Mucosal fixed drug eruption in a patient treated with ornidazole

Abstract

Background: Therapeutic drugs have been observed to cause a wide spectrum of adverse oral effects such as dry mouth, gingival enlargement, taste disturbance, oral mucosal ulceration, halitosis, etc. Observations:A rare case of intra-oral fixed drug eruption (FDE) induced by ornidazole presenting on the hard palate, an extremely rare site for FDE, in a 40-yearold male is reported. Conclusions:Ornidazole is a relatively newer 5-nitroimidazole derivative commonly prescribed for Amoebic dysentery in developing countries. FDE is a rare adverse drug effect characterized by onset of round/oval, erythematous macules on the skin or mucosa that can be associated with itching and burning sensation. The exact mechanism causing FDE is unknown. (J Dermatol Case Rep. 2012; 6(1): 21-24)

Tinidazole-Induced Fixed Drug Eruption: A Case Report

“…Most commonly involved sites are lips, palm and soles, genital areas. Commonlyinvolved sites as stated bySharma VK are trunk and limbs (24%), lips alone (20.8%) and genitalia alone (20%), generalised (14.4%), lips and genitalia together (11.2%), and trunk alone (8.8%) [14,19].…”

“…A single erythematousmacule is the commonest presentation, it may become pigmented.Typicallythey reappear at the same site, but on stoppage of the drug, they disappear, only residual hyperpigmentation can be found later. New lesions can develop on previously normal skin also [14].…”

“…Challenge test as oral and topical are used for confirmation of FDE.If there is no reaction with lesser dose then dose of the drug is increased up to full therapeutic dose to look for any reaction. Oral test is better than topical for confirmation of diagnosing [14].…”

“…The diagnosis of FDE is usually done based on characteristic hyperpigmentation following drug intake and persisting hyperpigmentation after improvement. Historyof drug intake and a past history of similar lesions at the same sites following intake of the same drug are important aspect of diagnosis of FDE [14].…”

Fixed Drug Eruption- Bane of a Boon

“…reported a case of FDE on the hard palate due to ornidazole. 7 Herpes simplex virus (HSV) is frequently reactivated in these areas of healthy individuals. 8 Some of the drugs causing FDE include Trimethoprim-Sulphamethoxazole, Fursemide, Tetracycline, Diclofenac Sodium, Ciprofloxacin, Ibuprofen, Metronidazole, Norfloxacin, Aspirin 6 , naproxen sodium, dipyrone, dimenhydrinate, paracetamol 9 , Fluconazole 10 , Paracetamol 11 , Citrizine 12 , Ornidazole 7 and several other drugs and possibly, any other drug could be an implicating agent, making it an important adverse drug reaction that the clinician must be aware of, to treat and more importantly, avoid.…”