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Published Online, 11 December 2007, www.theannals.com, DOI 10.1345/aph.1K419.
 The Annals of Pharmacotherapy: Vol. 42, No. 1, pp. 127-130. DOI 10.1345/aph.1K419
© 2008 Harvey Whitney Books Company.
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Simultaneous Erythema Nodosum and Erythema Multiforme After Local Lidocaine Injection

Alma Angélica Rodríguez-Carreón, MD

Resident, Dermatology, General Hospital Dr. Manuel Gea González, Mexico City, Mexico

Elisa Vega-Memije, MD

Attending Physician, Dermatopathology, General Hospital Dr. Manuel Gea González, Mexico City

Gabriela Moreno-Coutiño, MD

Attending Physician, Mycology, General Hospital Dr. Manuel Gea González, Mexico City

Lirio López-García, MD

Resident, Dermatology, General Hospital Dr. Manuel Gea González, Mexico City

Judith Domínguez-Cherit, MD

Attending Physician, Surgical Dermatology, General Hospital Dr. Manuel Gea González, Mexico City

Roberto Arenas, MD

Attending Physician, Mycology, General Hospital Dr. Manuel Gea González, Mexico City

Reprints: Dr. Arenas, Mycology Section, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800 Col. Sección XVI, Tlalpan CP. 14080 México, D.F., fax (5255) 40 00 3058, rarenas98{at}hotmail.com

OBJECTIVE: To report a case of simultaneous erythema nodosum and erythema multiforme after local lidocaine injection.

CASE SUMMARY: A 33-year-old female experienced coexisting erythema nodosum and erythema multiforme after lidocaine spray was used for upper gastrointestinal endoscopy. The reaction was exacerbated after localized injection of 2% lidocaine for a skin biopsy. An objective causality assessment revealed that an adverse drug reaction was highly probable.

DISCUSSION: Lidocaine is the most frequently used local anesthetic agent. The coexistence of erythema nodosum and erythema multiforme has been reported in lepromatous leprosy, Yersinia enterocolítica and Yersinia pseudotuberculosis gastrointestinal infection (both with diarrhea), histoplasmosis, hepatitis C, and milkers nodule, but not with lidocaine.

CONCLUSIONS: If clinicians observe similar lesions after lidocaine exposure, they should suspect an adverse drug reaction and exercise caution in the administration of amide anesthetics to patients with a documented history of adverse reaction to lidocaine.

Key Words: erythema multiforme, erythema nodosum, lidocaine

Published Online, December 11, 2007. www.theannals.com, DOI 10.1345/aph.1K419




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