IntroductionTriazole antifungals are commonly used in the treatmentof candidiasis. Fluconazole (FCZ) is one of the most frequentlyprescribed therapy for vaginal fungal infections.Rarely, FCZ has been shown to cause fixed drug eruptions(FDE).Case presentationThis is a report of FCZ-induced FDE in a 31-year-oldCaucasian woman with recurrent vaginal candidiasis. On4 consecutive occasions she tried treatment with oral150mg FCZ and each time skin lesions occurred in thesame spots with progressive severity, lasting about10 days, resulting in a hyperpigmentation, causing sufferingand poor self-confidence. Detailed history revealedthat the first time she noticed the eruption, there was asingle, erythematous plaque on the forehead. On the secondand third occasions, this same spot reappeared, butthis time accompanied by 2 more similar lesions on bothcheeks. The patient was told that this was “mild allergy”and not advised to seek specialized help. She was sent toour university clinic on the 4th occasion when she took asingle dose of oral 150mg FCZ (different brand name).The patient had 3 nummular, erythematous plaques: 1on the forehead (15mm D), 1 in the left and 1 in theright zygomatic areas (15 and 20mm D, respectively).Also, a medium edema in the middle part of her upperlip was present for the first time. The eruptions werecharacterized by pruritus, stinging and erythema, graduallyincreasing in intensity from 30min post-ingestion(PI). The edema of the upper lip was slightly painful andoccurred 6h PI. We treated the patient with Methylprednisolone60mg (1 day) and gave her Levocetirizine 5mgfor symptomatic relief; as this latter dose did not seemsufficient, we doubled it and this completely suppressedher symptoms. Topical Mometasone was added to thetreatment on Day 2. Skin lesions resolved almost completelyon Day 7, leaving mild hyperpigmentations. Theedema of the lip resolved on Day 3 with no sequel. Histologicevaluation, oral and topical provocation tests withFCZ were not performed because of the delicate facialsite of manifestation. Oral provocation test with Itraconazole100mg was performed and showed to be negative.ConclusionFDE induced by FCZ is not a common occurrence.When it does occur, it can be easily overlooked andmisdiagnosed. We rejected cross reactivity with Itraconazole,showing this drug is a viable alternative to FCZ.Oral Levocetirizine at a higher than usual dose helpedrelieve the subjective symptoms.
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