201
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Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy. Int J Mol Sci 2016; 17:ijms17081214. [PMID: 27472323 PMCID: PMC5000612 DOI: 10.3390/ijms17081214] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 01/25/2023] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base and spontaneous resolution usually within two weeks. Systemic involvement occurs in about 20% of cases. The course is mostly benign, and only in rare cases complications lead to life-threatening situations. Recent studies highlight the importance of genetic variations in interleukin-36 receptor antagonist gene (IL-36RN) in the pathogenesis of this disease. The physiopathology of AGEP remains unclear, but an involvement of innate and acquired immune cells together with resident cells (keratinocytes), which recruit and activate neutrophils via production of cytokines/chemokines such as IL-17, IL-36, granulocyte-macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor alpha (TNFα) and chemokine (C-X-C motif) ligand 8 (CXCL8)/IL-8, has been postulated. Treatment is based on the removal of the causative drug, supportive care, infection prevention and use of potent topical or systemic steroids.
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202
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Skowron F, Bensaid B, Balme B, Depaepe L, Kanitakis J, Nosbaum A, Maucort-Boulch D, Bérard F, D'Incan M, Kardaun S, Nicolas JF. Comparative histological analysis of drug-induced maculopapular exanthema and DRESS. J Eur Acad Dermatol Venereol 2016; 30:2085-2090. [DOI: 10.1111/jdv.13832] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- F. Skowron
- Department of Dermatology; CH de Valence; Valence France
| | - B. Bensaid
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
| | - B. Balme
- Department of Dermatopathology; CHU Lyon-Sud; Pierre-Bénite France
| | - L. Depaepe
- Department of Dermatopathology; CHU Lyon-Sud; Pierre-Bénite France
| | - J. Kanitakis
- Department of Dermatology; Groupement Hospitalier Edouard Herriot; Lyon France
| | - A. Nosbaum
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
- INSERM U1111 - CIRI; av T Garnier; Lyon France
| | | | - F. Bérard
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
- INSERM U1111 - CIRI; av T Garnier; Lyon France
| | - M. D'Incan
- Department of Dermatology; CHU Estaing; Clermont-Ferrand France
| | - S.H. Kardaun
- Department of Dermatology; Reference center for cutaneous adverse reactions; University Medical Center of Groningen; Groningen the Netherlands
| | - J.-F. Nicolas
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; CHU Lyon-Sud; Pierre-Bénite France
- INSERM U1111 - CIRI; av T Garnier; Lyon France
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203
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Kang H, Min TK, Yang HJ, Pyun BY. Cefotaxime-induced drug rash with eosinophilia and systemic symptoms syndrome in a 7-year-old boy. Ann Allergy Asthma Immunol 2016; 117:202-4. [PMID: 27364942 DOI: 10.1016/j.anai.2016.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Heejeong Kang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Taek Ki Min
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
| | - Bok Yang Pyun
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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204
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Gupta D, Forbes M, McKean M. Anticonvulsant hypersensitivity syndrome. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2016. [DOI: 10.1002/jppr.1177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Deepali Gupta
- Department of Pharmacy; Princess Alexandra Hospital; Woolloongabba Australia
| | - Malcolm Forbes
- John Cade Unit, Royal Melbourne Hospital; Melbourne Australia
| | - Mitchell McKean
- Sub and Post Acute Medicine; Ipswich Hospital; Ipswich Australia
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205
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206
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Histopathology of the Exanthema in DRESS Is Not Specific but May Indicate Severity of Systemic Involvement. Am J Dermatopathol 2016; 38:423-33. [DOI: 10.1097/dad.0000000000000439] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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207
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Bommersbach TJ, Lapid MI, Leung JG, Cunningham JL, Rummans TA, Kung S. Management of Psychotropic Drug-Induced DRESS Syndrome: A Systematic Review. Mayo Clin Proc 2016; 91:787-801. [PMID: 27126302 DOI: 10.1016/j.mayocp.2016.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 11/18/2022]
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous eruption that has been linked to several common drugs and drug categories, including antiepileptics, allopurinol, sulfonamides, and various antibiotics; however, because of a number of recent case reports linking psychotropic medications to this condition, DRESS is increasingly recognized among psychiatrists. We systematically reviewed all psychotropic drugs linked to DRESS syndrome, and this article summarizes the clinical management relevant to psychiatric professionals. A comprehensive search was performed using Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus, and Litt's Drug Eruption and Reaction Database for articles published in English during the past 20 years (1996-2015) using the search terms (1) psychotropic drugs OR serotonin uptake inhibitors AND DRESS or (2) psychotropic drugs AND drug reaction (or rash) eosinophilia systemic syndrome, and all article abstracts were screened for inclusion and exclusion criteria by 3 reviewers. Two independent reviewers examined the full text of 163 articles, of which 96 (25 original articles, 12 review articles, 55 case reports, and 4 letters to the editor) were included in the systematic review. We identified 1072 cases of psychotropic drug-induced DRESS, with carbamazepine, lamotrigine, phenytoin, valproate, and phenobarbital being the most implicated drugs. Based on our review of the literature, we outline management principles that include prompt withdrawal of the causative drug, hospitalization, corticosteroid therapy, and novel treatments, including intravenous immunoglobulin, cyclophosphamide, and cyclosporine, for corticosteroid-resistant DRESS. Finally, we outline strategies for treating comorbid psychiatric illness after a DRESS reaction to the psychotropic medication.
