Fixed drug eruption (FDE) induced by mefenamic acid with unusually cross‐reactivity to diclofenac: A case report
Abstract
Fixed drug eruption (FDE) is a common drug side effect constituting about 10% of all skin drug eruptions. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most common causes of FDE. Mefenamic acid (anthracitic acid derivative) and diclofenac (phenylacetic acid) both have a chemically distinct structures. Cross-reactivity between NSAIDs occurs frequently in patients with skin reactions and has been linked to NSAIDs with chemically related structures. Herein we describe a patient with FDE induced by mefenamic acid with unusually cross-reactivity to a chemically distinct NSAID diclofenac and has not been reported before. A 40-year-old patient without significant medical history presented to our department with multiple hyperpigmented lesions located on upper extremities and trunk and began 6 months earlier with no other symptoms. The patient reported that skin symptoms started 1 week after the beginning of mefenamic acid, paracetamol, and lansoprazole for post-traumatic knee pain with very pruritic erythematous and violaceous features. Skin eruptions resolved after corticosteroid therapy with residual hyperpigmentation. In Janaury 2019, the patient reported that the lesions became inflamed and very pruritic many hours after mefenamic acid intake for knee pain. The patient reported reactivation of skin eruption in May 2019 after mefenamic acid intake for the same pain. The patient denied taking any other NSAIDs or any herbal remedies. Routine laboratory tests were…
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