Erupção fixa bolhosa generalizada após reexposição à dipirona: relato de caso e revisão da literatura
Generalized bullous fixed drug eruption after reexposure to dipyrone: a case report and literature review
Nathalia Mota Gomes Almeida; Maria Inês Perelló Lopes Ferreira; Mara Morelo Rocha Felix3
Resumo
A erupção fixa à droga (EFD) é uma reação de hipersensibilidade tardia a medicamentos caracterizada por máculas ou pápulas eritematosas, violáceas ou acastanhadas, bem demarcadas, que aparecem após uso de uma medicação, e reaparecem na mesma localização após exposições repetidas. A erupção fixa à droga bolhosa generalizada (EFDBG) é uma variante rara da EFD que foi recentemente incluída pelo RegiSCAR no grupo das farmacodermias graves. Apresenta-se através de lesões cutâneas generalizadas características de EFD, com formação de bolhas, geralmente em pacientes com história prévia de EFD. Os principais medicamentos envolvidos na EFDBG são antibióticos e anti-inflamatórios não esteroidais. O diagnóstico é clínico, entretanto, a biópsia cutânea na fase aguda e o teste de contato após a recuperação do paciente, podem auxiliar a investigação. O tratamento requer geralmente apenas a suspensão do fármaco suspeito e medidas de suporte. Relatamos um caso de EFDBG em adolescente após reexposição à dipirona (metamizol) apesar da história prévia de hipersensibilidade a esta medicação. O objetivo deste relato é alertar sobre a importância do diagnóstico da EFDBG e ressaltar os principais pontos para o diagnóstico diferencial com a síndrome de Stevens-Johnson (SSJ)/necrólise epidérmica tóxica (NET).
Palavras-chave
Abstract
Fixed drug eruption (FDE) is a delayed drug hypersensitivity reaction characterized by erythematous, violaceous or brownish well-demarcated macules or papules that appear after use of a medication and reappear at the same site after repeated exposures. Generalized bullous fixed drug eruption (GBFDE) is a rare FDE variant that has been recently included by RegiSCAR in the group of severe cutaneous adverse reactions to drugs. GBFDE presents as generalized cutaneous lesions characteristic of FDE, with blistering, usually in patients with a previous history of FDE. The main drugs involved in GBFDE are antibiotics and nonsteroidal anti-inflammatory drugs. The diagnosis is clinical, but some tests can help the investigation, such as skin biopsy in the acute phase and patch testing after patient recovery. Treatment usually requires suspension of the suspected drug and some supportive measures. We report a case of GBFDE after reexposure to dipyrone (metamizole) in an adolescent with a previous history of hypersensitivity to this drug. The aim of this report is to warn about the importance of diagnosing GBFDE and to highlight the main points for differential diagnosis with StevensJohnson syndrome (SJS)/toxic epidermal necrolysis (TEN).
Keywords
Referências
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Submetido em:
02/06/2020
Aceito em:
23/08/2020
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