Abstract | April 14, 2023

Proton Pump Inhibitor-Induced Dermal Hypersensitivity Reaction Masquerading as an Arthropod-bite reaction

Raj Patel, MBA

Raj H. Patel, MBA, 3rd Year Medical Student, Edward Via College of Osteopathic Medicine, Monroe, LA, USA; Padma V. Chitnavis, MD, Dermatology, Carilion Clinic Dermatology and Mohs Surgery, Roanoke, VA, USA; and Patrick S. Rush, DO, Dermatopathology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.

Learning Objectives

  1. Our experience highlights the importance of considering PPIs as a possible cause of drug eruption in patients whose examination is more suggestive of arthropod bites.
  2. It is vital for clinicians to understand the varied appearance of cutaneous reactions to PPIs and to consider them as part of the differential diagnosis in at-risk patients.
  3. Increased awareness of this presentation can shorten the time to diagnosis, improving clinical management and patient outcomes.
  4. Upon completion of this lecture, learners should be better prepared to: understand the varied appearance of cutaneous reactions to PPIs to consider them as part of the differential diagnosis in at-risk patients.

Introduction: Proton pump inhibitors (PPIs) are widely prescribed as effective suppressants of gastric acid secretion and are generally well tolerated by patients. Several studies suggest that the adverse drug reactions caused by PPIs are increasing, however, the true rate of hypersensitivity reactions remains unknown despite the high frequency of prescription.

Diagnosis can often be challenging and is heavily reliant on history as the clinical presentation and histopathologic findings may be suggestive of skin conditions from a variety of unrelated sources.

Case Presentation: We present the case of a 73-year-old woman who presented to the dermatology clinic with a diffuse, erythematous, papular rash which was resistant to treatment with corticosteroids, antihistamines, and scabicides. The clinical features of the lesions in conjunction with histologic findings led to concern for an arthropod bite reaction.

Final Diagnosis: After extensive workup, pantoprazole was identified as the inducing factor as the patient reported significant improvement of the rash and alleviation of pruritic symptoms following discontinuation of this medication.

Outcome: To date, no reports have described a PPI-induced skin reaction with the clinicopathologic appearance of arthropod bite reaction lesions. Our case seeks to illustrate the importance of having a high index of suspicion for PPI-induced skin rashes in patients with an unsuggestive history for arthropod bite reaction. Early recognition can prevent extensive workup and treatment-related costs which may otherwise arise from the management of this atypical clinical situation.

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