Erythropoietin Induced Atypical Erythema Multiforme in a patient with chronic kidney disease- a rare presentation
Keywords:
Adverse drug reaction, rash, erythropoietin stimulating agentsAbstract
Introduction: Erythema multiforme is a hypersensitivity reaction to different antigenic stimuli, mostly due to infections followed by drugs. Erythropoietin Induced Erythema Multiforme is one of the rarest serious adverse effects seen till date.
Case Presentation: The patient was a case of Anaemia in Chronic Kidney disease and was advised Inj Erythropoietin 4000 IU, subcutaneously after every 15 days. After taking 2nd dose of Inj Erythropoietin, the patient developed erythematous polymorphous eruptions over palms, hands, abdomen. Following which the patient developed fever and athralgia. A diagnosis of Erythropoietin Induced Erythema Multiforme was made. Patient recovered completely over few weeks. The adverse event was reported to the regional Pharmacovigilance Centre.
Management: Erythropoesis Stimulating Agents (ESA) are used to treat anaemia in Chronic Kidney Disease. Drug Induced Erythema Multiforme is a delayed Type IV hypersensitivity reaction, associated with prodromal symptoms such as Fever, cough, difficulty in breathing, joint pain and swelling. Patient improves with IV corticosteroids, antihistamines and emollients.
Conclusion: Erythropoietin should be offered meticulously in patients with anaemia in CKD, considering its benefit in terms of quality of life and physical function. Extreme caution to be taken while prescribing Erythropoietin therapy in patients with history of stroke, or any hypersensitivity reaction.
References
Aswath, N., & Rakshana, R. (2022). Drug induced erythema multiforme of the oral cavity. Archive of clinical cases, 9(4), 157–160. https://doi.org/10.22551/2022.37.0904.10224
Hafsi W, Badri T. Erythema Multiforme. [Updated 2023 May 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470259/
Hayat, A., Haria, D., & Salifu, M. O. (2008). Erythropoietin stimulating agents in the management of anemia of chronic kidney disease. Patient preference and adherence, 2, 195–200. https://doi.org/10.2147/ppa.s2356
Macdougall I. C. (2024). Anaemia in CKD-treatment standard. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 39(5), 770–777. https://doi.org/10.1093/ndt/gfad250
Murayama, H., Sakuma, M., Takahashi, Y., & Morimoto, T. (2018). Improving the assessment of adverse drug reactions using the Naranjo Algorithm in daily practice: The Japan Adverse Drug Events Study. Pharmacology research & perspectives, 6(1), e00373. https://doi.org/10.1002/prp2.373
Parida S. (2013). Clinical causality assessment for adverse drug reactions. Indian journal of anaesthesia, 57(3), 325–326. https://doi.org/10.4103/0019-5049.115608
Rueangsri, R., & Laisuan, W. (2023). Epoetin-alfa induced pruritic maculopapular eruption: Case report and literature review. Asian Pacific journal of allergy and immunology, 41(3), 231–235. https://doi.org/10.12932/AP-040719-0592
Schoener B, Borger J. Erythropoietin Stimulating Agents. [Updated 2023 Mar 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536997/
Shaikh H, Hashmi MF, Aeddula NR. Anemia of Chronic Renal Disease. [Updated 2023 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539871/
Shivhare, P., Haidry, N., Sharma, A., Agrawal, D., Gupta, A., & Subramanyam, S. (2023). Drug-Induced Erythema Multiforme. Case reports in dermatological medicine, 2023, 8706006. https://doi.org/10.1155/2023/8706006
Downloads
Published
Issue
Section
License
Copyright (c) 2025 MADHURIMA ROY ROY
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
