Adverse Cutaneous Reactions to Selective Cyclooxygenase 2 Inhibitors: Experience of an Italian Drug-Surveillance Center

Probable etoricoxib-induced fixed drug eruption involving the oral mucosa: A case report

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by recurrence of lesions at the same sites each time a specific drug is taken. Oral mucosal involvement is rare. Nonsteroidal anti-inflammatory drugs are one of the most common offending drug groups in FDE; however, selective cyclooxygenase-2 inhibitors, such as etoricoxib, are rarely implicated. We present a case of oral mucosal and cutaneous FDE induced by etoricoxib that, to the best of our knowledge, is the first reported case of this nature. We describe the diagnostic challenges and review the pertinent literature. The value of drug provocation testing and patch testing in FDE is also discussed.

Drug-induced angioedema without urticaria: prevalence and clinical features

BACKGROUND

Angioedema without urticaria can be caused by drugs. The purpose of our study was to assess the prevalence and clinical features of patients with drug-induced angioedema without urticaria.

METHODS

This study retrospectively reviewed case records at Siriraj Hospital, between January 2007 and December 2008. Patients aged at least 15 years were included.

RESULTS

The prevalence of drug-induced angioedema without urticaria among patients with adverse drug reactions was 2.3%/year. Non-steroidal anti-inflammatory drugs (NSAID) were the most common cause (50%), followed by antibiotics (20%). The commonest NSAID which induced angioedema were ibuprofen and diclofenac. The common sites were periorbital area (67.3%) and lips (27.6%). The median duration of suspected drug therapy before the development of angioedema was 1 day with the range of 10 min to 23 days.

CONCLUSIONS

Non-steroidal anti-inflammatory drugs and antibiotics were the most common drugs causing angioedema without urticaria. The duration of onset ranged from minutes to days. After stopping the suspected drugs, symptoms disappeared within 2-5 days in most patients.