Multifocal Fixed Drug Eruption with COX-2 Inhibitor-Celecoxib
A 28-year-old nonatopic man presented with multiple (12), round, well-circumscribed erythematous-to-reddish brown patches of sizes ranging from 2 × 3 cm to 10 × 12 cm in diameter. The lesions were scattered asymmetrically over the trunk and upper and lower limbs []. A few of the lesions had central necrosis and blistering with hemorrhagic fluid. The lesions were associated with mild pruritus and burning sensation. The patient had no fever or other constitutional symptoms. There was no mucosal involvement and Nikolsky's sign was negative. No systemic abnormalities were found on physical and routine laboratory examination. The lesions appeared two hours after theinitialingestion of 200 mg of celecoxib which was prescribed to the patient for joint pains. The patient had not taken any other drug in the past one month. However, he had previously taken NSAIDs (not COX-2 inhibitors) and sulfa drugs on several occasions without any adverse effects. A clinical diagnosis of multifocal FDE was suspected based on clinical findings and the temporal association of drug intake. Histopathologically, the lesions showed features consistent with FDE []. Celecoxib was thereby discontinued, and the patient was treated with antihistaminics, topical steroids, and a short course of oral steroids tapered rapidly over three weeks. After three weeks, all the lesions subsided, leaving brownish black hyperpigmentation. One month after the resolution of the eruption, oral provocation was undertaken and the patient was given 50 mg of celecoxib (1/4th of the therapeutic dose) orally. Reactivation of the lesions occurred within 24 hours which subsided with topical steroids after two weeks with residual postinflammatory hyperpigmentation.