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Zhang X, Pan J, Zhang X, Yang Q, Li Z, Liu F. Safety profiles of tetracycline-class drugs: a pharmacovigilance analysis of the FAERS database. Expert Opin Drug Saf 2024:1-10. [PMID: 39158402 DOI: 10.1080/14740338.2024.2393276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND As synthesis technology advances, novel and efficient derivatives of tetracyclines are found. Three new antibiotics were approved within the past 18 years, and represent a new era in the use of tetracyclines. To gain further insight into adverse events linked to tetracyclines and better protect pediatric patients, ongoing monitoring of safety data is crucial. METHODS The FAERS data from the first quarter of 2004 to the third quarter of 2023 in the AERSMine were extracted to conduct disproportionality analysis. The association between five tetracyclines and adverse events was evaluated using reporting odds ratio, and their risk factors were explored by multivariate logistic regression analysis. RESULTS Our study showed that thyroid gland disorders had the strongest signal in children. Patients aged 12-18 and treatment with minocycline are risk factors for thyroid adverse events (12-18: OR = 10.727 [7.113-16.177], p < 0.0001; minocycline: OR = 17.025 [10.475-27.678], p < 0.0001). Second-generation tetracycline and third-generation tetracycline ADR patterns differed. Blood fibrinogen decreased and hypofibrinogenaemia was primarily reported with tigecycline and eravacycline. CONCLUSION This study provided basic evidence for further research on tetracyclines-related adverse events. However, the safety of third-generation tetracycline in children requires additional validation through a large-scale prospective study.
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Affiliation(s)
- Xu Zhang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Juan Pan
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Xiaojuan Zhang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Qiongliang Yang
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Zuyi Li
- Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, Changsha, China
| | - Furong Liu
- Institute of Clinical Pharmacy, Department of Pharmacy, The Affiliated Nanhua Hospital, Hengyang Medical School, Hengyang, China
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2
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Qiao Y, Chen Y, Wang Q, Liu J, Guo X, Gu Q, Ding P, Zhang H, Mei H. Safety profiles of doxycycline, minocycline, and tigecycline in pediatric patients: a real-world pharmacovigilance analysis based on the FAERS database. Front Pharmacol 2024; 15:1413944. [PMID: 39135789 PMCID: PMC11317777 DOI: 10.3389/fphar.2024.1413944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/25/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Recently, the rise of antibiotic resistance has prompted a reconsideration of tetracyclines. However, existing studies are inadequate in assessing the pediatric safety of this class of antibiotics. To address the gap, our study aims to comprehensively assess the safety of tetracyclines in children. Methods Adverse event (AE) reports from January 2005 to September 2023 were obtained from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database, and reporting odds ratio (ROR) was performed to identify potential risk signals in children under 18 years old who were administered any of the three tetracyclines: doxycycline, minocycline, and tigecycline. Results A total of 1903 AE cases were included in our study: 782 for doxycycline, 981 for minocycline, and 140 for tigecycline. Doxycycline and tigecycline were predominantly associated with "general disorders and administration site conditions" and "gastrointestinal disorders," while minocycline was more frequently linked to "skin and subcutaneous tissue disorders" and "gastrointestinal disorders." Psychiatric risks predominantly included depression, suicidal ideation, and suicide attempt. In the category of skin and subcutaneous tissues, 30.88% of the minocycline-induced drug reaction with eosinophilia and systemic symptoms (DRESS) cases resulted in death, alongside a high occurrence of co-occurring AEs such as multiple organ dysfunction syndrome, Type 1 Diabetes Mellitus (T1DM), and autoimmune thyroiditis. As for the endocrine system, both doxycycline and minocycline were found to potentially increase the risk of thyroid dysfunction. For children under the age of 8, doxycycline was associated with tooth discoloration (N = 7, ROR = 20.11%, 95% CI: 9.48-42.67), although it remained unclear whether the discoloration was permanent. Conclusion Our findings indicated that for pediatric patients, the majority of results were in line with the prescribing information and previous studies, and minocycline tended to cause more frequent and severe AEs than doxycycline. However, it is noteworthy that exceptions were found for psychiatric disorders and thyroid dysfunction associated with doxycycline, which are not mentioned in its FDA prescribing information. Additionally, further safety studies on tigecycline are still needed for children. When prescribing tetracyclines to pediatric patients, a careful risk-benefit assessment is crucial.
