BACKGROUND The clinical manifestations of drug eruption are complex and diverse,which can lead to missed diagnosis or misdiagnosis.The clinical manifestations of drug eruption caused by compound honeysuckle have not b...BACKGROUND The clinical manifestations of drug eruption are complex and diverse,which can lead to missed diagnosis or misdiagnosis.The clinical manifestations of drug eruption caused by compound honeysuckle have not been reported.CASE SUMMARY A 20-year-old man was admitted to our department of dermatology due to erythema and papules on the chest and abdomen with pruritus for 3 d.The next day after taking compound honeysuckle granules,the patient suddenly developed a rash and intense itching on his chest and abdomen.Physical examination revealed diffuse red needle-cap size macules and papules with welldefined borders on the chest and abdomen,and discoloration after finger pressure.No abnormality was observed in other areas of the skin.Back skin scratch was positive.White blood cells,eosinophil count and eosinophil ratio were higher than normal.Histopathological examination of the skin lesions on the left abdomen revealed intercellular edema,blurred focal basal cell layers,and focal lymphocyte infiltration in the superficial dermis and perivascular areas.Immunohistochemistry showed CD3+,CD4+and CD8+T lymphocytes.The diagnosis was drug eruption with special manifestations induced by compound honeysuckle.The skin lesions completely subsided without pruritus after 2 wk of antihistamine and hormone therapy.Follow-up for>1 mo showed no recurrence.CONCLUSION Chinese patent medicine compound honeysuckle granules can induce allergic reaction and rare skin damage.展开更多
Severe drug reactions are defined as mucocutaneous complications secondary to systemic administration of drugs likely to be life threatening. Our work was designed to determine the evolutionary epidemiological and eti...Severe drug reactions are defined as mucocutaneous complications secondary to systemic administration of drugs likely to be life threatening. Our work was designed to determine the evolutionary epidemiological and etiological characteristics of severe drug reactions to the Department of Dermatology Venereology, at Donka Teaching Hospital. A prospective descriptive study of all cases of severe drug reactions received at the Department of Dermatology Venereology of the Donka Teaching Hospital was conducted over a period of two years, from June 2009 to May 31, 2011. We identified 22 Stevens-Johnson syndrome, 13 Toxic Epidermal Necrolysis, 1 Stevens-Johnson syndrome Border Toxic Epidermal Necrolysis, 1 Drug Rash with Eosinophilia and Systemic Symptoms and 2 Acute generalized exanthematous pustulosis among 481 hospitalized patients, of whom 50 had consulted for drug reactions, that is to say, a frequence of 10.40%. The Stevens-Johnson syndrome accounted for 44%, the Stevens-Johnson syndrome Border Toxic Epidermal Necrolysis 2%, Toxic Epidermal Necrolysis 26%, Drug Rash with Eosinophilia and Systemic Symptoms 2% and Acute generalized exanthematous pustulosis 4% of drug reaction. The female sex was predominant (28 women vs. 11 men), that is to say 71.59% vs. 26.21 with a sex ratio of 2.55. The average age of our patients was 29.72 years;the range of ages 21 - 40 years was the most affected (51.28%) followed by 0 - 20 years (33.33%). The lethality rate was 9.09% (2/22) in the Stevens-Johnson syndrome and 53.85% (7/13) in the Toxic Epidermal Necrolysis. HIV infection was found in 17.95% (7/26) of our patients and 71.42% (5/7) of the deceased. The drug accountability was established in 79.48%;the most commonly implicated drugs in the Toxic Epidermal Necrolysis were sulfonamides followed by ARVs (nevirapine) and anti TB (isoniazid);in the SJS sulfonamides followed by salts of quinine and anti TB, the only case of DRESS was due to quinine. No drug was found in 20.52% (8 cases). HIV infection remains a poor prognostic factor. Our study shows the scarcity of Drug Rash with Eosinophilia and Systemic Symptoms and Acute generalized exanthematous pustulosis in our service.展开更多
Several clinical trials have demonstrated the potent antiviral efficacy of entecavir (ETV), and this relatively new nucleoside analogue drug has rapidly become a frequently prescribed therapy for chronic hepatitis B (...Several clinical trials have demonstrated the potent antiviral efficacy of entecavir (ETV), and this relatively new nucleoside analogue drug has rapidly become a frequently prescribed therapy for chronic hepatitis B (CHB) worldwide. While the studies have also shown a good overall safety profile for ETV, adverse drug reactions (ADRs) in patients with advanced cirrhosis have been reported and represent a broad spectrum of drug-induced injuries, including lactic acidosis, myalgia, neuropathy, azotemia, hypophosphatemia, muscular weakness, and pancreatitis, as well as immune-mediated responses (i.e., allergic reactions). Cutaneous ADRs associated with ETV are very rare, with only two case reports in the publicly available literature; both of these cases were classified as unspecified hypersensitivity allergic (type I) ADR, but neither were reported as pathologically proven or as evaluated by cytokine release analysis. Here, we report the case of a 45-year-old woman who presented with a generalized maculopapular rash after one week of ETV treatment for lamivudine-resistant CHB. The patient reported having experienced a similar skin eruption during a previous three-month regimen of ETV, for which she had self-discontinued the medication. Histopathological analysis of a skin biopsy showed acanthotic epidermis with focal parakeratosis and a perivascular lymphocytic infiltrate admixed with interstitial eosinophils in the papillary and reticular dermis, consistent with a diagnosis of drug sensitivity. A lymphocyte stimulation test showed significantly enhanced IL-4, indicating a classification of type IVb delayed hypersensitivity. The patient was switched to an adefovir-lamivudine combination regimen and the skin eruption resolved two weeks after the ETV withdrawal. This case represents the first pathologically and immunologically evidenced ETV-induced delayed type hypersensitivity skin reaction reported to date. Physicians should be aware of the potential, although rare, for cutaneous ADRs associated with ETV treatment.展开更多
文摘BACKGROUND The clinical manifestations of drug eruption are complex and diverse,which can lead to missed diagnosis or misdiagnosis.The clinical manifestations of drug eruption caused by compound honeysuckle have not been reported.CASE SUMMARY A 20-year-old man was admitted to our department of dermatology due to erythema and papules on the chest and abdomen with pruritus for 3 d.The next day after taking compound honeysuckle granules,the patient suddenly developed a rash and intense itching on his chest and abdomen.Physical examination revealed diffuse red needle-cap size macules and papules with welldefined borders on the chest and abdomen,and discoloration after finger pressure.No abnormality was observed in other areas of the skin.Back skin scratch was positive.White blood cells,eosinophil count and eosinophil ratio were higher than normal.Histopathological examination of the skin lesions on the left abdomen revealed intercellular edema,blurred focal basal cell layers,and focal lymphocyte infiltration in the superficial dermis and perivascular areas.Immunohistochemistry showed CD3+,CD4+and CD8+T lymphocytes.The diagnosis was drug eruption with special manifestations induced by compound honeysuckle.The skin lesions completely subsided without pruritus after 2 wk of antihistamine and hormone therapy.Follow-up for>1 mo showed no recurrence.CONCLUSION Chinese patent medicine compound honeysuckle granules can induce allergic reaction and rare skin damage.
