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PubMed1996

[Double infection of Chlamydia pneumoniae and Mycoplasma pneumoniae in children].

There have been fewer reports on Chlamydia pneumoniae infection during childhood than those in adults, although many of the C. pneumoniae infections occurred during childhood based on prevalence of the antibody. And there have been no reports concerning the double infection of C. pneumoniae and M. pneumoniae. We reported three cases of children with the double infection. We diagnosed this from significant alteration of these antibodies from the acute to convalescent phases. We omitted the cases without significant alteration of the antibodies, even diagnosed from isolation or detection of the antigens in the samples by direct fluorescent antibody. Case 1 was an 8-year-old-boy who was admitted to our hospital because of fever, cough with vomiting and erythema multiforme. The symptoms did not subside after administration of clindamycin but subsided after minocycline. Case 2 was an 1-year-old-boy who was admitted because of fever, cough, rhinorrhea and vomiting. C. pneumoniae organisms were isolated from the pharyngeal swab specimen, the symptoms subsided after administration of clindamycin. Case 3 was a 9-year-old boy who was admitted because of fever and a cough followed by erythema multiforme. The symptoms did not decrease after administration of clindamycin but after minocycline. The characteristic of these cases are a strong cough with vomiting, weak response of acute reactants on the laboratory data, and skin eruption similar with that due to M. mycoplasmae in two of the three cases. We suspect that these double infections may induce the eruption, about which there have been no previous reports.

Child↗
PubMedDate not supplied

[Cutaneous symptoms of ulcero-haemorragic rectocolitis and of Crohn's disease (author's transl)].

The association between ulcerative colitis, Crohn's disease and various abnormalities of the skin is reviewed. Erythema nodosum and pyoderma gangrenosum are the most specific external manifestations and thereby the ones of greatest diagnostic value. Erythema multiforme is probably a manifestation of drug hypersensitivity. Many other dermatosis have been observed in association with these gastrointestinal disorders. However, these associations are not statistically significant. A specific "aphtous colitis" may be observed in the course of Behçet's disease.

Colitis, Ulcerative↗
PubMed1987

Diagnosis and management of chronic oral mucosal bullous diseases.

Chronic blistering diseases involving the mouth are frequently difficult to diagnose correctly and can present a problem with management. Pemphigus vulgaris, cicatricial pemphigoid, and recurrent oral erythema multiforme may be difficult to separate from each other and from other erosive diseases such as recurrent aphthous stomatitis and erosive lichen planus. Essential to establishing a correct diagnosis is a pertinent history, a physical examination, and histopathologic and direct immunofluorescence studies. Oral pemphigus vulgaris can usually be managed successfully with prednisone alone but occasionally another immunosuppressive medication in concurrence with prednisone is necessary. Dapsone is the most efficacious treatment for oral cicatricial pemphigoid, and brief courses of prednisone usually control individual episodes of severe recurrent oral erythema multiforme. It is important that physicians who undertake treatment of these diseases be fully aware of the untoward effects of the medications that are being utilized.

Chronic Disease↗
PubMed2004

Successful intravenous human immunoglobulin treatment of drug-induced Stevens-Johnson syndrome in a dog.

A two-year-old, male English springer spaniel developed severe mucocutaneous ulceration following treatment with trimethoprim-potentiated sulphadiazine. The clinical signs were consistent with Stevens-Johnson syndrome (SJS): there were no target or arciform lesions typical of erythema multiforme minor and major; more than one mucosal surface was affected; epidermal detachment affected less than 10 per cent of the body surface area; and there was a clear history of drug exposure. Systemic signs included a severe hepatopathy, dyspnoea, pyrexia and cachexia. Glucocorticoid therapy was associated with secondary infection by Pseudomonas aeruginosa. The clinical signs rapidly resolved following a single intravenous infusion of 0.51 g/kg human immunoglobulin (ivHIG) as a 5 per cent solution. By blocking FAS/FAS ligand (CD95/CD95L) interactions, ivHIG is thought to prevent keratinocyte apoptosis. It also binds to immunoglobulin G Fc receptors, inhibiting cell activation and cytokine synthesis, neutralises autoantibodies and immune complexes, blocks complement activity, is antimicrobial and increases colloid osmotic pressure. To the authors' knowledge, this is the first report of successful treatment of canine SJS using ivHIG, although it has been used to treat erythema multiforme in a cat and toxic epidermal necrolysis in a dog.

Animals↗
PubMed1997

Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20-year survey.