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Affiliation(s)
- Tanner J Bommersbach
- Mayo Medical School, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
| | | | | | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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208
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Abstract
The symptomatic hypereosinophilic patient must be approached in a stepwise manner, with thorough assessment to determine whether the hypereosinophilia itself is contributing to damage and disease manifestations (thereby defining a hypereosinophilic syndrome), and to identify an eventual cause of hypereosinophilia, followed by initiation of treatment directed against the underlying condition or deleterious hypereosinophilic state. Situations encountered in the clinic are extremely heterogeneous because of the numerous potential causes of hypereosinophilia and the variable spectrum of eosinophil-mediated organ damage. A practical approach to many of these situations is presented in this review.
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209
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Iskandarli M, Ozturk G. Alopecia Areata and Vitiligo as a Long-term Sequelae of Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome. Indian J Dermatol 2016; 61:238. [PMID: 27057057 PMCID: PMC4817482 DOI: 10.4103/0019-5154.177781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Mehdi Iskandarli
- Department of Dermatology and Venereology, Faculty of Medicine, Ege University, Izmir, Bornova, Turkey. E-mail:
| | - Gunseli Ozturk
- Department of Dermatology and Venereology, Faculty of Medicine, Ege University, Izmir, Bornova, Turkey. E-mail:
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210
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Boyd A, Mills D, Hook K, Kaila R. Seventeen-year-old sexually active male with rash. Am J Emerg Med 2016; 34:764.e1-3. [DOI: 10.1016/j.ajem.2015.08.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/25/2015] [Indexed: 12/20/2022] Open
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211
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Drago F, Cogorno L, Broccolo F, Ciccarese G, Parodi A. A fatal case of DRESS induced by strontium ranelate associated with HHV-7 reactivation. Osteoporos Int 2016; 27:1261-1264. [PMID: 26519419 DOI: 10.1007/s00198-015-3384-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
We report the first case of drug rash with eosinophilia and systemic symptoms (DRESS) following strontium ranelate (SR) treatment associated with systemic human HHV-7 reactivation. DRESS syndrome is a severe adverse drug-induced reaction presenting as a diffuse maculopapular skin rash with fever, hematological abnormalities (leukocytosis, eosinophilia, and/or atypical lymphocytosis), and multiorgan involvement. In our patient, diagnosis of DRESS was confirmed by the presence of six of the seven diagnostic criteria established in 2006 by the Japanese Research Committee on Severe Cutaneous Adverse Drug Reaction: maculopapular skin rash developing at least 3 weeks after starting therapy with a limited number of drugs, prolonged clinical symptoms after discontinuation of the causative drug, lymphadenopathy, fever, leukocyte abnormalities, and liver abnormalities. The diagnostic criteria of human herpesvirus (HHV)-6 reactivation have not been fulfilled in our patient, but a HHV-7 active infection was demonstrated by the presence of HHV-7 DNA and IgM in the patient's serum. In fact, in some DRESS instances, reactivation of HHVs other than HHV-6 may be detected, including HHV-7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Our case underlines that not only HHV-6 but also HHV-7 systemic reactivation may be associated with a more severe and even fatal course of this syndrome.
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Affiliation(s)
- F Drago
- DISSAL Department of Dermatology, IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - L Cogorno
- DISSAL Department of Dermatology, IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - F Broccolo
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - G Ciccarese
- DISSAL Department of Dermatology, IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genoa, Italy.
| | - A Parodi
- DISSAL Department of Dermatology, IRCCS A.O.U. San Martino-IST, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
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212
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Abstract
Life-threatening and benign drug reactions occur frequently in the skin, affecting 8 % of the general population and 2-3 % of all hospitalized patients, emphasizing the need for physicians to effectively recognize and manage patients with drug-induced eruptions. Neurologic medications represent a vast array of drug classes with cutaneous side effects. Approximately 7 % of the United States (US) adult population is affected by adult-onset neurological disorders, reflecting a large number of patients on neurologic drug therapies. This review elucidates the cutaneous reactions associated with medications approved by the US Food and Drug Administration (FDA) to treat the following neurologic pathologies: Alzheimer disease, amyotrophic lateral sclerosis, epilepsy, Huntington disease, migraine, multiple sclerosis, Parkinson disease, and pseudobulbar affect. A search of the literature was performed using the specific FDA-approved drug or drug classes in combination with the terms 'dermatologic,' 'cutaneous,' 'skin,' or 'rash.' Both PubMed and the Cochrane Database of Systematic Reviews were utilized, with side effects ranging from those cited in randomized controlled trials to case reports. It behooves neurologists, dermatologists, and primary care physicians to be aware of the recorded cutaneous adverse reactions and their severity for proper management and potential need to withdraw the offending medication.
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Affiliation(s)
| | | | - Sylvia Hsu
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S Kass
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge St., 9th Floor, Houston, TX, 77030, USA.
