Abstract：
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the main causes of fixed drug eruption (FDE). Cross-sensitivity between chemically unrelated NSAIDs has been rarely described in FDE. We report herein two cases of NSAID-induced FDE confirmed by oral provocation test (OPT) with a literature review. Case 1 is a 49-year-old woman who took mefenamic, naproxen and acetaminophen for lumbago. On the second day, she noticed three erythematous plaques, located in the upper lip, chin and the right hand, which faded spontaneously, leaving residual patches. Three months later, she took mefenamic acid with reactivation of the same plaques. She received naproxen. On the same day, she exhibited a reactivation of lesions with the development of a new one. These lesions have disappeared leaving hyperpigmented sequelae. After negative patch test to naproxen, an OPT was performed with positive reaction, observed on the third day. To establish the cross-reactivity, she underwent OPTs, which gave positive results to indomethacin, ketoprofen and tiaprofenic acid. Case 2 is a 52-year-old woman who presented painful dusky-red macules, located in the right and left wrists, 24 hours after taking mefenamic acid. She described two similar events that occurred in the past with an undefined drug and piroxicam. Patch tests to lysine acetylsalicylate, mefenamic acid, piroxicam, naproxen and celecoxib were negative. OPTs to the same NSAIDs gave positive results to lysine acetylsalicylate, piroxicam and mefenamic acid. Thirteen case reports, seven case series and one retrospective analysis, including cases with confirmed cross-reactivity between NSAIDs, were reported in literature. Clinicians should be aware of such phenomenon.
摘要：
非甾体类抗炎药（NSAIDs）是引起固定药疹（FDE）的主要原因之一。在FDE中很少描述化学无关的NSAIDs之间的交叉敏感性。我们在此报告了两例通过口服激发试验（OPT）证实的NSAID诱导的FDE，并进行了文献综述。病例1是一名49岁的妇女服用了美芬那胺,萘普生和对乙酰氨基酚治疗腰痛。第二天,她注意到了三个红斑,位于上唇，下巴和右手，自发褪色，留下残留的补丁。三个月后,她服用甲芬那酸并重新激活相同的斑块。她接受了萘普生。在同一天,随着新病变的发展，她表现出病变的重新激活。这些病变已经消失，留下色素沉着的后遗症。萘普生斑贴试验阴性后，OPT以阳性反应进行，在第三天观察。为了建立交叉反应性，她接受了OPT,给消炎痛带来了积极的结果，酮洛芬和硫洛芬酸。病例2是一名52岁的女性，她出现了痛苦的暗红色黄斑，位于左右手腕，服用甲芬那酸后24小时。她描述了过去发生的两个类似事件，其中使用了未定义的药物和吡罗昔康。赖氨酸乙酰水杨酸盐的贴片测试，甲芬那酸,吡罗昔康,萘普生和塞来昔布均为阴性。相同NSAIDs的OPT对赖氨酸乙酰水杨酸酯产生阳性结果，吡罗昔康和甲芬那酸。13例病例报告,七个病例系列和一个回顾性分析，包括证实NSAIDs交叉反应的病例，在文献中报道。临床医生应该意识到这种现象。