Studies on the epidemiology of common adverse cutaneous drug reactions have rarely been reported, since they can only be successfully conducted in clinics of internal medicine employing consultant dermatologists and having a comprehensive or intensive system of monitoring. Between 1974 and 1993, the adverse skin reactions occurring in divisions of general internal medicine of three different hospitals were monitored by a computerized comprehensive system. The "drug-monitoring patient" was defined as the recipient of at least one drug during hospitalization. The relationship of the skin reactions to drug causality in these patients had to be either definite (proven by re-exposure) or probable (drug relation greater than that of nondrug causality). The skin reactions were classified into four diagnostic groups. Maculopapular exanthema, urticaria, and vasculitis were the three main groups. The fourth group comprised cases of nonhomogeneous but clinically well-defined special exanthema. For selected drugs and years of observation, special emphasis was placed on the study of time patterns (reaction time, exposure time). A total of 1317 definite or probable drug-induced skin reactions occurred during the hospitalization of 48,005 consecutively admitted "drug-monitoring patients": 1201 cases of maculopapular exanthema, 78 cases of urticaria, 18 cases of cutaneous vasculitis, and 20 cases of special exanthema (five of erythema multiforme minor, six of fixed eruption, one of photosensitivity reaction, and eight of acneiform eruption). The main drugs involved did not differ for the three main types of skin reactions, penicillins ranking in the first place, followed by sulfonamides--most often combined with trimethoprim--and in the third place nonsteroidal anti-inflammatory drugs. The reaction time (time from last drug exposure to first skin manifestation) for urticaria showed a relevant proportion of the acute type (within 1 h) and most of the subacute type (1-24 h). For maculopapular exanthema, the subacute or, rarely, the latent type (1-8 days, exceptionally more than 8 days) predominated. For aminopenicillins, the rate of occurrence of skin reactions increased with increasing exposure time up to 12 days, and then markedly diminished. Possibly due to the tendency to withdraw suspected drugs even in the case of minor (e.g., maculopapular) skin reactions, no severe events such as erythema multiforme major/Stevens-Johnson syndrome or toxic epidermal necrolysis occurred.

Adverse Drug Reaction Reporting Systems↗
PubMed1993

Coccidioidomycosis and pregnancy.

Pregnant women with respiratory symptoms of pleuritic pain and productive cough should undergo evaluation for coccidioidomycosis. This should include a history of travel or residency in endemic areas and careful assessment for toxic erythema, erythema nodosum, or erythema multiforme. To confirm a diagnosis of this disease, a sputum culture, wet mount, and serological tests should be performed. The risk of dissemination, which is highest in the second and third trimesters, can be estimated by a complement-fixation titer. In disseminated cases aggressive treatment with amphotericin B has improved the previously reported high maternal and neonatal mortality rate. Fortunately, case reports do not indicate that transplacental spread occurs. Reactivation or exacerbation of a chronic low-grade infection during pregnancy may occur in patients treated for prior disseminated disease (32, 34). Interestingly, both of the reported cases of reactivation or exacerbation occurred in insulin-dependent diabetics.

Adult↗
PubMed1977

Orf: a family with unusual complications.

Three members of a farming family and their local postman contracted orf. One of those affected had had no direct contact with infected sheep. Two of the family developed a widespread papulo-vesicular eruption of the skin and mucosae with pyrexia, malaise and lymphadenopathy lasting 4-5 weeks. The eruption did not resemble erythema multiforme or the toxic erythemas usually associated with this infection.

Adolescent↗
PubMed1987

Plasma anaphylatoxin concentrations in inflammatory skin diseases.

To study the possible involvement of the complement system in inflammatory skin disorders, we measured the concentrations of C3a and C4a anaphylatoxins in the peripheral blood of 148 patients with various inflammatory skin disorders and 48 healthy control subjects by radioimmunoassay. Significant increases in mean levels of both C3a and C4a anaphylatoxins were found in 59 patients with psoriasis. Remarkable increases in both C3a and C4a anaphylatoxins were also noted in some patients with leukocytoclastic vasculitis, urticarial vasculitis or unspecified toxic erythema. On the other hand, elevation of C4a alone was noted in a case of systemic lupus erythematosus. In contrast, using the mean of the normal control +/- 2 S.D., no significant anaphylatoxin elevation was found in 16 patients with pustulosis palmaris et plantaris, 7 with pityriasis rosea, 3 with erythema multiforme, and 3 with erythema nodosum or autoimmune bullous dermatoses.

Anaphylatoxins↗