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213
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Marzano AV, Borghi A, Cugno M. Adverse drug reactions and organ damage: The skin. Eur J Intern Med 2016; 28:17-24. [PMID: 26674736 DOI: 10.1016/j.ejim.2015.11.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
Cutaneous adverse drug reactions are frequent, affecting 2-3% of hospitalized patients and in one twentieth of them are potentially life-threatening. Almost any pharmacologic agent can induce skin reactions, and certain drug classes, such as non-steroidal anti-inflammatory drugs, antibiotics and antiepileptics, have drug eruption rates ranging from 1% to 5%. Cutaneous drug reactions recognize several different pathomechanisms: some skin manifestations are immune-mediated like allergic reactions while others are the result of non immunological causes such as cumulative toxicity, photosensitivity, interaction with other drugs or different metabolic pathways. Cutaneous adverse drug reactions can be classified into two groups: common non-severe and rare life-threatening adverse drug reactions. Non-severe reactions are often exanthematous or urticarial whereas life-threatening reactions typically present with skin detachment or necrosis of large areas of the body and mucous membrane involvement, as in the Stevens-Johnson syndrome or toxic epidermal necrolysis. Clinicians should carefully evaluate the signs and symptoms of all cutaneous adverse drug reactions thought to be due to drugs and immediately discontinue drugs that are not essential. Short cycles of systemic corticosteroids in combination with antihistamines may be necessary for widespread exanthematous rashes, while more aggressive corticosteroid regimens or intravenous immunoglobulins associated with supportive treatment should be used for patients with Stevens-Johnson syndrome or toxic epidermal necrolysis.
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Affiliation(s)
- Angelo V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandro Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Massimo Cugno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
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214
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Jeong YJ, Ghanh B, Lee JW, Park J, Kim TB, Cho YS, Moon HB, Kwon HS. Rapid-onset of severe tigecycline-induced coagulopathy in drug reaction with eosinophilia and systemic symptom syndrome. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.1.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Yeong Jin Jeong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeongzu Ghanh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Wan Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinoh Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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215
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Kim SJ, Nam YH, Juong JY, Kim EY, Lee SM, Son YK, Nam HJ, Kim KH, Lee SK. DRESS syndrome with acute interstitial nephritis caused by quinolone and non-steroidal anti-inflammatory drugs. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Soo Jin Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young-Hee Nam
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
- Regional Pharmacovigilance Center, Busan, Korea
| | - Ji Young Juong
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Su Mi Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young Ki Son
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hee-Joo Nam
- Regional Pharmacovigilance Center, Busan, Korea
- Department of Pharmacy Dong-A University Hospital, Busan, Korea
| | - Ki-Ho Kim
- Department of Dermatology, Dong-A University College of Medicine, Busan, Korea
| | - Soo-Keol Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
- Regional Pharmacovigilance Center, Busan, Korea
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216
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Munzer TG, Shah MD, Stojan JN. A 2½-Year-Old Girl With a Diffuse Erythematous Rash and Fever. Clin Pediatr (Phila) 2015; 54:1299-301. [PMID: 25724991 DOI: 10.1177/0009922815574084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Meera D Shah
- University of Michigan Health System, Ann Arbor, MI, USA
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217
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Blair PW, Herrin D, Abaalkhail N, Fiser W. DRESS syndrome presenting after initiation of mycobacterium avium complex osteomyelitis treatment. BMJ Case Rep 2015; 2015:bcr-2015-210907. [PMID: 26438676 DOI: 10.1136/bcr-2015-210907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is characterised by fever, rash, eosinophilia and organ damage that develops 2-6 weeks after the initiation of a medication. We report a case of DRESS syndrome in a 79-year-old man that developed after the introduction of rifabutin, ethambutol and clarithromycin used to treat Mycobacterium avium complex (MAC) vertebral osteomyelitis. This case highlights treatment and management challenges in a patient with known MAC vertebral osteomyelitis requiring prolonged steroids. Steroids are the mainstays of treatment for moderate to severe cases of DRESS syndrome. Initiation of steroids for the treatment of DRESS syndrome among patients with concomitant infections requires multidisciplinary collaboration for optimal management.
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Affiliation(s)
- Paul W Blair
- School of Medicine and Health Sciences, George Washington University, Washington DC, USA
| | - Douglas Herrin
- School of Medicine and Health Sciences, George Washington University, Washington DC, USA
| | - Nawaf Abaalkhail
- School of Medicine and Health Sciences, George Washington University, Washington DC, USA
| | - Wesley Fiser
- School of Medicine and Health Sciences, George Washington University, Washington DC, USA
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218
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Turney R, Skittrall JP, Donovan J, Agranoff D. Drug Reaction, Eosinophilia and Systemic Symptoms (DRESS) syndrome secondary to allopurinol with early lymphadenopathy and symptom relapse. BMJ Case Rep 2015; 2015:bcr-2015-211222. [PMID: 26438678 DOI: 10.1136/bcr-2015-211222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare condition with a mortality rate of up to 10%. Herein, we describe a case of DRESS syndrome secondary to allopurinol and which may have been precipitated by amoxicillin, the diagnostic challenge it represented and the successful treatment of the condition with corticosteroids.
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Affiliation(s)
- Rhiannon Turney
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
| | - Jordan Peter Skittrall
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
| | - Joseph Donovan
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
| | - Daniel Agranoff
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
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219
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Turney R, Skittrall JP, Donovan J, Agranoff D. Drug Reaction, Eosinophilia and Systemic Symptoms (DRESS) syndrome secondary to allopurinol with early lymphadenopathy and symptom relapse. BMJ Case Rep 2015. [PMID: 26438678 DOI: 10.1136/bcr-2015-211222.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare condition with a mortality rate of up to 10%. Herein, we describe a case of DRESS syndrome secondary to allopurinol and which may have been precipitated by amoxicillin, the diagnostic challenge it represented and the successful treatment of the condition with corticosteroids.
