Purpuric drug eruption secondary to itraconazole

Abstract

CASE REPORT A 65-year-old woman with onychomycosis of the left great and right fifth toenails was treated with oral itraconazole, 200 mg twice daily. She had hypertension and migraine headaches treated with verapamil hydrochloride, enalapril maleate, and sumatriptan succinate for 1 to 3 years. She reported allergies to codeine phosphate and erythromycin ethylsuccinate. Two days after itraconazole was started, pruritus occurred with a subsequent morbilliform eruption on the trunk and upper extremities. Itraconazole was discontinued, but the other medications were continued. The patient was treated with diflorasone diacetate 0.05% cream, diphenhydramine hydrochloride, and loratadine. Two days later, the eruption intensified, became more extensive, and, in some areas, purpuric. A biopsy specimen revealed a vacuolar interface dermatitis, a sparse superficial perivascular lymphoid cell infiltrate with rare eosinophils, and extravasated red blood cells, consistent with a purpuric drug reaction (Fig. 1). Nine days after discontinuation of itraconazole the eruption cleared, leaving hyperpigmented faintly erythematous macules at sites of previous purpura.