FIXED DRUG ERUPTION TO FLUCONAZOLE IN A 28 YEAR OLD WOMAN WITH RECURRENT VAGINAL CANDIDIASIS

Abstract

Introduction Fixed Drug eruption (FDE) is a delayed type hypersensitivity reaction to certain drugs, characterized by single or multiple round patches, which may or may not have vesicles, often healing with hyper pigmentation (1) (2). FDE to Fluconazole is not common and few cases have been reported (2) (3). Case Description 28-year old woman with past medical history of chronic urticaria, eczema and hypothyroidism presenting with recurrent rash in the same exact locations after every Fluconazole use for recurrent vaginal candidiasis. Her first episode of rash was 12 months ago. Within minutes of taking Fluconazole for a vaginal yeast infection (previously used) she developed an erythematous flat, 2×2 cm rash on her nose, upper lip, right ankle and upper leg. Within 24 hours rash developed small vesicles followed by crusting. Since then she has taken Fluconazole three separate times and every time she developed the same rash on the same exact locations. The rash is pruritic in the first few days and heals with post inflammatory hyper pigmentation. She denies lesions in the genital area or on palms or soles. At the time of examination, the rash had healed with post inflammatory hyper pigmentation. Discussion Fluconazole is often used in the treatment of vaginal or esophageal candidiasis (1). FDE with Fluconazole may be more common than previously thought and should be kept in mind when patients have recurrent, classic rashes after Fluconazole use. Fluconazole should be re-prescribed with caution, since recurrent FDE lesions can be greater in size and number on repeat exposure (3). Fixed Drug eruption (FDE) is a delayed type hypersensitivity reaction to certain drugs, characterized by single or multiple round patches, which may or may not have vesicles, often healing with hyper pigmentation (1) (2). FDE to Fluconazole is not common and few cases have been reported (2) (3). 28-year old woman with past medical history of chronic urticaria, eczema and hypothyroidism presenting with recurrent rash in the same exact locations after every Fluconazole use for recurrent vaginal candidiasis. Her first episode of rash was 12 months ago. Within minutes of taking Fluconazole for a vaginal yeast infection (previously used) she developed an erythematous flat, 2×2 cm rash on her nose, upper lip, right ankle and upper leg. Within 24 hours rash developed small vesicles followed by crusting. Since then she has taken Fluconazole three separate times and every time she developed the same rash on the same exact locations. The rash is pruritic in the first few days and heals with post inflammatory hyper pigmentation. She denies lesions in the genital area or on palms or soles. At the time of examination, the rash had healed with post inflammatory hyper pigmentation. Fluconazole is often used in the treatment of vaginal or esophageal candidiasis (1). FDE with Fluconazole may be more common than previously thought and should be kept in mind when patients have recurrent, classic rashes after Fluconazole use. Fluconazole should be re-prescribed with caution, since recurrent FDE lesions can be greater in size and number on repeat exposure (3).