Fixed drug eruption to propofol: Case series and clinical implications.

BACKGROUND

Fixed drug eruption (FDE) is a type IV delayed hypersensitivity reaction characterized by recurrent lesions at the same site upon drug re-exposure. Propofol-induced FDE is extremely rare.

CASE REPORT: We report four cases of FDE following propofol administration, presenting with erythematous or bullous lesions at fixed sites, sometimes with mucosal involvement. Standard skin tests and lymphocyte transformation tests were frequently negative, particularly when performed outside previously affected areas. Diagnosis was confirmed by controlled intravenous provocation in one adult case. Histology supported the diagnosis when available.

DISCUSSION: FDE to propofol is likely under-recognized due to delayed onset of lesions. Diagnostic testing can be challenging, and controlled re-exposure may be required. Awareness of this rare reaction is important given propofol's widespread use and limited alternative anaesthetic options. Reporting such cases improves recognition and guides safe management.