History of Present Illness: The patient is an 18 year-old male who presents with a rash that appeared 7 days ago. The rash is located on his torso, back, and lower lip. It is pruritic. Three days prior to the appearance of the rash, he had a sore throat and intermittently took ibuprofen over the ensuing 3 days. He stopped taking ibuprofen 4 days after his sore throat abated. He denies any fever, nausea, vomiting, shortness of breath, chest pain, abdominal pain, diarrhea, extended travel in the past year, sick contacts, new soaps/detergents, insect bites, chemical exposure, and new foods.
Vitals: HR 93, BP 116/58, O2 Sat 95% RA, T 98.3 F
HEENT: Unremarkable oropharynx without mucosal involvement
Pulmonary: Lungs clear to auscultation bilaterally
Abdominal: Abdomen is soft and non-tender
Skin: There are several dozen raised, hyperpigmented circular lesions 1-1.5 inches in diameter on the patient’s torso and back. The borders are sharply demarcated. Some of the lesions appear to be fluid-filled. Nikolsky sign is negative.
Pathology report: “Parakeratosis, dyskeratotic keratinocytes, and vacuolar interface dermatitis in the superficial epidermis with prominent pigment incontinence.”
The photos depict a Fixed Drug Eruption (FDE). FDE is characterized by oval, raised, well-demarcated, and hyperpigmented lesions. The diagnosis is supported by a recent history (hours to days) of exposure to NSAIDs.
Always consider a Fixed Drug Eruption when a patient reports recent NSAID exposure and presents with a diffuse pruritic rash consisting of circular lesions.