title: Fixed eruption due to quinine in tonic water: a case report with high-performance liquid chromatography and ultraviolet A analyses.
abstract: Fixed drug eruption is a common cutaneous adverse reaction in young patients with a characteristic clinical appearance. However, the diagnosis and identification of the substance may be difficult if food or food additives provoke the fixed eruption. A 26-year-old man had a history of two episodes of cutaneous erythema with residual pigmentation. Close examination of the history including his diet in addition to an oral challenge test and patch testing led to the diagnosis of fixed eruption secondary to quinine in tonic water. We examined for the presence of quinine in commercially available brands of tonic water using ultraviolet A and irradiation and high-performance liquid chromatography. Both Schweppes and CANADA DRY brands of tonic water emitted fluorescent light upon ultraviolet A irradiation, and contained quinine at concentrations of 67.9 and 61.3 mg/L, respectively. Quinine contained in some tonic waters may trigger fixed eruption.
authors.affiliation: Department of Dermatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
authors.forename: Aoi
authors.initials: A
authors.lastname: Ohira
authors.forename: Sayaka
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyagi
authors.forename: Yu-Ichi
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamada
authors.forename: Hideo
authors.initials: H
authors.lastname: Shiohira
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hagiwara
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Uno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uezato
authors.forename: Kenzo
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D002253:Carbonated Beverages / Q000032:analysis*; D003875:Drug Eruptions / Q000209:etiology*; D006801:Humans; D008297:Male; D009125:Muscle Relaxants, Central / Q000009:adverse effects* / Q000032:analysis; D011803:Quinine / Q000009:adverse effects* / Q000032:analysis
chemical_list: D009125:Muscle Relaxants, Central; D011803:Quinine
keywords: fixed eruption; high-performance liquid chromatography; quinine; tonic water; ultraviolet A