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Affiliation(s)
- Yanli Qiao
- Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yechao Chen
- Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Qiaoyun Wang
- Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jingrui Liu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Xiaohui Guo
- Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Qiaoling Gu
- Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Peng Ding
- Department of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Haixia Zhang
- School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
| | - Hongliang Mei
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
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Cherepacha N, St George-Hyslop F, Chugani B, Alabdeen Y, Sanchez-Espino LF, Mahood Q, Sibbald C, Verstegen RHJ. Management and Long-Term Outcomes of Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS) in Children: A Scoping Review. Am J Clin Dermatol 2024; 25:609-621. [PMID: 38755503 DOI: 10.1007/s40257-024-00867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DReSS) is known to cause mortality and long-term sequelae in the pediatric population, however there are no established clinical practice guidelines for the management of pediatric DReSS. We conducted a scoping review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to summarize the currently available data on treatment, mortality, and long-term sequelae of DReSS in children (aged 0-18 years). Data from 644 individuals revealed that various treatment strategies are being used in the management of pediatric DReSS, and strategies were often used in combination. The diversity in treatment approaches cannot be solely attributed to age or disease severity and reflects the lack of evidence-based management guidelines for DReSS. Children are also at risk of developing autoimmune sequelae following DReSS, most commonly thyroid disease and type 1 diabetes mellitus. We found that the eventual development of autoimmune disease was more often associated with DReSS caused by antibiotics, especially minocycline and sulfamethoxazole, in comparison with individuals who did not develop sequelae. In this study, we identify strengths and weaknesses in the currently available literature and highlight that future prospective studies with structured and long-term follow-up of children with DReSS are needed to better understand potential risk factors for mortality and development of sequelae after DReSS.
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Affiliation(s)
- Nicole Cherepacha
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Frances St George-Hyslop
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Bindiya Chugani
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Yousef Alabdeen
- Division of Immunology and Allergy, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Luis F Sanchez-Espino
- Division of Dermatology, Department of Paediatrics, Stollery Children's Hospital, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Quenby Mahood
- Hospital Library, The Hospital for Sick Children, Toronto, ON, Canada
| | - Cathryn Sibbald
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ruud H J Verstegen
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
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4
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Zhao Z, Lu M, Ying Y. Case Report: Minocycline-induced drug reaction with eosinophilia and systemic symptoms syndrome: a case report and literature review. Front Pharmacol 2024; 15:1355774. [PMID: 38515844 PMCID: PMC10955048 DOI: 10.3389/fphar.2024.1355774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Minocycline is a tetracycline commonly used for several dermatological diseases. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe adverse event which can be caused by minocycline. An 18-year-old male patient developed fever, acute rash, pharyngeal pain, lymphadenopathy, hematologic abnormalities, increased creatinine level, elevated liver enzyme levels, and splenomegaly 4 weeks after the oral treatment of minocycline, 100 mg daily, for acne. Once diagnosed with DRESS syndrome, intravenous methylprednisolone was applied and his clinical manifestations and laboratory results remarkably improved. Then, a total of 13 DRESS syndrome cases induced by minocycline were reviewed and their clinical characteristics were summarized. In these cases, only two patient (15.4%) was present with pharynx involved. In conclusion, we reported a rare minocycline-induced DRESS syndrome who developed fever, eosinophilia, acute rash, pharyngitis, lymphadenopathy, acute kidney injury, hepatitis, and splenomegaly. Our report provides detailed clinical features of minocycline-induced DRESS syndrome, which helps us further understand this severe adverse event.
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Affiliation(s)
- Zhe Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Ming Lu
- Department of Infectious Disease, Peking University Third Hospital, Beijing, China
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yingqiu Ying
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
- Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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5
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Bettuzzi T, Sanchez-Pena P, Lebrun-Vignes B. Cutaneous adverse drug reactions. Therapie 2024; 79:239-270. [PMID: 37980248 DOI: 10.1016/j.therap.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 11/20/2023]
Abstract
Cutaneous adverse drug reactions (ADRs) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Maculopapular exanthema and urticaria are the most common types of cutaneous ADR. Serious cutaneous ADRs, which may cause permanent sequelae or have fatal outcome, may represent 2% of all cutaneous ADR and must be quickly identified to guide their management. These serious reactions include bullous manifestations (epidermal necrolysis i.e. Stevens-Johnson syndrome and toxic epidermal necrolysis), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Some risk factors for developing cutaneous ADRs have been identified, including immunosuppression, autoimmunity or genetic variants. All drugs can cause cutaneous ADRs, the most commonly implicated being antibiotics (especially aminopenicillins and sulfonamides), anticonvulsants, allopurinol, antineoplastic drugs, non-steroidal anti-inflammatory drugs and iodinated contrast media. Pathophysiology is related to immediate or delayed "idiosyncratic" immunologic mechanisms, i.e., usually not related to dose, and pharmacologic/toxic mechanisms, commonly dose-dependent and/or time-dependent. If an immuno-allergic mechanism is suspected, allergological explorations (including epicutaneous patch testing and/or intradermal test) are often possible to clarify drug causality, however these have a variable sensitivity according to the drug and to the ADR type. No in vivo or in vitro test can consistently confirm the drug causality. To determine the origin of a rash, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis (especially infectious etiologies) is required, completed with a literature search. Reporting to pharmacovigilance system is therefore essential both to analyze drug causality at individual level, and to contribute to knowledge of the drug at population level, especially for serious cutaneous ADRs or in cases involving newly marketed drugs.