文摘Severe drug reactions are defined as mucocutaneous complications secondary to systemic administration of drugs likely to be life threatening. Our work was designed to determine the evolutionary epidemiological and etiological characteristics of severe drug reactions to the Department of Dermatology Venereology, at Donka Teaching Hospital. A prospective descriptive study of all cases of severe drug reactions received at the Department of Dermatology Venereology of the Donka Teaching Hospital was conducted over a period of two years, from June 2009 to May 31, 2011. We identified 22 Stevens-Johnson syndrome, 13 Toxic Epidermal Necrolysis, 1 Stevens-Johnson syndrome Border Toxic Epidermal Necrolysis, 1 Drug Rash with Eosinophilia and Systemic Symptoms and 2 Acute generalized exanthematous pustulosis among 481 hospitalized patients, of whom 50 had consulted for drug reactions, that is to say, a frequence of 10.40%. The Stevens-Johnson syndrome accounted for 44%, the Stevens-Johnson syndrome Border Toxic Epidermal Necrolysis 2%, Toxic Epidermal Necrolysis 26%, Drug Rash with Eosinophilia and Systemic Symptoms 2% and Acute generalized exanthematous pustulosis 4% of drug reaction. The female sex was predominant (28 women vs. 11 men), that is to say 71.59% vs. 26.21 with a sex ratio of 2.55. The average age of our patients was 29.72 years;the range of ages 21 - 40 years was the most affected (51.28%) followed by 0 - 20 years (33.33%). The lethality rate was 9.09% (2/22) in the Stevens-Johnson syndrome and 53.85% (7/13) in the Toxic Epidermal Necrolysis. HIV infection was found in 17.95% (7/26) of our patients and 71.42% (5/7) of the deceased. The drug accountability was established in 79.48%;the most commonly implicated drugs in the Toxic Epidermal Necrolysis were sulfonamides followed by ARVs (nevirapine) and anti TB (isoniazid);in the SJS sulfonamides followed by salts of quinine and anti TB, the only case of DRESS was due to quinine. No drug was found in 20.52% (8 cases). HIV infection remains a poor prognostic factor. Our study shows the scarcity of Drug Rash with Eosinophilia and Systemic Symptoms and Acute generalized exanthematous pustulosis in our service.
基金Supported by grant from the Chungbuk National University Hospital(2013)
文摘Several clinical trials have demonstrated the potent antiviral efficacy of entecavir (ETV), and this relatively new nucleoside analogue drug has rapidly become a frequently prescribed therapy for chronic hepatitis B (CHB) worldwide. While the studies have also shown a good overall safety profile for ETV, adverse drug reactions (ADRs) in patients with advanced cirrhosis have been reported and represent a broad spectrum of drug-induced injuries, including lactic acidosis, myalgia, neuropathy, azotemia, hypophosphatemia, muscular weakness, and pancreatitis, as well as immune-mediated responses (i.e., allergic reactions). Cutaneous ADRs associated with ETV are very rare, with only two case reports in the publicly available literature; both of these cases were classified as unspecified hypersensitivity allergic (type I) ADR, but neither were reported as pathologically proven or as evaluated by cytokine release analysis. Here, we report the case of a 45-year-old woman who presented with a generalized maculopapular rash after one week of ETV treatment for lamivudine-resistant CHB. The patient reported having experienced a similar skin eruption during a previous three-month regimen of ETV, for which she had self-discontinued the medication. Histopathological analysis of a skin biopsy showed acanthotic epidermis with focal parakeratosis and a perivascular lymphocytic infiltrate admixed with interstitial eosinophils in the papillary and reticular dermis, consistent with a diagnosis of drug sensitivity. A lymphocyte stimulation test showed significantly enhanced IL-4, indicating a classification of type IVb delayed hypersensitivity. The patient was switched to an adefovir-lamivudine combination regimen and the skin eruption resolved two weeks after the ETV withdrawal. This case represents the first pathologically and immunologically evidenced ETV-induced delayed type hypersensitivity skin reaction reported to date. Physicians should be aware of the potential, although rare, for cutaneous ADRs associated with ETV treatment.