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Affiliation(s)
- Rhiannon Turney
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
| | - Jordan Peter Skittrall
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
| | - Joseph Donovan
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
| | - Daniel Agranoff
- Department of Microbiology and Infection, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
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220
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Skowron F, Bensaid B, Balme B, Depaepe L, Kanitakis J, Nosbaum A, Maucort-Boulch D, Bérard F, D'Incan M, Kardaun S, Nicolas J. Drug reaction with eosinophilia and systemic symptoms (DRESS): clinicopathological study of 45 cases. J Eur Acad Dermatol Venereol 2015; 29:2199-205. [DOI: 10.1111/jdv.13212] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/22/2015] [Indexed: 01/25/2023]
Affiliation(s)
- F. Skowron
- Departement of Dermatology; Centre Hospitalier de Valence; Valence France
| | - B. Bensaid
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - B. Balme
- Departement of Dermatopathology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - L. Depaepe
- Departement of Dermatopathology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - J. Kanitakis
- Departement of Dermatology; Groupement Hospitalier Edouard Herriot; Lyon Cedex 03 France
| | - A. Nosbaum
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - D. Maucort-Boulch
- Department of Biostatistics; Hospices Civils de Lyon; Lyon France
- CNRS UMR 5558; Equipe Biostatistique Santé; Pierre-Bénite France
- Université Lyon I; Villeurbanne France
| | - F. Bérard
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
- INSERM U1111 - CIRI; Lyon France
| | - M. D'Incan
- Departement of Dermatology; CHU Estaing; Clermont-Ferrand France
| | - S.H. Kardaun
- Department of Dermatology; Reference center for cutaneous adverse reactions; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - J.F. Nicolas
- Drug Allergy Unit-CCR2A; Department of Allergy and Clinical Immunology; Centre Hospitalier Lyon Sud; Pierre Bénite France
- INSERM U1111 - CIRI; Lyon France
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221
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Abstract
Eosinophil-associated disorders can affect practically all tissues and organs in the body, either individually or in combination. This article provides an overview of end-organ manifestations of eosinophilia and discusses selected organ systems, including the upper and lower respiratory, cardiovascular, gastrointestinal, nervous, dermatologic, and renal systems. Mechanisms by which eosinophilia leads to end-organ damage are also considered.
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Affiliation(s)
- Praveen Akuthota
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
| | - Peter F Weller
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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222
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Lin IC, Yang HC, Strong C, Yang CW, Cho YT, Chen KL, Chu CY. Liver injury in patients with DRESS: A clinical study of 72 cases. J Am Acad Dermatol 2015; 72:984-91. [PMID: 25801338 DOI: 10.1016/j.jaad.2015.02.1130] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/18/2015] [Accepted: 02/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) is a syndrome involving multiple systems. Liver injury is the most common visceral manifestation. OBJECTIVE The purpose of this study was to investigate the types of liver injury and factors associated with DRESS. METHODS A retrospective cohort study was conducted in Taiwan using a DRESS database compiled from December 2000 to March 2013. RESULTS Seventy-two cases were included in this study. Among them, 62 (86.1%) cases involved liver injury, 6 of which (9.7%) were liver injury before skin presentation. The distribution of liver injury patterns at initial presentation was 23 cholestatic type (37.1%), 17 mixed type (27.4%), and 12 hepatocellular type (19.4%). Patients with hepatocellular-type injuries were younger, with a median age of 31.5 (P = .044). Individuals with liver function results more than 10 times the upper limit were more likely to have fever (P = .026), took more time to recover, and had fewer eosinophils in the dermis (P = .002). LIMITATIONS The study was a retrospective cohort study with limited cases. CONCLUSIONS Liver injury is common in DRESS and frequently associated with atypical lymphocytosis. The cholestatic type is the most common type. Patients with cholestatic-type injuries were older and more frequently had interface changes in skin pathology.
