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PubMedDate not supplied

[Toxic epidermal necrolysis after the use of intermediate dose of cytosine arabinoside].

UNLABELLED: Toxic epidermal necrolysis is a drug-induced dermatologic disease related to Lyell syndrome, erythema multiforme and Stevens-Johnson syndrome. PURPOSE: To report a fatal case of toxic epidermal necrolysis owing to intermediate dose of cytarabine. CASE REPORT: A 16 year-old female patient with acute lymphocytic leukemia (LLA-L1) treated with the Protocol of the Brazilian Group for Treatment of Leukemia of Childwood (GBTLI-85-AR). On the second day after the administration of intermediate dose of cytarabine (1.5 g/m2 i.v. every 12 hours for 3 days), she presented bullous lesions in the left buttock that disseminated envolving to necrosis, sepsis, and death on the 13th day. CONCLUSION: Cytarabine is frequently associated with dermatologic toxicity but, until now, there is no other case of toxic epidermal necrolysis described.

Adolescent↗
PubMed2003

What do we (not) know about the human bartonelloses?

The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrion's disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella sp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases.

Angiomatosis, Bacillary↗
PubMed2001

Biopsy-proved acute tubulointerstitial nephritis and toxic epidermal necrolysis associated with vancomycin.

A 70-year-old man receiving vancomycin for a methicillin-resistant Staphylococcus aureus (MRSA) abscess developed a drug-induced hypersensitivity reaction with rash, eosinophilia, and acute renal failure requiring dialysis. Renal biopsy revealed diffuse and marked interstitial and tubular infiltration by mononuclear cells and eosinophils; acute tubulointerstitial nephritis (TIN) was diagnosed. The rash progressed to erythema multiforme major after rechallenge with vancomycin in the setting of MRSA peritoneal catheter-related peritonitis and then to fatal toxic epidermal necrolysis in the setting of steroid taper and persistent serum vancomycin levels. This case further implicates vancomycin as a drug that infrequently can cause severe acute TIN and exfoliative dermatitis. When a renally excreted drug such as vancomycin is administered, serum drug levels should be serially monitored and high-dosage steroids be maintained or tapered slowly until serum drug levels become undetectable.

Acute Disease↗
PubMed1999

Non-plaque-induced gingival lesions.

The origin of gingival inflammation is occasionally different from that of routine plaque-associated gingivitis, and such non-plaque-associated types of gingivitis often present characteristic clinical features. Examples of such forms of gingivitis are specific bacterial, viral, and fungal infections. Specific bacterial infections of gingiva may be due to Neisseria gonorrhea, Treponema pallidum, streptococci, and other organisms. The most important viral infections of gingiva are herpes simplex virus type 1 and 2 and varicella-zoster virus. Fungal infections may be caused by several fungi, the most important of these being Candida species including C. albicans, C. glabrata, C. krusei, C. tropicalis, C. parapsilosis, and C. guillermondii. Gingival histoplasmosis is a granulomatous disease caused by the fungus Histoplasma capsulatum and, as for the other specific infections of gingiva, a confirmed diagnosis may require histopathologic examination and/or culture. Atypical gingivitis may also occur as gingival manifestations of dermatological diseases, the most relevant of these being lichen planus, pemphigoid, pemphigus vulgaris, erythema multiforme, and lupus erythematosus. Non-plaque induced gingival inflammation can be caused by allergic reactions to dental restorative materials, toothpastes, mouthwashes, and foods. In addition, gingival inflammation may result from toxic reactions, foreign body reactions, or mechanical and thermal trauma.

Communicable Diseases↗
PubMed2006

Serious skin reactions and selective COX-2 inhibitors: a case series from prescription-event monitoring in England.

