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D3.101 - Etoricoxib Associated Fixed Drug Eruption: A Case Series from a Tertiary Allergy and Clinical Immunology Centre, United Arab Emirates

Poster abstract

Case report

Background:

Fixed drug eruption (FDE) is a delayed type IV hypersensitivity reaction mediated by resident CD8+ T cells, characterised by sharply demarcated erythematous or violaceous plaques that recur at identical anatomical sites and resolve with residual hyperpigmentation. Non-steroidal anti-inflammatory drugs (NSAIDs) are recognised triggers. Although selective cyclo-oxygenase-2 (COX-2) inhibitors are often considered safer alternatives, etoricoxib-induced FDE has been reported in case series and confirmed by patch testing and histopathology1,2.

Methods:

We retrospectively reviewed five patients referred to our tertiary allergy centre with suspected etoricoxib-associated FDE. Diagnosis was clinical, based on temporal relationship, lesion morphology, site-specific recurrence, and residual hyperpigmentation.

Results:

Five patients (four female; age 34–64 years) developed lesions within 6–24 hours of etoricoxib ingestion. Presentations ranged from solitary plaques to multifocal and extensive eruptions involving up to 50% body surface area. All cases demonstrated sharply demarcated plaques resolving with persistent hyperpigmentation. Recurrence at identical sites occurred upon re-exposure in all patients, confirming causality. No mucosal involvement or systemic features suggestive of severe cutaneous adverse reactions were observed. One patient reported a similar reaction to ibuprofen, while another tolerated alternative NSAIDs, simialr pattern has been described previously1.

Conclusions:

Etoricoxib is an important and potentially under-recognised cause of FDE, with presentations ranging from localised to extensive disease. Careful drug history and recognition of characteristic recurrence are essential. Selective avoidance and identification of safe alternative analgesics are key to management.

References:

  1. Martínez Antón MD, Galán Gimeno C, Sánchez de Vicente J, Jáuregui Presa I, Gamboa Setién PM. Etoricoxib-induced fixed drug eruption: Report of seven cases. Contact Dermatitis. 2021 Mar;84(3):192-195. doi: 10.1111/cod.13659.
  2. Makris M, Papapostolou N, Koumprentziotis IA, Pappa G, Katoulis AC. Nimesulide-Induced Fixed Drug Eruption Followed by Etoricoxib-Induced Fixed Drug Eruption: An Unusual Case Report and Review of the Literature. J Clin Med. 2024 Mar 10;13(6):1583. doi: 10.3390/jcm13061583.