and has expressed her keen interest in Internal Medicine. She aspires to pursue her residency in the United States.

Abhimanyu Rakesh, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar; Baba Farid University of Health Sciences, Faridkot, Punjab, India

Dr Abhimanyu Rakesh Graduated from Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar with a degree of MBBS in March, 2020.  

Dr. Abhimanyu Rakesh is currently working as a resident medical officer at Magnus Hospital, Panchkula, Haryana, India. He recently graduated from Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. He has rotated in the United States for 3 months to gain hands on clinical experience and has expressed his appreciation for the US clinical set up.

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Published

2020-12-09

How to Cite

Kaushal, J., & Rakesh, A. . (2020). Fixed Drug Eruption: A Rare Case of Polysensitivity between Two Unrelated Fixed Dose Combination Preparations - A Case Report. International Journal of Medical Students, 8(3), 291–294. https://doi.org/10.5195/ijms.2020.646

Issue

Section

Case Report

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