NSAID-Induced Bullous Fixed Drug Eruption Presenting with Bilateral Lip Lesions: A Case Report

Abstract

Background and Objectives:  Fixed drug eruption (FDE) is a cutaneous Type IV hypersensitivity reaction characterized by recurrent lesions at the same anatomical site upon re-exposure to an offending drug. Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently implicated agents. Bullous FDE with rapid onset and bilateral presentation is uncommon and rarely reported without concurrent mucosal involvement.

Presentation of case: We report a 60-year-old female with no significant comorbidities who developed painful, fluid-filled perioral bullae within 20 minutes of ingesting ibuprofen for musculoskeletal pain. Lesions progressed through erythema then bullous formation then crusting and lastly post-inflammatory hyperpigmentation over one week. Notably, lesions were bilaterally symmetrical and perioral, with no mucosal involvement, an atypical presentation. Histopathological examination confirmed interface dermatitis with basal cell vacuolization and melanin incontinence, consistent with FDE.

Discussion: The patient was counselled to discontinue the offending NSAID and prescribed acetaminophen as an alternative analgesic. No recurrence was observed following drug cessation. Residual post-inflammatory hyperpigmentation resolved gradually over 3 months.

Conclusion: This case highlights a clinically distinctive presentation of NSAID-induced bullous FDE with bilateral symmetry and absence of mucosal involvement. Prompt recognition and drug withdrawal resulted in complete resolution without complications.