Fixed drug eruption pada perioral akibat obat golongan quinoloneFixed drug eruption in the perioral due to quinolone medications

Abstract

Pendahuluan: Fixed Drug Eruption (FDE) adalah salah satu diagnosis reaksi hypersensitivitas tipe 4 yang bermanifestasi di kulit berbentuk makula merah kebiruan dan kadang-kadang bula diatasnya, serta muncul ditempat yang sama apabila terpapar obat yang sama. Tujuan laporan kasus ini untuk memberikan informasi mengenai reaksi hypersensitivitas berupa fixed drug eruption pada perioral akibat obat golongan quinolone. Laporan kasus: Pasien mengeluhkan bibir atas sebelah kanan tebal dan berwarna biru keunguan, setelah minum obat levofloxacin (golongan quinolone). Pasien memiliki riwayat beberapa waktu yang lalu pernah mengalami kondisi yang sama dan dilokasi yang sama, setelah minum obat ciprofloxacin (golongan quinolone). Mekanisme fixed drug eruption terjadi karena hapten obat berikatan dengan sel basal keratinosit atau dengan melanosit pada lapisan basal epidermis menyebabkan pelepasan sitokin seperti TNF-α, keratinosit mengekspresikan ICAM-1 yang menarik sel CD8⁺ yang kemudian bertahan di lokasi lesi. Sel CD8⁺ memberikan memori fenotip, sehingga ketika paparan obat terulang, respon akan berkembang lebih cepat pada lokasi yang sama. Penatalaksanaan kasus dengan menghentikan penggunaan obat penyebab dihentikan dan pemberian methylprednisolone 4mg selama 10 hari. Lesi pada perioral warnanya memudar, tetapi tidak hilang dan menetap. Simpulan: Pasien fixed drug eruption dapat sembuh dengan menghentikan obat yang diduga sebagai alergen, serta diberikan anti inflamasi kortikosteroid, meskipun Lesi pada perioral warnanya memudar, tetapi tidak hilang dan menetap.

Kata kunci : Fixed drug eruption, quinolone, perioral.

ABSTRACT

            Introduction: Fixed drug eruption (FDE) is one diagnosis of type 4 hypersensitivity reactions manifests on bluish-red macular skin and sometimes with the presence of bullae, and appears at the same place when exposed to the same type of medication. The purpose of this case report was to provide information regarding hypersensitivity reactions in the form of fixed drug eruption (FED) in the perioral due to quinolone medications. Case report: The patient was presented with a chief complaint of the thick and purplish blue right upper lip after taking the levofloxacin (quinolone group drug). Patients had a history of experiencing the same condition and in the same location after taking ciprofloxacin (quinolone group drug) quite some times before. Mechanism of fixed drug eruption occurred because the drug’s hapten was bound to the keratinocytes basal cell or with melanocytes in the epidermis basal layer causing the release of cytokines such as TNF-α. Keratinocytes expressed ICAM-1 that attract CD8⁺ cells which then persisted at the lesion site. CD8⁺ cells provided a phenotypic memory so that when drug exposure was repeated, the response at the same location will develop faster. Management of cases was performed by stopping the use of the causative drug and administration of 4 mg of methylprednisolone for 10 days. The perioral lesions colour was faded but had not lost and still maintained. Conclusion: Fixed drug eruption patient was able to recover by stopping the use of the drugs suspected as allergens, and administration of anti-inflammatory corticosteroids, even though the lesions had not lost and still maintained, but the perioral lesions colour was fading.

Keywords: Fixed drug eruption, quinolone, perioral.