Biopsy Confirmed Skin Drug Eruption in Setting of Ticagrelor Use

When there is concern that a rash may be a drug eruption reaction, there are many well-known culprits such as antibiotics and phenytoin. When an uncommon or previously unknown offending medication is being considered to have caused a drug eruption, diagnostic skin biopsy can help confirm the diagnosis. Our patient is a 54-year-old female with past medical history of prediabetes and obesity. She had ST segment-elevation myocardial infarction that was treated appropriately with timely percutaneous coronary intervention, which included angioplasty and drug-eluting stent placement. She was maintained on treatment regimen, and over the next 3 months, she developed a worsening maculopapular rash across her torso and upper extremities. Her biopsy showed superficial and mid-dermal perivascular lymphohistiocytic inflammation with focal spongiosis and scattered eosinophils, a common pathologic finding seen in drug eruptions. Although the patient was not taking any well-known offending agents, her ticagrelor was discontinued and she was transitioned to clopidogrel. Shortly after the transition, the patient's drug rash resolved without recurrence. Drug eruptions are a common etiology for rashes leading to presentation in primary care clinics. Our patient illustrates an exceedingly rare case of ticagrelor-induced drug reaction, as a review of the literature shows only 2 previously published case reports.