Generalized Bullous Fixed Drug Eruption due to Clopidogrel Hypersensitivity Successfully Treated Using the Jefferson Procedure

Generalized bullous fixed drug eruption (GBFDE) is a rare variant of fixed drug eruption that is known to clinically mimic Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). Numerous medications have been reported to cause GBFDE, including antiplatelet agents like ticagrelor, but few reports exist linking this reaction to clopidogrel specifically. We report a case of a medically complex 80-year-old male who was found to have clopidogrel hypersensitivity manifesting as GBFDE based on clinical characteristics and pathology. He was successfully treated using the Jefferson desensitization protocol, which was developed by cardiologists to enable continuation of clopidogrel. While clopidogrel hypersensitivity reactions are well-reported, there is a shortage of dermatology literature characterizing the clinical characteristics of these rashes and highlighting the use of the Jefferson desensitization protocol. This case reports on an etiology for GBFDE that is rarely observed and emphasizes the importance of histopathology when differentiating this entity from SJS/TEN. It also reports the successful use of the Jefferson protocol for GBFDE secondary to clopidogrel hypersensitivity.