Paracetamol
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Generalised fixed drug eruption: case report An infant girl [exact age at onset not stated] developed generalised fixed drug eruption during treatment with paracetamol for fever. At the age of 5 years, the girl with Fitzpatrick skin type 5 presented with a 4-year history of the recurrent cutaneous eruption. She had experienced 6 identical episodes in the previous three years and were always observed after fever and flu-like symptoms. On the current hospitalisation, her dermatological examination revealed oval erythematous-violaceous patches on the abdomen, back, chest, and limbs. The lesions were erythematous that became purple and it recurred at the same areas with each subsequent episode. Her laboratory reports for total blood count, C-reactive protein, kidney, and liver function tests were normal except for the increase in the absolute eosinophil count. Her histopathological examination showed mild acanthosis with focal parakeratosis and spongiosis with vacuolar degeneration of the basal layer. In the upper epidermis region, scattered eosinophils, pigmentary incontinence, and lymphocytic infiltration were observed. On anamnesis, it was revealed that she developed each episode of rash within 30 minutes to 1 hour of oral or IV paracetamol administration [acetaminophen; dosage not stated] for fever. Clinicopathological findings confirmed paracetamol induced generalised fixed drug eruption with an Naranjo’s score of 9 (definite adverse drug reaction). Treatment with paracetamol was discontinued and the skin lesions subsided within 10 days without any treatment. However, the girl had slight hyperpigmentation was left. Paracetamol oral provocation test was avoided with the risk of severe eruption, but an oral challenge with ibuprofen was tested and found negative. Hence, ibuprofen was advised for fever. Genovese G, et al. Acetaminophen-induced generalized fixed drug eruption in a 5-year-old girl. Pediatric Dermatology 37: 756-758, No. 4, Jul-Aug 2020. Available from: 803498158 URL: http://doi.org/10.1111/pde.14161
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Reactions 29 Aug 2020 No. 1819
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