Drug-induced chronic bullous disease of childhood in a two-year-old Filipino male triggered by cefaclor or cefuroxime: A case report
- Author:
Sher Claranza O. Liquido
1
;
Maria Jasmin J. Jamora
1
,
2
,
3
,
4
Author Information
- Publication Type:Case Reports
- Keywords: Vesiculobullous
- MeSH: Linear IgA Bullous Dermatosis; Cefaclor; Cefuroxime
- From: Journal of the Philippine Dermatological Society 2021;30(1):41-44
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Chronic bullous disease of childhood (CBDC) is a rare immune-mediated subepidermal vesiculobullous eruption,
characterized by linear IgA deposition along the basement membrane zone of the skin. Although mostly idiopathic, CBDC may
be triggered by factors such as infection, and drugs. Clinical and immunohistopathological features of drug-induced cases are
heterogeneous and indistinguishable from the idiopathic form.
Case report:A two-year-old Filipino male presented with pruritic vesicles and bullae on the back several days after finishing a course of cefuroxime, and cefaclor. Examination revealed multiple tense vesicles and bullae, some coalescing into a rosette pattern with central crusts on the perioral, scalp, neck, back, perineal, and perianal areas. Histopathology showed a subepidermal split with neutrophilic and eosinophilic infiltrates. Direct immunofluorescence revealed strong linear deposition of IgA, and granular deposits of C3 and IgM at the basement membrane zone, thus confirming the di- agnosis of CBDC. Dapsone at 2mg/kg/day was started, with oral prednisolone (1.3mg/kg/day), and cloxacillin syrup (40mg/kg/day). Topical care with betamethasone dipropionate and mupirocin ointment was included. After eight weeks, patient showed significant im- provement with few vesicles and resolved lesions healing with post-inflammatory hyperpigmentation.
Conclusion:We report a case of a two-year-old male presenting with vesiculobullous lesions after a course of cefuroxime, and cefaclor. As both were given and withdrawn in a period of close proximity, it is difficult to determine the probable culprit drug. Spontaneous resolution upon withdrawal of the suspected drug is variable. Systemic therapy such as dapsone may be necessary for treatment. - Full text:jpds8.pdf
