title: Fixed drug eruption caused by three unrelated drugs: promethazine, pethidine and omeprazole.
abstract: We report a case of fixed drug eruption (FDE) caused by three unrelated drugs. A 52-year-old woman presented with a diagnosis of FDE after taking a drug to treat a common cold. An oral provocation test and a patch test were carried out, and the patient reacted to promethazine, which is a derivative of phenothiazine. To determine the core structure of the antigen, we performed patch testing and/or an oral provocation testing with six drugs that are similar in structure to promethazine. The patient reacted to five of the six drugs, and the antigenic determinant was identified as a phenothiazine and a tricyclic structure. The patient had similar eruptions at the same sites 3 years later after taking pethidine. Seven months after that reaction, a more severe eruption was caused by oral omeprazole. This is an extremely rare case of FDE caused by three structurally unrelated drugs.
authors.affiliation: Department of Dermatology, Faculty of Medicine, Oita University, Oita, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kai
authors.forename: O
authors.initials: O
authors.lastname: Okamoto
authors.forename: S
authors.initials: S
authors.lastname: Fujiwara
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects*; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006634:Histamine H1 Antagonists / Q000009:adverse effects*; D006801:Humans; D008614:Meperidine / Q000009:adverse effects; D008875:Middle Aged; D009853:Omeprazole / Q000009:adverse effects; D010328:Patch Tests; D011398:Promethazine / Q000009:adverse effects; D012871:Skin Diseases / Q000139:chemically induced*
chemical_list: D000701:Analgesics, Opioid; D004791:Enzyme Inhibitors; D006634:Histamine H1 Antagonists; D008614:Meperidine; D011398:Promethazine; D009853:Omeprazole