Tuesday, 9 December 2014
Exhibition Hall-Poster Area (Sul America)
Eduardo Longen, MD
,
Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
Ana Carolina D'onofrio-Silva, MD
,
Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
Marcelo Vivolo Aun, MD
,
Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
Marisa Rosimeire Ribeiro, MD
,
Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
Laila Sabino Garro, MD, PhD
,
Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
Violeta Regnier Galvão, MD
,
Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
Jorge Kalil, PhD
,
Department of Allergy and Immunology, University of São Paulo, São Paulo, Brazil
Pedro Giavina - Bianchi, MD, PhD
,
Clinical Immunology and Allergy Division, Sao Paulo University, São Paulo, Brazil
Antonio Abílio Motta, MD, PhD
,
Clinical Immunology and Allergy Division, University of São Paulo, São Paulo, Brazil
Background: The symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a delayed-type hypersensitivity drug reaction (HDR) that causes symmetrical erythematous lesions in flexural areas, including buttocks and groin, which arise following exposure to drugs, especially beta-lactams. The involvement of palms and soles is rare and, until now, it has only been described after exposure of amoxicillin. We hereby report a patient with SDRIFE and involvement of the palms and soles after taking cephalexin and another patient who developed SDRIFE after exposure to doxycyclin.
Methods: Literature review and case description.
Results: Two patients referred to our outpatient clinic specialized in HDR for evaluation of adverse drug reactions compatible to SDRIFE. The first patient was a man, 50 years of age, with a history of erythematous lesions with blisters in flexural areas, including groin, associated with lesions of the palms and soles 20 hours after he had started taking cephalexin to an orbital cellulitis. We performed intradermal skin tests with penicillin, cefazolin and ceftriaxone, which resulted negative. We also performed oral drug provocation test (DPT) with amoxicillin and cefuroxime, in order to provide therapeutical options with different betalactams. The patient was also advised to avoid taking cephalexin and other betalactams with similar group side chains. The second patient was a woman, 64 years of age, with a history of skin lesions in flexural areas, including groin, compatible to SDRIFE. She had started taking doxycyclin to treat erysipelas four days before the first lesions appeared. She was hospitalized for five days and got better with prednisone 0.5mg/kg and fexofenadine. The antibiotic was switched to clindamycin and she was told to avoid tetracyclines for the future.
Conclusions: SDRIFE is a rare HDR and betalactams are the main cause of these reactions. However, as far as we know, these were the first patients presenting palm and sole involvement due to cephalexin and a typical SDRIFE after taking doxycyclin.
