PMC5934989_01
(a-d) The patient's skin and oral lesions at arrival
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F1
Subsequently, a well-demarcated bullous lesion appeared within hours involving the dorsal surface of the proximal and middle phalanx of the left 4th finger [Figure 1a]. Similarly, a well-defined painful oral ulcer developed in the hard palate following initial burning sensation and bulla formation [Figure 1b]. The detailed physical examination revealed also an erythematous lesion in the upper lip [Figure 1b] and a painless ulcer in the ventral surface of penile shaft. In addition, an erythematous patch was found in the right lower abdominal wall with size of 6 cm x 8 cm [Figure 1c]. Further examination showed a similar erythematous patch in the left medial malleolus sized 2 cm x 3 cm [Figure 1d].
The microscopic pictures of the patient's abdominal skin biopsies
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F2
The microscopic studies of abdominal skin tissue showed hyperkeratosis of the epidermis, mild hydropic degeneration of basal layer, mixed inflammatory infiltration in the dermoepidermal junction with eosinophilic predominance, neutrophilic infiltration of blood vessels and melanin incontinence in the papillary dermis [Figure 2].
The microscopic pictures of the patient's malleolar skin biopsies
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F3
In addition, saw tooth appearance, mild spongiosis as well as lymphocyte-predominant inflammatory infiltration of dermoepidermal junction were seen in the malleolar skin biopsies [Figure 3].
The recovery of patient's skin and oral lesions within next weeks following withdrawal of the causative medication. Note hyperpigmentation of recovered lesions characteristic of fixed drug eruption. (a) patient's finger lesion, (b) upper lip lesion, (c) malleolar skin, (d) abdominal skin
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F4
His oral and skin lesions have been recovered with residual hyperpigmentation within the next weeks [Figure 4].