A fixed drug eruption that developed cross-sensitivity among amide local anaesthetics, including mepivacaine hydrochloride, lidocaine hydrochloride and propitocaine hydrochloride

摘要

A 50-year-old Japanese man kad received a regional nerve block using mepivacaine for his lumbar disc hemiation in 2006. The patient soon developed several areas of mild macular erythema on his face from the neck and enanthem. The patient later developed a similar macular erythema again after a dental treatment using lidocaine in 2006. The patient had used propitocaine hydrochloride and felypressin (Citanest-Octapressin) during dental treatment at our hospital on 22 March, 18 April and 25 April 2006. Lymphocyte stimulating test results were negative for prilocaine, lidocaine, mepivacaine and propitocaine before treatment. On 26 April 2006, the patient developed slate-coloured, well-circumscribed, round erythema with irritation from his face to the upper arms and on his oral and genital mucosa (fig. 1). The macular erythema recurred at similar sites three times. A propitocaine-induced fixed drug eruption (FDE) was suspected; thus, propitocaine was discontinued during the dental treatment. The patient was given clobetasol butyrate ointment topically and prednisolone hydrochloride orally. His symptoms finally disappeared by 7 May 2006. After the patient's symptoms had resolved, patch testing was done. Various amide local anaesthetics (LAs), including propitocaine, lidocaine and felypressin, were each adjusted to a weight ratio of 1 % and 2 % in Vaseline.