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Affiliation(s)
- Thomas Bettuzzi
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; EpiDermE, université Paris Est Créteil Val-de-Marne, 94000 Créteil, France
| | - Paola Sanchez-Pena
- Service de pharmacologie médicale, centre régional de pharmacovigilance de Bordeaux, CHU de Bordeaux, 33000 Bordeaux, France; Groupe FISARD de la Société française de dermatologie, France
| | - Bénédicte Lebrun-Vignes
- EpiDermE, université Paris Est Créteil Val-de-Marne, 94000 Créteil, France; Groupe FISARD de la Société française de dermatologie, France; Service de pharmacologie médicale, centre régional de pharmacovigilance Pitié-Saint-Antoine, groupe hospitalier AP-HP-Sorbonne université, 75013 Paris, France.
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6
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Dagnon da Silva M, Domingues SM, Oluic S, Radovanovic M, Kodela P, Nordin T, Paulson MR, Joksimović B, Adetimehin O, Singh D, Madrid C, Cardozo M, Baralic M, Dumic I. Renal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of 71 Cases. J Clin Med 2023; 12:4576. [PMID: 37510691 PMCID: PMC10380880 DOI: 10.3390/jcm12144576] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
Unlike other adverse drug reactions, visceral organ involvement is a prominent feature of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and correlates with mortality. The aim of this study was to systematically review cases published in PubMed-indexed, peer-reviewed journals in which patients had renal injury during the episode of DRESS syndrome (DS). We found 71 cases, of which 67 were adults and 56% were males. Female sex was associated with higher mortality. Chronic kidney disease (CKD) was present in 14% of patients who developed acute kidney injury (AKI) during DS. In 21% of cases, the kidneys were the only visceral organ involved, while 54% of patients had both liver and kidney involvement. Eosinophilia was absent in 24% of patients. The most common classes of medication associated with renal injury in DS were antibiotics in 34%, xanthine oxidase inhibitors in 15%, and anticonvulsants in 11%. Among antibiotics, vancomycin was the most common culprit in 68% of patients. AKI was the most common renal manifestation reported in 96% of cases, while isolated proteinuria or hematuria was present in only 4% of cases. In cases with AKI, 88% had isolated increase in creatinine and decrease in glomerular filtration (GFR), 27% had AKI concomitantly with proteinuria, 18% had oliguria, and 13% had concomitant AKI with hematuria. Anuria was the rarest manifestation, occurring in only 4% of patients with DS. Temporary renal replacement therapy was needed in 30% of cases, and all but one patient fully recovered renal function. Mortality of DS in this cohort was 13%, which is higher than previously reported. Medication class, latency period, or pre-existing CKD were not found to be associated with higher mortality. More research, particularly prospective studies, is needed to better recognize the risks associated with renal injury in patients with DS. The development of disease-specific biomarkers would also be useful so DS with renal involvement can be easier distinguished from other eosinophilic diseases that might affect the kidney.
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Affiliation(s)
| | | | - Stevan Oluic
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL 60402, USA
| | - Milan Radovanovic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | | | - Terri Nordin
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Family Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Margaret R Paulson
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Bojan Joksimović
- Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, The Republic of Srpska, Bosnia and Herzegovina
| | - Omobolanle Adetimehin
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Devender Singh
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Cristian Madrid
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Milena Cardozo
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
| | - Marko Baralic
- Department of Nephrology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA
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7
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Koss KM, Son T, Li C, Hao Y, Cao J, Churchward MA, Zhang ZJ, Wertheim JA, Derda R, Todd KG. Toward discovering a novel family of peptides targeting neuroinflammatory states of brain microglia and astrocytes. J Neurochem 2023:10.1111/jnc.15840. [PMID: 37171455 PMCID: PMC10640667 DOI: 10.1111/jnc.15840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023]
Abstract
Microglia are immune-derived cells critical to the development and healthy function of the brain and spinal cord, yet are implicated in the active pathology of many neuropsychiatric disorders. A range of functional phenotypes associated with the healthy brain or disease states has been suggested from in vivo work and were modeled in vitro as surveying, reactive, and primed sub-types of primary rat microglia and mixed microglia/astrocytes. It was hypothesized that the biomolecular profile of these cells undergoes a phenotypical change as well, and these functional phenotypes were explored for potential novel peptide binders using a custom 7 amino acid-presenting M13 phage library (SX7) to identify unique peptides that bind differentially to these respective cell types. Surveying glia were untreated, reactive were induced with a lipopolysaccharide treatment, recovery was modeled with a potent anti-inflammatory treatment dexamethasone, and priming was determined by subsequently challenging the cells with interferon gamma. Microglial function was profiled by determining the secretion of cytokines and nitric oxide, and expression of inducible nitric oxide synthase. After incubation with the SX7 phage library, populations of SX7-positive microglia and/or astrocytes were collected using fluorescence-activated cell sorting, SX7 phage was amplified in Escherichia coli culture, and phage DNA was sequenced via next-generation sequencing. Binding validation was done with synthesized peptides via in-cell westerns. Fifty-eight unique peptides were discovered, and their potential functions were assessed using a basic local alignment search tool. Peptides potentially originated from proteins ranging in function from a variety of supportive glial roles, including synapse support and pruning, to inflammatory incitement including cytokine and interleukin activation, and potential regulation in neurodegenerative and neuropsychiatric disorders.