BACKGROUND: The erythema multiforme (EM) spectrum of bullous eruptions (toxic epidermal necrolysis [TEN] and Stevens-Johnson syndrome [SJS]) are rare and serious skin reactions that have been reported for cyclo-oxygenase (COX)-2 selective inhibitors. Our objectives were to identify and describe cases of serious skin reactions reported during postmarketing studies of COX-2 selective inhibitors. METHODS: A retrospective review of information from reports of serious skin reactions reported during prescription-event monitoring (PEM) studies of rofecoxib, celecoxib, etoricoxib and valdecoxib conducted in England since 1999. Exposure data were derived from dispensed prescriptions written by primary care physicians for each study drug. Outcome data were derived from questionnaires posted to prescribers at least 9 months after the date of the first prescription for each patient (valdecoxib data collection ongoing at the time of this study). Reports of EM, exfoliative dermatitis, SJS, TEN and symptoms associated with EM (EM syndrome) were identified from the PEM database. Additional data on diagnosis, relevant risk factors and management were requested for each case from the prescriber. A causality assessment was undertaken by a Drug Safety Research Unit research fellow and referred for expert review to a consultant dermatologist. RESULTS: Nine cases of serious skin reactions and two cases of symptoms associated with EM (EM syndrome) were identified. No reports of TEN were recorded. Six skin reaction questionnaires were returned. Of the nine cases of serious skin reactions, four cases (all SJS; one for each COX-2 selective inhibitor studied) were assessed as possibly related to use of the study drug (for combined cohorts: incidence risk 0.008%, 4 of 52,644 patients; rate 0.019 per 1000 patient-months of treatment). These four cases (two male, two female; age range 54-64 years) occurred within 2 weeks of starting treatment; the patient prescribed rofecoxib had reported risk factors (history of allergy, adverse reaction [asthma] to ibuprofen). The two cases from the EM syndrome search (one female, 35 years; one male, 80 years) occurred within 2 weeks of starting treatment; both were assessed as possibly related to use of celecoxib but considered suggestive of angio-oedema/urticaria and hypersensitivity reactions. CONCLUSIONS: This case series provides useful and complementary information to other published studies about serious skin reactions reported during treatment with COX-2 selective inhibitors. The crude incidence of cases of SJS possibly related to the use of a COX-2 selective inhibitor in this case series is very low (0.008% for all four cohorts combined). Prescribers and patients should be aware of the severe and life-threatening risk of EM potentially associated with NSAIDs, including COX-2 selective inhibitors.

Adult↗
PubMed1990

Pharmacological management of recurrent oral mucosal ulceration.

A number of diseases can cause recurrent intraoral ulceration. This review focuses principally on drug management of intraoral ulceration associated with local and systemic conditions most likely to be observed on an outpatient basis by the general practitioner. These consist of recurrent aphthous stomatitis, erosive lichen planus, benign mucous membrane pemphigoid (BMMP), erythema multiforme. Behçet's disease, allergic stomatitis and infection. Information is provided on a spectrum of medication found useful in ulcer management, including topical antimicrobial and antifungal agents, topical and systemic corticosteroids, topical and systemic analgesics, and systemic immunosuppressive and anxiolytic drugs, plus details of dosage, important adverse reactions and interactions. A treatment guide for management of recurrent aphthae is presented. The reader is presumed to be familiar with differential diagnosis and the importance of establishing an accurate impression before starting drug therapy.

Humans↗
PubMed2004

Levamisole in dermatology : a review.

Levamisole, an anthelmintic agent with a wide range of immunomodulatory actions, has been used successfully as monotherapy and an adjunct to treatment in a variety of diseases. Since 1990, combination therapy of levamisole and fluorouracil has played an important role in the treatment of resected Dukes stage C adenocarcinoma of the colon. Because of its immunomodulating effects levamisole has been used in a wide range of diseases with and without success. In dermatologic disease levamisole has been successfully used in the treatment of parasitic, viral and bacterial infections including leprosy, collagen vascular diseases, inflammatory skin diseases and children with impaired immune a variety of reasons. It has also been used in combination with other drugs for treating a number of dermatologic disorders, e.g. in combination with cimetidine for treating recalcitrant warts, with prednisolone for treating lichen planus, erythema multiforme and aphthous ulcers of the mouth. Adverse affects of levamisole are mild and infrequent and include rash, nausea, abdominal cramps, taste alteration, alopecia, arthralgia, and a flu-like syndrome. It can rarely cause agranulocytosis. More studies need to be undertaken to study the full potential of levamisole in dermatologic diseases.

Adjuvants, Immunologic↗
PubMed2006

Cutaneous reactions to chemotherapy and their management.