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Affiliation(s)
- I-Chun Lin
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chih Yang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Carol Strong
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Che-Wen Yang
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Tsu Cho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kai-Lung Chen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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224
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Ingen-Housz-Oro S, Hotz C, Valeyrie-Allanore L, Sbidian E, Hemery F, Chosidow O, Wolkenstein P. Acute generalized exanthematous pustulosis: a retrospective audit of practice between 1994 and 2011 at a single centre. Br J Dermatol 2015; 172:1455-7. [PMID: 25399843 DOI: 10.1111/bjd.13540] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- S Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Referral Center for Toxic and Autoimmune Disease, Créteil, France
| | - C Hotz
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - L Valeyrie-Allanore
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Referral Center for Toxic and Autoimmune Disease, Créteil, France
| | - E Sbidian
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris Est-Créteil Val de Marne, Créteil, France
| | - F Hemery
- Department of Medical Information, AP-HP, Henri Mondor Hospital, Créteil, France
| | - O Chosidow
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Referral Center for Toxic and Autoimmune Disease, Créteil, France.,Université Paris Est-Créteil Val de Marne, Créteil, France.,INSERM, Centre d'Investigation Clinique 006, AP-HP, Créteil, France
| | - P Wolkenstein
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Referral Center for Toxic and Autoimmune Disease, Créteil, France.,Université Paris Est-Créteil Val de Marne, Créteil, France.,INSERM, Centre d'Investigation Clinique 006, AP-HP, Créteil, France
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225
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Ahluwalia J, Abuabara K, Perman MJ, Yan AC. Human herpesvirus 6 involvement in paediatric drug hypersensitivity syndrome. Br J Dermatol 2015; 172:1090-5. [PMID: 25369238 DOI: 10.1111/bjd.13512] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human herpesvirus (HHV)6 positivity in the context of drug hypersensitivity syndrome (DHS) may influence disease severity. Systemic corticosteroid treatment of those with DHS testing positive for HHV6 has been speculated to prolong the duration of disease. OBJECTIVES To evaluate whether paediatric HHV6-positive patients with DHS develop a more severe illness than those without presumed reactivation, and to evaluate the response to systemic corticosteroid treatment. METHODS A retrospective case series of 29 paediatric inpatients treated for DHS and tested for HHV6 was undertaken. HHV6-positive and -negative patients were identified and stratified into groups treated or not treated with systemic corticosteroids to examine their disease severity on the basis of hospital length of stay (LOS), total number of febrile days (Tfeb) and days until cessation of progression (CTP). RESULTS Human herpesvirus6-positive patients had similar demographic characteristics to those of HHV6-negative patients, but had significantly longer hospital LOS (11·5 days vs. 5 days, P = 0·039), Tfeb (12·5 days vs. 3 days, P = 0·032) and CTP (4 days vs. 2 days, P = 0·014). All HHV6-positive patients and most (80%) of the HHV6-negative patients received systemic corticosteroids. Among the HHV6-negative patients, those who received corticosteroids showed significantly shorter CTP than those who did not (3 days vs. 2 days, P = 0·043). Additionally, there was a trend towards shorter hospital LOS and Tfeb among HHV6-negative patients who received corticosteroids vs. those who did not, although these differences were not statistically significant. The most common inciting drugs included trimethoprim-sulfamethoxazole (34%), phenytoin (10%) and amoxicillin (10%). CONCLUSIONS Human herpesvirus6 positivity with DHS is associated with a more severe disease course. Treatment with systemic corticosteroids was associated with a trend towards reduced hospital LOS and Tfeb, and a significantly reduced number of days until cessation of progression.
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Affiliation(s)
- J Ahluwalia
- Department of Pediatrics, Division of General Pediatrics, Section of Dermatology, The Children's Hospital of Philadelphia, 3550 Market Street, 2nd Floor, Philadelphia, 19104, PA, U.S.A
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226
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Lew T, Creamer D, Mackenzie J, Walsh S. Post-traumatic stress disorder following drug reaction with eosinophilia and systemic symptoms. Br J Dermatol 2015; 172:836-7. [DOI: 10.1111/bjd.13375] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- T.T. Lew
- Dermatology Department; King's College Hospital NHS Foundation Trust; London SE5 9RS U.K
| | - D. Creamer
- Dermatology Department; King's College Hospital NHS Foundation Trust; London SE5 9RS U.K
| | - J. Mackenzie
- Dermatology Department; King's College Hospital NHS Foundation Trust; London SE5 9RS U.K
| | - S.A. Walsh
- Dermatology Department; King's College Hospital NHS Foundation Trust; London SE5 9RS U.K
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227
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DRESS syndrome as a complication of treatment of hepatitis C virus-associated post-inflammatory liver cirrhosis with peginterferon α2a and ribavirin. Postepy Dermatol Alergol 2015; 31:401-4. [PMID: 25610356 PMCID: PMC4293381 DOI: 10.5114/pdia.2014.40939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/10/2013] [Accepted: 10/20/2013] [Indexed: 11/23/2022] Open
Abstract
Various skin and systemic symptoms may develop as a complication of treatment with different medications and medicinal substances. One of them is a relatively rare drug reaction with eosinophilia and systemic symptoms, referred to as DRESS syndrome. The morphology of skin lesions and the patient's general health can differ; the management involves withdrawal of drugs suspected of triggering DRESS syndrome, and administration of local and systemic glucocorticosteroids. In this paper we present a case of a patient with HCV associated chronic hepatitis, treated with peginterferon α2a (PEG-IFN-α2a) and ribavirin, who developed skin lesions and systemic symptoms typical of DRESS syndrome.
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228
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DeClerck B, Jhun P, Bright A, Herbert M. Trust me, this is the worst "acne" of your life! Ann Emerg Med 2015; 65:147-50. [PMID: 25601250 DOI: 10.1016/j.annemergmed.2014.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Brittney DeClerck
- Clinical Pathology and Dermatology, University of Southern California, Los Angeles, CA.
