Summary

Fixed drug eruption (FDE) is a delayed cutaneous adverse drug reaction characterized by recurrent lesions at the same anatomical site upon re-exposure to the causative agent. We report the case of an 8-year-old girl with a history of recurrent skin eruptions initially diagnosed as urticaria multiforme in the context of suspected beta-lactam hypersensitivity. Previous allergological work-up, including specific IgE testing and skin prick tests, was negative.

At the age of 8 years, the patient developed recurrent, well-demarcated erythematous-violaceous lesions with post-inflammatory hyperpigmentation following exposure to clarithromycin, with reproducible recurrence at identical sites upon re-administration. The lesions were non-pruritic, persistent, and resolved with residual hyperpigmentation, leading to a clinical diagnosis of fixed drug eruption. Subsequent drug provocation tests excluded beta-lactam allergy, allowing reintroduction of these antibiotics.

This case highlights the diagnostic challenge of FDE in paediatric patients and underscores the importance of careful clinical history in identifying the culprit drug. Macrolides, although rarely reported, should be considered as potential triggers of FDE. Accurate diagnosis is essential to avoid unnecessary drug restrictions. This case underscores the importance of detailed clinical history and targeted allergological evaluation in guiding safe and effective management.

References

  1. Nino M, Francia MG, Costa C, et al. Bullous Fixed Drug Eruption Induced by Paracetamol: Report of a Pediatric Case. Case Rep Dermatol 2009;1:56-59. https://doi.org/10.1159/000243728.
  2. Valeyrie-Allanore L, Lebrun-Vignes B, Bensaid B, et al.; sous l’égide du groupe toxidermie de la Société française de dermatologie (FISARD). Érythème pigmenté fixe: épidémiologie, physiopathologie, clinique, diagnostic différentiel et modalités de prise en charge [Fixed pigmented erythema: Epidemiology, physiopathology, clinical features, differential diagnosis and therapeutic management]. Ann Dermatol Venereol 2015;142:701-706. French. https://doi.org/10.1016/j.annder.2015.07.010.
  3. Anderson HJ, Lee JB. A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption. Medicina (Kaunas) 2021;57:925. https://doi.org/10.3390/medicina57090925.
  4. Panachiyil GM, Babu T, Sebastian J, et al. A pediatric case report of fixed drug eruption related to carmoisine colorant present in paracetamol syrup. Indian J Pharmacol 2019;51:279-281. https://doi.org/10.4103/ijp.IJP_29_19.
  5. Phillips EJ, Bigliardi P, Bircher AJ, et al. Controversies in drug allergy: Testing for delayed reactions. J Allergy Clin Immunol 2019;143:66-73. https://doi.org/10.1016/j.jaci.2018.10.030.
  6. Hamamoto Y, Ohmura A, Kinoshita E, et al. Fixed drug eruption due to clarithromycin. Clin Exp Dermatol 2001;26:48-49. https://doi.org/10.1046/j.1365-2230.2001.00760.x.
  7. Canavan TN, Mathes EF, Frieden I, et al. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review. J Am Acad Dermatol 2015;72:239-245. https://doi.org/10.1016/j.jaad.2014.06.026.
  8. Dilley M, Geng B. Immediate and Delayed Hypersensitivity Reactions to Antibiotics: Aminoglycosides, Clindamycin, Linezolid, and Metronidazole. Clin Rev Allergy Immunol 2022;62:463-475. https://doi.org/10.1007/s12016-021-08878-x.
  9. Shiohara T. Fixed drug eruption: pathogenesis and diagnostic tests. Curr Opin Allergy Clin Immunol 2009;9:316-321. https://doi.org/10.1097/ACI.0b013e32832cda4c.
  10. Barbaud A. Patch-tests medicamenteux dans l’exploration des toxidermies [Drug patch tests in the investigation of cutaneous adverse drug reactions]. Ann Dermatol Venereol 2009;136:635-644. French. https://doi.org/10.1016/j.annder.2009.06.021.
  11. Pecorari L, Mori F, Barni S, et al. Aspetti clinici e diagnostici dell’allergia ai macrolidi nel bambino. Rivista di Immunologia e Allergologia Pediatrica 2012;(3):8-16..
  12. Huynh VA, Lungoci E, Villani A, et al. Érythème pigmenté fixe à la clarithromycine : importance des tests de provocation pour le diagnostic [Fixed drug eruption to clarithromycin: The importance of challenge tests in diagnosis]. Ann Dermatol Venereol 2016;143(:852-855. French. https://doi.org/10.1016/j.annder.2016.03.007.
  13. de Waard-van der Spek FB, Darsow U, Mortz CG, et al. EAACI position paper for practical patch testing in allergic contact dermatitis in children. Pediatr Allergy Immunol 2015;26:598-606. https://doi.org/10.1111/pai.12463.
  14. Sillcox C, Gabrielli S, O’Keefe A, et al. Evaluating Pediatric Macrolide Allergy Using Direct Graded Oral Challenges. JAMA Pediatr 2024;178:1362-1364. https://doi.org/10.1001/jamapediatrics.2024.3685.
  15. Şahin MK, Topçak AB, Kökçü Karadağ Şİ, et al. Fixed drug eruption induced by clarithromycin and paracetamol in a child. Pediatr Allergy Immunol 2025;36:e70255. https://doi.org/10.1111/pai.70255.

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Authors

Federica Tonello - Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, Italy

Iria Neri - Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy

Lorenza Parini - Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy

Marcello Lanari - Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy

Arianna Giannetti - Paediatrics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy

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Copyright (c) 2026 Italian Journal of Pediatric Allergy and Immunology

How to Cite
Tonello, F., Neri, I., Parini, L., Lanari, M., & Giannetti, A. (2026). Clarithromycin-Induced Fixed Drug Eruption in a Paediatric Patient. Italian Journal of Pediatric Allergy and Immunology, 67(2). https://doi.org/10.53151/2531-3916/2026-2502
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