D1.102 - Furosemide-induced erythroderma: a diagnosis to consider

Erythroderma is defined as a generalized redness and scaling of the skin. It is a clinical manifestation of a variety of underlying diseases including malignancy, pre-existing dermatoses, drug reactions. Many drugs have been known to induce this disease. Herein, we report a case of furosemide-induced erythroderma.

A 79-year-old-man with a 3-year-history of hypertension treated with captopril (50 mg daily). Furosemide at the doses of 20 mg daily was added for the treatement of his hypertension. Few days after the treatement, he presented to the dermatology department  with a chief complaint of a generalized pruritic and erythematous rash spread all over his body. A laboratory work-up showed a normal blood cell count. A liver test, renal function, serum electrolytes and blood sugars were all normal. Serology of infectious agents including hepatitis and  cytomegalovirus were negative. Skin biopsy showed hyperkeratosis associated with a chronic inflammatory infiltrate with rare eosinophils. Drug-induced erythroderma was suspected and furosemide was discontinued. The eruption resolved within 10 days. 

Erythroderma is a complex disorder whose prognosis depends on the etiologic cause. Drugs have been known to be among the most important etiologic agents of the disease. Currently, antiepileptics, antihypertensives and antibiotics are the most frequent causes of drug-induced erythroderma. Furosemide, a loop diuretic, may induce adverse drug reactions such as pruritic rash, exanthema and fixed drug eruption. Furosemide-induced erythroderma is rare. In our case and according to the Naranjo probability scale, furosemide-induced erythroderma was probable. When assessing a patient with possible erythroderma, clinicians should always consider a broad differential diagnosis. The disease can often be clinically mistaken as an infectious process or a malignant etiology. This may lead to a delay on the diagnosis causing a higher mortality rate especially in elderly who are particularly vulnerable to this adverse drug reaction.

Drug-induced erythroderma recover completely with prompt initial management and rapid removal of the offending drug. Furosemide is among drugs inducing erythroderma.