| | - Paul Jhun
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA
| | - Aaron Bright
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
| | - Mel Herbert
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA
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229
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Cottin V, Cordier JF. Eosinophilic Pneumonia. ORPHAN LUNG DISEASES 2015. [PMCID: PMC7121898 DOI: 10.1007/978-1-4471-2401-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eosinophilic pneumonia may manifest as chronic or transient infiltrates with mild symptoms, chronic idiopathic eosinophilic pneumonia, or the frequently severe acute eosinophilic pneumonia that may be secondary to a variety of causes (drug intake, new onset of tobacco smoking, infection) and that may necessitate mechanical ventilation. When present, blood eosinophilia greater than 1 × 109 eosinophils/L (and preferably greater than 1.5 × 109/L) is of considerable help for suggesting the diagnosis, however it may be absent, as in the early phase of idiopathic acute eosinophilic pneumonia or when patients are already taking corticosteroids. On bronchoalveolar lavage, high eosinophilia (>25 %, and preferably >40 % of differential cell count) is considered diagnostic of eosinophilic pneumonia in a compatible setting, obviating the need of video-assisted thoracic surgical lung biopsy, which is now performed only on very rare occasions with inconsistency between clinical, biological, and imaging features. Inquiry as to drug intake must be meticulous (www.pneumotox.com) and any suspected drug should be withdrawn. Laboratory investigations for parasitic causes must take into account the travel history or residence and the epidemiology of parasites. In patients with associated extrathoracic manifestations, the diagnosis of eosinophilic granulomatosis with polyangiitis or of the hypereosinophilic syndromes should be raised. Presence of airflow obstruction can be found in hypereosinophilic asthma, allergic bronchopulmonary aspergillosis, idiopathic chronic eosinophilic pneumonia, eosinophilic granulomatosis with polyangiitis, or in the recently identified syndrome of hyperosinophilic obliterative bronchiolitis. Corticosteroids remain the cornerstone of symptomatic treatment for eosinophilic pneumonias, with a generally dramatic response. Relapses are common when tapering the doses or after stopping treatment especially in idiopathic chronic eosinophilic pneumonia. Cyclophosphamide is necessary only in patients with eosinophilic granulomatosis with polyangiitis and poor-prognostic factors. Imatinib is very effective in the treatment of the myeloproliferative variant of hypereosinophilic syndromes. Anti-interleukin-5 monoclonal antibodies are promising in the spectrum of eosinophilic disorders.
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230
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Geduk A, Birtas Atesoglu E, Mehtap O, Terzi Demirsoy E, Can B, Tarkun P, Hacihanefioglu A. Late-onset Anticonvulsant Hypersensitivity Syndrome Mimicking Lymphoma. Intern Med 2015; 54:3201-4. [PMID: 26666613 DOI: 10.2169/internalmedicine.54.5111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anticonvulsant hypersensitivity syndrome is a fatal, idiosyncratic drug reaction that is caused by aromatic antiepileptic drugs. This cutaneous drug reaction is also called pseudolymphoma because of its clinical and histological similarities with malignant lymphoma. The primary clinical findings are fever, skin rashes, enlarged lymph nodes, single or multiple internal organ involvement and hematological abnormalities. Typically, anticonvulsant hypersensitivity syndrome occurs 1-8 weeks after drug administration. We herein present the case of a patient who had been on anticonvulsant therapy for five years and died from late-onset anticonvulsant hypersensitivity syndrome.
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Affiliation(s)
- Ayfer Geduk
- Department of Hematology, Kocaeli University Medical Faculty, Turkey
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231
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Abstract
Roseola infantum, also known as exanthem subitum or sixth disease, is a generally benign febrile exanthem of infancy. It has a characteristic clinical course of high fever followed by the appearance of an exanthem upon defervescence. Febrile seizures are a frequent complication. Roseola is caused by infection with human herpesviruses 6 or 7 (HHV-6/7), which are acquired at a young age. Diagnosis is made by serology or by virus detection in body fluids and tissues. Treatment of roseola is supportive; recovery is usually complete with no significant sequelae. However, HHV-6/7 can reactivate in immunocompetent as well as immunocompromised individuals with severe systemic consequence.
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232
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Lim HY, Huang GKL, Torresi J, Johnson D. Red herring in returned traveler: drug reaction with eosinophilia and systemic symptom (DRESS) syndrome mimicking sepsis. J Travel Med 2014; 21:425-8. [PMID: 25345985 DOI: 10.1111/jtm.12152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/04/2014] [Accepted: 04/08/2014] [Indexed: 11/27/2022]
Abstract
We report a case of a 51-year-old Han Chinese recently returned traveler, who was admitted with a generalized maculopapular rash, fevers, shock, and multi-organ failure. Extensive investigations failed to reveal an infective cause. Skin biopsy findings together with the recent commencement of allopurinol raised a diagnosis of drug reaction with eosinophilia and systemic symptom syndrome. High-dose prednisolone was commenced and the patient made a rapid recovery. This case highlights that not all sepsis-like presentations in returned travelers are due to infective causes and that severe drug reactions need to be considered in the differential diagnosis.
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Affiliation(s)
- Hui Yin Lim
- Department of General Medicine, Austin Health, Heidelberg, Australia
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233
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Kardaun SH, Mockenhaupt M, Roujeau JC. Comments on: DRESS syndrome. J Am Acad Dermatol 2014; 71:1000-1000.e2. [PMID: 25437959 DOI: 10.1016/j.jaad.2013.11.053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 11/21/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Sylvia H Kardaun
- Department of Dermatology, Reference Center for Cutaneous Adverse Reactions, University Medical Center Groningen, University of Groningen, The Netherlands.
