Fixed drug eruption is among the most common types of cutaneous undesirable drug reactions. lesions on extremities and trunk since 1 day. On evaluation, he previously background of ingestion of tabs rabeprazole and domperidone mixture for gastritis as recommended by an over-all practitioner two times back again. On further evaluation we found that the patient was earlier taking H2 blockers (tab ranitidine) for gastritis, but because of unsatisfactory response, he was prescribed tab rabeprazole and domperidone combination. Patient developed skin lesions within 12 h of ingestion of this combination. On exam, multiple (approximately 50) hyper-pigmented macules of size 1 2 cm to 4 5 cm with surrounding erythema were spread on the trunk along with few lesions within the extremities [Numbers ?[Numbers11 and ?and2].2]. Oral cavity, genitals, palms, and soles were normal. A suspected analysis of multiple common fixed drug eruptions probably due to rabeprazole and domperidone combination was made. Individual was asked never to take this offending medication and was treated with topical steroids and antihistamines anymore. Systemic steroids had been withheld due to gastritis. He had not been provided any placebo. Individual improved within 14 days with persistence of post-inflammatory hyperpigmentation dramatically. The individual was advised to come after 6 weeks for an oral challenge test for domperidone and rabeprazole. Open up in another window Amount 1 Multiple hyperpigmented macules with encircling erythema on entrance element of trunk Open up in another window Amount 2 Multiple hyperpigmented macules Fluorouracil manufacturer with encircling erythema on back again of trunk However, the patient came back after 2 Fluorouracil manufacturer a few months and up to date that he once again developed gastritis that pantoprazole 40 mg was recommended by another doctor. Fortunately, pantoprazole was good was and tolerated continued. It was astonishing to find out that pantoprazole regardless of getting in the same course caused no issue. After entrance and with all crisis medicines and resuscitative tools available at hands, oral provocation check was finished with tabs domperidone with appropriate consent of individual. Tabs domperidone 2.5 mg (1/4 of Tab 10 mg) was presented with without the untoward event and was increased gradually to 10 mg twice or thrice each day. Since tabs domperidone was well tolerated without the undesirable effect, therefore the chances of tabs rabeprazole becoming the offending medication were even more. As you can find few reviews of combination medicines becoming the offending agent rather than its specific constituents leading to FDE,[2,3] so there is a want of the dental concern check with rabeprazole about useful and educational grounds. Two weeks later on, tabs rabeprazole 5 mg (1/4 tabs rabeprazole 20 mg) was presented with. The individual began developing scratching and gentle erythema for the older FDE lesions showing rabeprazole as the offending drug. Patient was in follow up for some other H4 problem for more than 6 months and no delayed hypersensitivity reaction was seen. The Naranjo scale, is a questionnaire-based scale to determine the likelihood of whether an adverse drug reaction is actually due to the drug or because of other factors.[4] The score ranges from -4 to +13. According to this score a drug reaction can be definite (score 9), possible (rating 5C8), feasible (rating 1C4), or doubtful (rating 0). After full work up of our case, Naranjo algorithm score was 12 [Table 1], indicating that the event was definitely an adverse drug reaction. So, based on the clinical presentation, history, challenge and withdrawal test, a final diagnosis of multiple widespread fixed drug eruptions due to rabeprazole was made. Table 1 Naranjo scale thead th align=”left” rowspan=”1″ colspan=”1″ Questions /th th align=”center” rowspan=”1″ colspan=”1″ Yes /th th align=”center” rowspan=”1″ colspan=”1″ No /th th align=”center” rowspan=”1″ colspan=”1″ Dont know /th th align=”center” rowspan=”1″ colspan=”1″ Score /th /thead 1. Are there previous conclusive reports on this reaction?+10012. Did the adverse event appear after the suspected drug was administered?+2-1023. Did the adverse reaction improve when the drug was discontinued or a specific antagonist was administered?+10014. Did the adverse reaction reappear when the drug was re-administered?+2-1025. Are there alternative causes (other than the drug) that could on their own have caused the reaction?-1+2026. Did the reaction reappear when Fluorouracil manufacturer a placebo was given?-1+1017. Was the drug detected in the blood (or other fluids) in concentrations known to be toxic?+10008. Was the reaction more severe when the dose was increased or less severe when the.