[Clinical and laboratory data supporting the possible relationship between dental foci and erythema exudativum multiforme].
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We describe a healthy peripheral blood stem cell (PBSC) donor who developed a cutaneous reaction, erythema exsudativum multiforme, during the administration of granulocyte colony-stimulating factor (G-CSF) for mobilization. The cutaneous lesions were located on his hips, apart from the site of G-CSF injection. Treatment with topical corticosteroid was commenced, and the lesions resolved completely within a week. Adverse cutaneous reactions induced by G-CSF have been reported infrequently in healthy donors. Further documentation of cases and their full evaluation will be of great importance for both physicians and PBSC donor.
Mucocutaneous side-effects from etretinate are common and are usually dose-dependent, whereas hypersensitivity drug eruptions are rare. Two patients are described in whom erythema multiforme-like eruptions appeared several days after oral intake of etretinate. In one patient etretinate rechallenge again produced the skin eruption. A brief review of the less common skin manifestations of etretinate therapy is provided.
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A localized skin reaction occurred within 4 weeks following IV administration of mitomycin C and 5-FU. Erythematous papules appeared proximal to the forearm site used for drug administration that histologically resembled an erythema multiforme-like drug reaction. A localized hypersensitivity reaction to mitomycin C is suspected.
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BACKGROUND: Erythema multiforme and toxic epidermal necrolysis can occur as serious and even life-threatening adverse drug reactions. The underlying mechanisms are unknown, but evidence suggests that affected individuals may have impaired capacity to detoxify reactive intermediate drug metabolites. Such intermediates may be directly toxic or may react with host tissues to form antigens, evoking an immune response. We describe our investigation of a patient with carbamazepine-induced erythema multiforme and toxic epidermal necrolysis. The inflammatory infiltrate was examined immunocytochemically in lesional skin specimens from the patient, in the patient's patch test response to carbamazepine, and in lesional skin specimens from five other patients with drug-induced erythema multiforme. The patient's lymphocytes were examined both for susceptibility to cytotoxic damage by liver microsome-induced carbamazepine metabolites and for proliferative responses to native carbamazepine, which might indicate cell-mediated immune sensitization. OBSERVATIONS: Lesions of toxic epidermal necrolysis were more florid, but findings were essentially similar in all the skin samples examined. In the dermis there were CD14+ macrophages, CD1a+ Langerhans cells, and CD3+ CD45RO+ T cells. The CD4-CD8 T-cell ratio was 2:1, and 10% of the T cells were CD25+, suggesting activation by recent encounter with antigen. The epidermis contained CD14+ macrophages and T cells, but the CD8+ cells out-numbered the CD4+ cells. Up to 25% of the T cells were CD25+. Lymphocyte proliferation was not induced by native carbamazepine, but the patient's lymphocytes were significantly more susceptible to cytotoxic killing by liver microsome-induced carbamazepine intermediates. CONCLUSIONS: The inflammatory reaction in skin affected by erythema multiforme and toxic epidermal necrolysis was rich in CD8+ T cells, suggesting an immune cytotoxic reaction. The patient appeared to have a reduced capacity to detoxify reactive intermediates. This, together with the lack of lymphocyte response to native drug but a positive patch test response, suggests that the immune response may be directed at drug-modified epidermal cells.
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