L’érythème pigmenté fixe bulleux généralisé au vaccin de la grippe : à propos d’un cas

Abstract

IntroductionGeneralized bullous fixed drug eruption is a variant of fixed drug eruption occurring in rare cases. It is a severe drug-induced eruption requiring special management. Few cases of generalized bullous fixed drug eruption occurring after the influenza vaccine have been described in the literature, we report a new case of generalized bullous fixed drug eruption occurring after the influenza vaccine. ObservationThe patient is a 58-year-old female patient with generalized bullous fixed drug eruption occurring three days after the influenza shot. The patient did not receive any treatment that could potentially cause the clinical symptomatology. Skin biopsy showed apoptotic keratinocytes in the epidermis with the onset of subepidermal cleavage. DiscussionFixed drug eruption is a common drug eruption characterized by single or multiple rounded erythematous plaques giving way to scarring hyperpigmented macules. It recurs on the same cutaneous or mucosal sites, with the possibility of the appearance of other plaques, each time the incriminated agent is taken. The most commonly incriminated drugs are non-steroidal anti-inflammatory drugs, antibiotics and anti-epileptic drugs. Generalized bullous fixed drug eruption is a rare variant of fixed drug eruption, with only a few cases reported following the annual flu vaccine. The differential diagnosis includes Stevens-Johnson syndrome and toxic epidermal necrolysis in which lesions appear within 1 to 4 weeks of drug administration and almost always involve mucous membranes with marked systemic involvement. Although generalized bullous fixed drug eruption is less severe than these syndromes, it can be potentially fatal, especially in elderly subjects. ConclusionGeneralized bullous fixed drug eruption is a rare entity of fixed drug eruption, often confused with bullous dermatoses and severe drug eruptions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. The drugs involved are numerous, but few cases of generalized bullous fixed drug eruption following the influenza vaccination have been reported.