Érythème pigmenté fixe bulleux généralisé : à propos d’un cas

Abstract

Introduction

Generalized bullous fixed drug eruption is a rare and severe form of fixed drug eruption, often induced by cotrimoxazole, which may be confused with Stevens-Johnson syndrome.

Observation

A 45-year-old patient with no relevant history developed Generalized bullous fixed drug eruption 8 hours after taking cotrimoxazole for gastroenteritis. A similar episode localized to the extremities had been reported 5 years earlier, occurring 4 days after taking the same drug. Clinico-pathological correlation led to the diagnosis of Generalized bullous fixed drug eruption. Treatment consisted of discontinuation of cotrimoxazole and local care, resulting in healing of all lesions, with post-inflammatory hyperpigmentation. Reintroduction of the drug was prohibited, and a pharmacovigilance report was made.

Discussion

Fixed drug eruption is a drug-induced toxidermia characterized by well-limited skin lesions, recurring at the same site after re-exposure to the causative drug. Generalized bullous fixed drug eruption is a rare and severe form, which can mimic Stevens-Johnson syndrome/toxic epidermal necrolysis, particularly in cases of extensive mucosal involvement. Diagnosis is based on clinico-pathological correlation and a detailed drug history. Treatment consists of discontinuing the causative drug, combined with local care. Topical or systemic corticosteroids may be necessary in severe forms.

Conclusion

Erythema pigmentosum fixed bullosa generalizada (EPFBG) is a rare and misunderstood condition. Further efforts are needed to develop more reliable and safer methods for identifying the drugs involved in equivocal situations.