Generalized neutrophilic fixed drug eruption induced by gabapentin

Acar, Emine Müge; Şirin, Serpil Çorum; Kilitçi, Asuman; Elmas, Ömer Faruk; Kemeriz, Funda; Günay, Ümran

doi:10.5606/tftrd.2021.5723

Cited by 4 publications

(7 citation statements)

References 10 publications

(3 reference statements)

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“…The presence of abundant neutrophils in FDE may lead to difficulty in differentiating these cases from neutrophilic conditions, especially Sweet syndrome (SS). Both Soares et al 10 and Acar et al 15 reported cases with prominent clinical pathological resemblance to drug-induced SS (DISS). In both cases, the presentation fulfilled diagnostic criteria for SS (fever, response to steroids, and biopsy showing a neutrophilic infiltrate without neutrophilic leukocytosis while histologically the epidermis was seemingly relatively spared) and the diagnosis of FDE was based only on the fact that lesions appeared on the same site.…”

Section: Discussionmentioning

confidence: 99%

Neutrophils in Fixed Drug Eruptions: Correction of a Mistaken Hypothesis

Li¹,

Kazlouskaya

2021

The American Journal of Dermatopathology

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:Classical histopathological findings of fixed drug eruption (FDE) include a lichenoid/interface dermatitis and perivascular infiltrate in the upper and deep dermis composed of lymphocytes and eosinophils accompanied by pigment incontinence. The presence of neutrophils is also an established finding but is less investigated. Sporadic cases of “neutrophilic FDE” have been reported and suggested as a separate entity, a rare variant, or an early stage of the condition. In this article, we report 16 cases of FDE with quantitative analysis showing that neutrophils are relatively common in FDE (68.8%) and that cases with abundant neutrophils had a significantly shorter onset-to-biopsy interval (3.7 vs. 16.9 days, P < 0.023). Our findings support that neutrophilic FDE more likely represents the early phase of FDE rather than a different entity. The presence of neutrophils expands the histopathological differential diagnosis of FDE to include neutrophilic dermatosis, signifying the value of clinical correlation.

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Section: Discussionmentioning

confidence: 99%

Neutrophils in Fixed Drug Eruptions: Correction of a Mistaken Hypothesis

Li¹,

Kazlouskaya

2021

The American Journal of Dermatopathology

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“…Neutrophilic FDE has previously been reported to be associated with naproxen, as was seen in Case 1 above 8,9 . Other reported causative agents include amoxicillin–clavulanic acid, sulfamethoxazole–trimethoprim, etoricoxib, and gabapentin 5,6,8,11,12 . Interestingly, the entity has also been reported in a case of seafood ingestion, aptly termed “neutrophilic fixed food eruption.” 13 …”

Section: Discussionmentioning

confidence: 89%

“…However, the term “neutrophilic fixed drug eruption” was chosen given the recurrent and fixed nature of the lesions clinically 5 . This constellation of findings has been subsequently reported in several other cases of neutrophilic FDE 6,7,9,20 . Conversely, a case showing the typical epidermal interface changes of classic FDE with an underlying inflammatory infiltrate containing neutrophils has also been reported 8 …”

Section: Discussionmentioning

confidence: 99%

“…A range of histopathologic features has been described including a neutrophilic inflammatory infiltrate that can be superficial or deep, interstitial or perivascular, and sometimes accompanied by leukocytoclasis, suggestive of a neutrophilic dermatosis. In addition, interstitial eosinophils, papillary dermal edema, and interface dermatitis have all been reported 5–8 . Exocytosis of neutrophils with intraepidermal pustule formation has been described 9 .…”

Section: Introductionmentioning

confidence: 99%

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Neutrophilic fixed drug eruption, a histopathologic variant or an expected finding?—A report of two cases and review of the literature

et al. 2023

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Fixed drug eruption (FDE) is an adverse drug reaction characterized by recurrent circumscribed lesions at the same location upon re-exposure to the culprit medication, resulting in distinct postinflammatory hyperpigmentation. Histopathologically, FDE demonstrates a predominantly lymphocytic interface or lichenoid infiltrate with basal cell vacuolar changes and keratinocyte dyskeratosis/apoptosis. The term "neutrophilic fixed drug eruption" has been used to describe cases in which the inflammatory infiltrate is predominantly neutrophilic. The infiltrate can extend deeper in the dermis, potentially mimicking a neutrophilic dermatosis such as Sweet syndrome.We present two cases and review the literature to discuss the possibility that a neutrophilic inflammatory infiltrate may be an expected finding in FDE, rather than a histopathologic variant.

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“…Histopathological differentials to be considered are Sweet's syndrome, autoinflammatory urticaria and acute generalised exanthematous pustulosis. Generalised neutrophilic fixed drug eruption has been described due to gabapentin 37 and etoricoxib. 38…”

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confidence: 99%