International data from 2002 report 10.9 million new cases of cancer and 6.7 million cancer deaths. Chemotherapy is an essential component in the multidisciplinary management of most cancers. Cutaneous reactions to chemotherapeutics are common and may contribute significantly to the morbidity, and rarely to the mortality, of patients undergoing such treatments. Recognition and management of these reactions is important to provide optimal care. This article aims to present the most common cutaneous reactions to frequently used chemotherapies and provides management guidelines. A MEDLINE search from 1966 through June 2005 was conducted to identify reports of common cutaneous toxicities with systemic chemotherapy and their appropriate management. An analysis of our literature search is presented in review form outlining common chemotherapy-related cutaneous reactions and their management, as well as the chemotherapeutics responsible for the cutaneous toxicity. Chemotherapy-related cutaneous toxicity includes generalized rashes such as the spectrum between erythema multiforme and toxic epidermal necrolysis, and site-specific toxicity such as mucositis, alopecia, nail changes, extravasation reactions, or hand-foot syndrome. Most of the toxicity is reversible with chemotherapy dose reductions or delays. Certain toxicities can be effectively treated or prevented, allowing optimal delivery of chemotherapy (e.g. premedications to prevent hypersensitivity, prophylactic mouthwashes to prevent mucositis). Newer non-chemotherapeutic targeted therapies such as epidermal growth factor receptor inhibitors (e.g. gefitinib, cetuximab) may also be associated with cutaneous toxicity and can be distressing for patients. Recent data suggest that skin toxicity associated with these agents may correlate with efficacy. Cutaneous toxicity occurs frequently with chemotherapy and non-chemotherapeutic biologic therapies. Early recognition and treatment of the toxicity facilitates good symptom control, prevents treatment-related morbidity, and allows continuation of anti-cancer therapy.

Antineoplastic Agents↗
PubMed2006

Stevens-Johnson syndrome associated with intravenous acetazolamide administration for evaluation of cerebrovascular reactivity. Case report.

A 62-year-old man with left middle cerebral artery stenosis manifesting as transient ischemic attack underwent evaluation of regional cerebrovascular reactivity to acetazolamide using single photon emission computed tomography. Three days after intravenous administration of acetazolamide, erythematous eruptions of various sizes appeared on his back and spread over almost his entire body. Subsequently, painful ulcerations developed on his lips, and oral and nasal mucosa, and the conjunctiva became hyperemic, indicating Stevens-Johnson syndrome. The results of the lymphocyte transformation test were positive to only acetazolamide. Stevens-Johnson syndrome, also known as erythema multiforme major, can be life-threatening, and may be induced by intravenous administration of acetazolamide.

Acetazolamide↗
PubMedDate not supplied

[Is Vojvodina a risk area for contact weed allergies?].

INTRODUCTION: After detecting erythema multiforme due to contact with weeds, dandelion (Taraxacum officinale, Compositae) and common chickweed (Stellaria media, Caryophyllaceae), which are ubiquitous plants in Vojvodina, and concerning properties of commercial screening allergens in detection of allergy to plants, we investigated contact allergy to dandelion and to common chickweed, using their extracts. MATERIAL AND METHODS: Epicutaneous tests were performed using originally prepared ether extracts of these plants, 0.1% and 3% pet., in 263 individuals: 43 with extrinsic atopic dermatitis, 55 with allergic contact dermatitis, 118 with non-allergic chronic inflammatory skin diseases and 47 healthy adults. RESULTS: Our results have shown that testing with both extracts (both concentrations) represents a safe method, since no irritation or sensibilization occurred. The overall prevalence of allergy to dandelion extract was 1.14%, and for common chickweed extract 2.28%. DISCUSSION: Plant allergies (especially Compositae) cannot always be detected by standard screening allergens. Additional testing with dandelion extract can detect most cases, which is in agreement with our results. Isolation of essential oil from common chickweed proved the allergenic potential of this plant. The prevalence of detected allergy to dandelion as well as to common chickweed was higher than 1%. CONCLUSION: These ubiquitous weeds and high prevalence of detected allergies have included Vojvodina into a risk zone for getting contact sensitivity to dandelion and common chickweed. Dandelion extract should be considered for Compositae screening series and common chickweed extract for specific plant series in Vojvodina.

Adolescent↗
PubMed2006

Stevens-Johnson syndrome associated with glipizide therapy.

