Fluconazole
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Erythema multiforme: case report A 35-year-old man developed severe erythema multiforme (EM) during treatment with fluconazole for onychomycosis. The man presented to the oral health clinic due to multiple symptomatic lesions spread throughout the oral mucosa and lips. Three weeks prior to the presentation, he had started receiving fluconazole oral 100mg once a week for onychomycosis. He reported that he had developed generalised swelling on the lower lip 2 hours after taking fluconazole. The intraoral lesions had appeared the following day. He had received an unspecified antiallergy medication without any clinical improvement. He continued to receive fluconazole for additional 2 weeks, and the oral lesions exacerbated. He then consulted to a physician, who replaced his fluconazole by itraconazole. The drug replacement did not alleviate symptoms, and again the oral lesions worsened. At the final consultation with the physician, he reported dysphonia. On presentation to the oral health clinic, there was no evidence of previous herpes or Mycoplasma infection, and he denied any systemic alterations in health. The extraoral examination showed accentuated trismus, multiple superficial ulcerated lesions covered by hemorrhagic crusts on the upper and lower lips, superficial ulcers on the right and left ocular mucosa and erythematous macules on the right cervical region. The intraoral examination showed multiple superficial ulcers covered by a serofibrinous pseudomembrane located on the dorsum and both lateral borders of the tongue, labial mucosa, buccal mucosa, floor of the mouth and retromolar trigone. A diagnosis of fluconazole-induced erythema multiforme was made. The man’s therapy with itraconazole was discontinued on admission to the oral health clinic, and a single dose of betamethasone dipropionate/betamethasone sodium phosphate [Diprospan] was administered. The oral lesions began to improve 1 day after the initiation of betamethasone dipropionate/betamethasone sodium phosphate and showed partial regression 2 days later, with significant reduction of trismus. At the 7-day follow-up, complete healing of all lesions on the lips, buccal mucosa, floor of the mouth, tongue, retromolar trigone, cervical region and ocular mucosa was noted. de Aquino da Silva VS, et al. Erythema multiforme induced by fluconazole in an immunocompetent patient: a case report and review of the literature. General Dentistry 68: 803507142 50-54, No. 2, Mar-Apr 2020. Available from: URL: https://pubmed.ncbi.nlm.nih.gov/32105227/
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Reactions 17 Oct 2020 No. 1826
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