| | - Maja Mockenhaupt
- Department of Dermatology, Dokumentationszentrum schwerer Hautreaktionen (dZh), University Medical Center, Freiburg, Germany
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234
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Kostopoulos T, Krishna S, Brinster N, Ortega‐Loayza A. Acute generalized exanthematous pustulosis: atypical presentations and outcomes. J Eur Acad Dermatol Venereol 2014; 29:209-214. [DOI: 10.1111/jdv.12721] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/28/2014] [Indexed: 12/11/2022]
Affiliation(s)
- T.C. Kostopoulos
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - S.M. Krishna
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - N.K. Brinster
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
| | - A.G. Ortega‐Loayza
- Department of Dermatology Virginia Commonwealth University Medical Center Richmond VA USA
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235
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Swanson EA, Low L, Naini BV. Severe enterocolitis associated with antiepileptic-induced drug reaction with eosinophilia and systemic symptoms. Hum Pathol 2014; 45:1973-7. [DOI: 10.1016/j.humpath.2014.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/04/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022]
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236
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Eungdamrong NJ, Higgins C, Guo Z, Lee WH, Gillette B, Sia S, Christiano AM. Challenges and promises in modeling dermatologic disorders with bioengineered skin. Exp Biol Med (Maywood) 2014; 239:1215-24. [PMID: 24951469 DOI: 10.1177/1535370214538747] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The tremendous cost of drug development is often attributed to the long time interval between identifying lead compounds in preclinical studies to assessing clinical efficacy in randomized clinical trials. Many candidate molecules show promise in cell culture or animal models, only to fail in late stage in human investigations. There is a need for novel technologies that allow investigators to quickly and reliably predict drug safety and efficacy. The advent of microtechnology has made it possible to integrate multiple microphysiologic organ systems into a single microfabricated chip. This review focuses on three-dimensional engineered skin, which has enjoyed a long history of uses both in clinical treatments of refractory ulcers and as a laboratory model. We discuss current biological and engineering challenges in construction of a robust bioengineered skin and provide a blueprint for its potential utility to model dermatologic disorders such as psoriasis or cutaneous drug reactions.
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Affiliation(s)
- Narat J Eungdamrong
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA Departments of Dermatology, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
| | - Claire Higgins
- Departments of Dermatology, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
| | - Zongyou Guo
- Departments of Dermatology, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
| | - Wen-Han Lee
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Brian Gillette
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Samuel Sia
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - Angela M Christiano
- Departments of Dermatology, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA Department of Genetics & Development, Columbia University College of Physicians & Surgeons, New York, NY 10032, USA
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237
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Noguera-Morel L, Hernández-Martín Á, Torrelo A. Cutaneous drug reactions in the pediatric population. Pediatr Clin North Am 2014; 61:403-26. [PMID: 24636653 DOI: 10.1016/j.pcl.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cutaneous adverse drug reactions (ADRs) constitute a major pediatric health problem frequently encountered in clinical practice, and represent a diagnostic challenge. Children are more susceptible than adults to errors in drug dosage because of their smaller body size; moreover, ADRs can mimic other skin diseases of children, especially viral exanthems. Most ADRs with cutaneous involvement are mild and resolve on withdrawal of the causative drug. The most common forms of cutaneous ADRs, maculopapular exanthems and urticarial reactions, have excellent outcomes. Less frequent but more severe reactions may incur a risk of mortality.
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Affiliation(s)
- Lucero Noguera-Morel
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain
| | - Ángela Hernández-Martín
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain
| | - Antonio Torrelo
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain.
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238
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Rowe CJ, Robertson I, James D, McMeniman E. Warfarin-induced erythroderma. Australas J Dermatol 2014; 56:e15-7. [DOI: 10.1111/ajd.12140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 12/19/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Casey J Rowe
- Department of Dermatology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- University of Queensland Centre for Clinical Research; Herston Queensland Australia
| | - Ivan Robertson
- Department of Dermatology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Daniel James
- Department of Anatomical Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Erin McMeniman
- Department of Dermatology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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239
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Lam T, Wolverton SE, Davis CL. Drug hypersensitivity syndrome in a patient receiving vismodegib. J Am Acad Dermatol 2014; 70:e65-6. [DOI: 10.1016/j.jaad.2013.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/19/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
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240
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Descamps V. Dysphagia, a major early manifestation in DRESS syndrome. J Am Acad Dermatol 2014; 69:1057-8. [PMID: 24238168 DOI: 10.1016/j.jaad.2013.08.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Vincent Descamps
- Department of Dermatology, Bichat Claude Bernard Hospital, Paris, France.
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241
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Abstract
DRESS syndrome (Drug rash with eosinophilia and systemic symptoms) is a severe drug-induced hypersensitivity syndrome characterized by diffuse skin rash, fever, eosinophilia, atypical lymphocytes and organ involvement. We report a case of drug reaction with eosinophilia and systemic symptoms (DRESS) to sulphasalazine. A 54-year-old woman developed a widespread papulovesicular rash after treatment with sulphasalazine (1000 mg daily). She was successfully treated with systemic corticosteroids.
