A Case of Intertriginous and Flexural Exanthema caused by Amoxicillin

We report a 50-year-old male patient who presented to the Dermatological Outpatient Clinic at the Hospital Universitario San Cecilio, Granada, Spain, in 2017 with symmetrical inguinal eruption and eruption on the dorsum of both feet four hours after the intake of amoxicillin. Physical examination showed confluent non-palpable purpuric macules covering the dorsum of both feet and medial malleolus, giving rise to dusky erythema in some areas. Only oral antihistamines were prescribed and cutaneous exanthema resolved within three weeks. Symmetric drug-related intertriginous and flexural exanthema (SDRIFE) is a sub-type of systemic allergic contact dermatitis, where previous sensitisation can only be demonstrated in up to 50% of patients by skin patch testing. Therefore, a provocation test was performed with amoxicillin without prior skin patch testing. As drug provocation produced the same reaction, the patient was diagnosed with SDRIFE. A parvovirus B19 infection was ruled out by negative serology. SDRIFE is challenging to distinguish from other skin rashes with similar features and distribution; it is important to be aware of these characteristics and their possible causes.Keywords: Exanthema; Amoxicillin; Drug Allergy; Drug Eruption; Groin; Feet; Case Report; Spain.

Allergy-Related Medication Error Reports Submitted to a Large Patient Safety Reporting System

Medication allergies can and do cause patient harm. Managing a patient’s allergies is a challenge for institutionsbecause failures can happen throughout the medication-use process. A total of 854 Medication Error events associated with patient allergies that occurred between July 2016 and June 2018 were reported through a large event reporting database. Analysts categorized these events into the following five stages: obtaining information from the patient, documenting allergies in the record, ordering medications, verifying orders, and administering medications. More than half (56.3%; n = 481) of the events reached the patient. Most likely to reach patients were events involving breakdowns when obtaining information from the patient (74.7%, n = 68 of 91) and administering medications (97.6%, n = 281 of 288). In reports that indicated allergies were properly documented, the majority (87.3%, n = 289 of 331) of the events that reached patients passed through two or more stages. Organizations may use this information to inform proactive efforts to implement system-based strategies to improve the medication-use process. Keywords: drug allergy, drug reaction, medication errors, medication safety, patient safety