Generalized bullous fixed drug eruption mimicking Stevens-Johnson syndrome: a case report

Bullous fixed drug eruption (BFDE) is a rare but severe cutaneous adverse drug reaction that may mimic Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). A 58-year-old male with diabetes, hypertension, and coronary artery disease developed multiple erythematous and bullous lesions within 24 hours of initiating levofloxacin and ornidazole for a nail bed infection. He had a prior history of similar reaction. Clinical diagnosis of generalized BFDE was made based on history and presentation. Naranjo score indicated a possible adverse drug reaction. The suspected drugs were discontinued. The patient was managed conservatively with topical steroids, antihistamines, and supportive care. The patient improved with residual hyperpigmentation. Early recognition and differentiation from SJS/TEN are crucial to avoid unnecessary aggressive treatment and prevent recurrence.