[Multilocular fixed drug reaction simulating intertrigo in a diabetic patient].

HISTORY AND CLINICAL FINDINGS

A 57-year-old man with diabetes and hypertension was treated with amoxycillin, clarithromycin and pantoprazole for a gastric ulcer positive for Helicobacter pylori. On the second treatment day he developed inguinal pruritus with erythema. He presented at out-patient clinic on the 5th day suspected of having Candida intertrigo. He had bright red, relatively well-circumscribed erythema, most marked at the edges, mainly over the inguinal region and the inside of the thigh. There were no other symptoms.

INVESTIGATIONS AND DIAGNOSIS

Bacteriological and mycological tests of the affected skin were unremarkable. Immunological tests showed a normal total IgE but were negative in the CAP-FEIA test for penicilloyl G, penicilloyl V, amoxycilloyl and ampicilloyl. An epifocal epicutaneous test with amoxycillin and ampicillin (5% each in vaseline and doritin) gave a +2 positive reaction and confirmed a suspected fixed drug reaction.

TREATMENT AND COURSE

After amoxycillin had been discontinued and local class III steroids had been administered (mometasone furoate, Ecural) for one week the cutaneous changes disappeared without complication, except for slight hyperpigmentation. H. pylori eradication was continued without further complications using clarithromycin, metronidazole and pantoprazole. The patient was issued with an "allergic to penicillin" card.

CONCLUSION

Intertriginous changes during antibiotic treatment may not be due to Candida intertrigo, which is fairly common, but to a prognostically much more important drug reaction.