We describe a patient with Stevens-Johnson syndrome (erythema multiforme major) associated with an increase in glipizide dosage administration. Glipizide is a second-generation sulfonylurea commonly used to treat patients with noninsulin-dependent diabetes mellitus. Although several reports have documented Stevens-Johnson syndrome caused by first-generation sulfonylureas, our case appears to be the first report of a second-generation sulfonylurea associated with Stevens-Johnson syndrome.

Adult↗
PubMedDate not supplied

Readministration of spironolactone in the spironolactone-intolerant patient.

We report a successful practical protocol for readministration of spironolactone in a patient with cirrhosis and severe ascites whose initial exposure to spironolactone resulted in erythema multiforme. Because salt and water restriction and other diuretics were ineffective, readministration of spironolactone was considered appropriate. In the absence of in vitro or in vivo diagnostic tests for drug allergy to spironolactone, serial increasing doses from 1 mg to 400 mg were administered over a 14 day period and tolerated uneventfully. A mild maculopapular rash appeared a month later but resolved despite continuation of spironolactone. The patient has now received spironolactone successfully for a total of 20 months without evidence of subsequent drug hypersensitivity. Although proven drug hypersensitivity attributable to spironolactone is very rare, when allergic manifestations have occurred in a patient who may require readministration of spironolactone, we believe that the suggested protocol for test-dosing be considered.

Drug Hypersensitivity↗
PubMedDate not supplied

Multiple antibiotic sensitivity in a pediatric population.

Multiple antibiotic sensitivity (MAS), a common but complex clinical problem, has not been reviewed in the pediatric population. We evaluated 120 children with a history of MAS. The offending antibiotics were beta lactam (186 adverse reactions), sulfonamide (86 adverse reactions), macrolide (32 adverse reactions), erythromycin/sulfisoxazole (26 adverse reactions), aminoglycoside (2 adverse reactions), and tetracycline (2 adverse reactions). Urticaria occurred in 183 reactions, followed by polymorphous rash (n = 71), angioedema (n = 19), erythema multiform (n = 9), bronchospasm (n = 8), arthralgia (n = 7), serum sickness (n = 4), and laryngeal edema (n = 3), the mean age for the first reaction was 3 years (range 1 month to 13 years). Adverse reaction to three classes of antibiotics were noted in 22 patients, and two patients were noted to have adverse reactions to four or more antibiotic classes. Skin tests (ST) were performed in 98 children using penicillin G, a commercial benzyl penicilloyl polylysine, a minor determinant mixture, and a beta lactam analog. Positive ST were noted in 26% (31/120) of the MAS patients. Children with a history of MAS are likely to have true IgE-mediated reactions as documented by positive immediate hypersensitivity reactions to penicillin and/or its minor determinants. Therefore, MAS patients should be carefully evaluated for antibiotic sensitivity and not be assumed to have sensitivity to drug formulation as a basis for MAS.

Anti-Bacterial Agents↗
PubMedDate not supplied

Stevens-Johnson syndrome (SJS): effectiveness of corticosteroids in management and recurrent SJS.

To confirm that corticosteroids are beneficial in the treatment of Stevens-Johnson syndrome (SJS), 15 patients with the syndrome were evaluated by the same group of physicians over 2 years. All patients had cutaneous and most had mucosal lesions. Patients were treated with corticosteroids ranging from prednisone 40 mg daily to methylprednisolone 750 mg daily. The same group of physicians participated in the management of these patients until recovery. No deaths occurred among the 15 patients. Recovery was complete in all cases, and there was no residual skin, mucosal, or visceral damage except for minimal scarring in one patient. In some cases, reversal of disease after onset of corticosteroid therapy was sufficiently dramatic to demonstrate a benefit. The use of corticosteroids in the treatment of SJS remains controversial. We conclude that corticosteroids are beneficial in treatment of the syndrome. They may be lifesaving in some patients and should be the standard of therapy. SJS should be considered to be erythema multiforme with either bullous lesions or visceral involvement or both.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Recurrent Stevens-Johnson syndrome secondary to herpes simplex: a follow up on a successful management program.