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Affiliation(s)
- K. Pałgan
- Department of Allergology, Clinical Immunology and Internal Diseases, Nicolaus Copernicus University in Toruń, Collegium Medicum of L. Rydygier in Bydgoszcz, Poland
| | - Z. Bartuzi
- Department of Allergology, Clinical Immunology and Internal Diseases, Nicolaus Copernicus University in Toruń, Collegium Medicum of L. Rydygier in Bydgoszcz, Poland
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242
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Dermatologic Side Effects of Psychotropic Medications. PSYCHOSOMATICS 2014; 55:1-20. [DOI: 10.1016/j.psym.2013.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 12/21/2022]
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243
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Abstract
Sub-Saharan Africa is the epicenter of the HIV pandemic and HIV-infected people are more susceptible to inflammatory dermatoses, infections, and drug eruptions. Many of the drugs used for HIV-associated opportunistic infections are associated with a higher incidence of drug-related toxicities and drug interactions. This article discusses the epidemiology, pharmacogenetics, and clinical features of idiosyncratic drug reactions in HIV-infected Africans. Special considerations in this population, including immune reconstitution inflammatory syndrome, multiple drug hypersensitivity syndrome, drug reactions in pregnancy, drug rechallenge in lichenoid drug eruptions, and anxiety/depression after cutaneous adverse drug reactions, are also briefly discussed.
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244
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Drago F, Javor S, Bruzzone L, Drago F, Parodi A, Picciotto A. Pityriasis rosea in a hepatitis B-positive patient treated with pegylated interferon α2a: report of a case and review of the literature. Dermatology 2013; 228:10-3. [PMID: 24335203 DOI: 10.1159/000356176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/06/2013] [Indexed: 11/19/2022] Open
Abstract
Pityriasis rosea (PR) is an acute, self-limiting exanthematous disease caused by the endogenous reactivation of human herpesvirus (HHV)-6 and/or HHV-7 infection in conditions of altered immunity. In addition, many drugs have been incriminated as possible triggers of PR-like eruptions, characterized by clinical, morphological and histopathological features that differ from typical PR. Here, we report a case of PR in a patient with chronic hepatitis B, receiving pegylated interferon α2a (PEG-IFN-α2a). PR, arising after the second administration of the PEG-IFN-α2a, might be considered a clinical expression of the patient's altered immune condition as reported in the immune reconstitution inflammatory syndrome affecting patients with human immunodeficiency virus infection after high-dose antiretroviral therapy.
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Affiliation(s)
- Francesco Drago
- Department of Endocrinological and Metabolic Sciences, Section of Dermatology, University of Genoa, Genoa, Italy
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245
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Alkhateeb H, Said S, Cooper CJ, Gaur S, Porres-Aguilar M. DRESS syndrome following ciprofloxacin exposure: An unusual association. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:526-8. [PMID: 24340128 PMCID: PMC3858202 DOI: 10.12659/ajcr.889703] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/03/2013] [Indexed: 11/19/2022]
Abstract
Patient: Female, 24 Final Diagnosis: DRESS syndrome Symptoms: Fever • rash • facial and body swelling • muscular pain • diarrhea Medication: Ciprofloxacin Clinical Procedure: — Specialty: Internal Medicine • Hematology
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Affiliation(s)
- Haider Alkhateeb
- Department of Internal Medicine, Texas Tech University Health Science Center, Paul L. Foster School of Medicine, El Paso, TX, U.S.A
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246
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Schwartz RA, Husain Z, Reddy BY. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and dysphagia: A noteworthy association. J Am Acad Dermatol 2013; 69:1058. [DOI: 10.1016/j.jaad.2013.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/14/2013] [Indexed: 10/26/2022]
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247
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A maculopapular-type eruption associated with deferasirox administration. J Am Acad Dermatol 2013; 69:e265-e267. [DOI: 10.1016/j.jaad.2013.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 11/27/2022]
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248
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Schallhorn JM, Gonzales J. Ocular toxoplasmosis: the treatment dilemma. J AAPOS 2013; 17:454-5. [PMID: 24160961 DOI: 10.1016/j.jaapos.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Julie M Schallhorn
- Francis I. Proctor Foundation, University of California, San Francisco, California
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249
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Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: Part II. Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. J Am Acad Dermatol 2013; 69:187.e1-16; quiz 203-4. [PMID: 23866879 DOI: 10.1016/j.jaad.2013.05.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/06/2013] [Accepted: 05/10/2013] [Indexed: 02/01/2023]
Abstract
Toxic epidermal necrolysis (TEN) is a life-threatening, typically drug-induced, mucocutaneous disease. TEN has a high mortality rate, making early diagnosis and treatment of paramount importance. New but experimental diagnostic tools that measure serum granulysin and high-mobility group protein B1 (HMGB1) offer the potential to differentiate early TEN from other, less serious drug reactions, but these tests have not been validated and are not readily available. The mainstay of treatment for TEN involves discontinuation of the offending drug, specialized care in an intensive care unit or burn center, and supportive therapy. Pharmacogenetic studies have clearly established a link between human leukocyte antigen allotype and TEN. Human leukocyte antigen testing should be performed on patients of East Asian descent before the initiation of carbamezapine and on all patients before the initiation of abacavir. The effectiveness of systemic steroids, intravenous immunoglobulins, plasmapheresis, cyclosporine, biologics, and other agents is uncertain.
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Affiliation(s)
- Robert A Schwartz
- Dermatology, Preventive Medicine, and Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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250
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Shin B, Park SY, Yoon SY, Shin EH, Yang YJ, Cho HJ, Jang IY, Kang DU, Kim TB, Cho YS, Moon HB, Kwon HS. Dapsone-induced drug reaction with eosinophilia and systemic symptoms syndrome, misdiagnosed as lymphoma. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.4.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bomi Shin
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - So Young Park
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - Sun-Young Yoon
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - Eun-Hye Shin
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Joo Yang
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Hyung-Jin Cho
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Il-Young Jang
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Uk Kang
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea
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