Herpes Simplex virus has been implicated as a cause of sporadic and recurrent erythema multiforme and Stevens-Johnson syndrome. Acyclovir has been used with success rates of 55% in treating these episodes. We have previously described and reported a successful management protocol for prevention of recurrent Stevens-Johnson syndrome due to herpes simplex virus reactivation in a 36-year-old white male. Four years later we describe the outcome of initiating this management protocol in the same patient for 17 episodes of recurrent herpes simplex virus stomatitis. Continuous low dose acyclovir with the prompt institution of a regimen of prednisone and higher dose acyclovir successfully prevented the prolonged duration of recurrent herpes simplex virus stomatitis and progression to Stevens-Johnson syndrome.

Acyclovir↗
PubMedDate not supplied

Outpatient management of Stevens-Johnson syndrome: a report of four cases and management strategy.

Stevens-Johnson syndrome is a severe form of erythema multiforme with or without bullous lesions. This is a potentially life-threatening condition that has traditionally required hospitalization for optimal management. We report the successful management of four patients who developed this syndrome following administration of antimicrobial agents. In our experience, for individuals with mild to moderate disease, Stevens-Johnson syndrome can be managed with corticosteroids as an outpatient.

Adrenal Cortex Hormones↗
PubMed1993

Detection and partial characterization of ocular cicatricial pemphigoid antigens on COLO and SCaBER tumor cell lines.

Ocular cicatricial pemphigoid (OCP) is a chronic autoimmune inflammatory disease which affects the conjunctiva and other squamous epithelial mucous membranes resulting in a scarring process. It is characterized by the deposition of an anti-basement membrane zone (BMZ) antibody in vivo. Sera from 11 patients with active OCP were studied. Using monkey esophagus and normal skin as substrate, weak staining of the BMZ was observed in conventional indirect immunofluorescence (IIF) assay. Using salt split human skin as substrate, the OCP sera demonstrated binding to the epidermal side of the split, in low titers with weak staining. Ten of the 11 sera were positive on an immunoblot assay using COLO and SCaBER tumor cell lysates demonstrating 230, 205, 160, and 85 kD proteins. Sera from six bullous pemphigoid (BP) patients, with only cutaneous involvement and high titer of anti-BMZ antibody, as detected by IIF, also bound to 230, 160, and 85 kD proteins on both lysates in comigration experiments. Serum from five normal individuals and two patients each with severe atopic conjunctival disease, erythema multiforme with chronic conjunctivitis and systemic lupus erythematosus (SLE), did not demonstrate those bands. When the two lysates were first absorbed with BP sera and then the same lysates were immunoblotted with OCP sera, in all ten OCP sera the 230, 160, and 85 kD bands were eliminated and only a single 205 kD band was uniformly present. These results indicate that OCP sera recognize peptide(s) present in 230, 205 and 160 kD proteins in lysates from COLO and SCaBER tumor cells. These proteins contain the immunodominant region of the BMZ molecule(s) in which the OCP antigen(s) reside. The OCP antigen(s) appears to be distinct from the BP antigen(s).

Animals↗
PubMed1987

Clinical aspects of skin reactions to NSAIDs.

In many countries, increasing rates of skin eruptions are attributed to non-steroidal anti-inflammatory drugs (NSAIDs). They are usually mild, and life-threatening reactions such as Stevens-Johnson Syndrome (SJS) or toxic epidermal necrolysis (TEN) are rare. The commonest reactions are pruritus, morbilliform rashes, urticaria and photosensitivity. Urticaria is most frequent in salicylate-sensitive patients, and photosensitivity--a real clinical problem with benoxaprofen--is mainly a phototoxic reaction, predictable from preclinical studies. Other skin reactions are unusual although purpura and cutaneous vasculitis have been attributed to NSAIDs. The main concern is bullous drug reactions--erythema multiforme (EM), SJS and TEN. Whilst EM and SJS have many other causes besides drugs, most cases of TEN are drug-induced. NSAIDs have played an increasing role in the aetiology of TEN and it may be that drugs with a longer serum half-life carry higher risk, especially when administered to patients for infectious complaints who have a predisposing genetic background (HLA-B12). In pre- and post-marketing studies of a new drug, careful attention must be paid to the nature of side-effects, as a high rate of mild reactions belonging to the EM spectrum may be indicative of higher risks of SJS and TEN.

Anti-Inflammatory Agents, Non-Steroidal↗