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Affiliation(s)
- K M Koss
- Comprehensive Transplant Center and Department of Surgery, Feinberg School of Medicine, Northwestern University, Illinois, Chicago, USA
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Alberta, Edmonton, Canada
- Department of Surgery, University of Arizona College of Medicine, Arizona, Tucson, USA
| | - T Son
- Comprehensive Transplant Center and Department of Surgery, Feinberg School of Medicine, Northwestern University, Illinois, Chicago, USA
| | - C Li
- Department of Chemistry, University of Alberta, 11227 Saskatchewan Dr NW, Edmonton, AB T6G 2G2, Canada
| | - Y Hao
- Department of Chemistry, University of Alberta, 11227 Saskatchewan Dr NW, Edmonton, AB T6G 2G2, Canada
| | - J Cao
- Department of Chemistry, University of Alberta, 11227 Saskatchewan Dr NW, Edmonton, AB T6G 2G2, Canada
- 48Hour Discovery Inc, 11421 Saskatchewan Dr NW, Edmonton, AB T6G 2M9, Canada
| | - M A Churchward
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Alberta, Edmonton, Canada
- Department of Biology and Environmental Sciences, Concordia University of Edmonton, Alberta, Edmonton, Canada
| | - Z J Zhang
- Comprehensive Transplant Center and Department of Surgery, Feinberg School of Medicine, Northwestern University, Illinois, Chicago, USA
| | - J A Wertheim
- Comprehensive Transplant Center and Department of Surgery, Feinberg School of Medicine, Northwestern University, Illinois, Chicago, USA
- Department of Surgery, University of Arizona College of Medicine, Arizona, Tucson, USA
| | - R Derda
- Department of Chemistry, University of Alberta, 11227 Saskatchewan Dr NW, Edmonton, AB T6G 2G2, Canada
- 48Hour Discovery Inc, 11421 Saskatchewan Dr NW, Edmonton, AB T6G 2M9, Canada
| | - K G Todd
- Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Alberta, Edmonton, Canada
- Department of Biomedical Engineering, University of Alberta, Alberta, Edmonton, Canada
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8
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Tempark T, Tangthanapalakul A, Deekajorndech T, Chatproedprai S, Supornsilchai V, Wananukul S. Graves' disease: an uncommon cause of late sequelae following DRESS (drug reaction with eosinophilia and systemic symptoms). Clin Exp Pediatr 2022; 65:602-604. [PMID: 35760411 PMCID: PMC9742765 DOI: 10.3345/cep.2022.00381] [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: 03/04/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Therdpong Tempark
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Tawatchai Deekajorndech
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Susheera Chatproedprai
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vichit Supornsilchai
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siriwan Wananukul
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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9
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Tempark T, Deekajorndech T, Chatproedprai S, Supornsilchai V, Wananukul S. Late sequelae of drug reaction with eosinophilia and systemic symptoms (DRESS) cause thyroid dysfunction and thyroiditis: review of literature. J Pediatr Endocrinol Metab 2022; 35:567-575. [PMID: 35119800 DOI: 10.1515/jpem-2021-0685] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/17/2022] [Indexed: 12/18/2022]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) is one of the severe cutaneous adverse drug reactions (SCARs) with high mortality rate and variable long term sequelae, especially in thyroid dysfunction and thyroiditis. In this article, we review clinical course, culprit drugs, onset of diagnosis, and type of thyroid dysfunction in DRESS patients. There were a total of 51 cases including 12 children (aged less than 18 years old) and 39 adults from our review. The most common thyroid dysfunction was Hashimoto's thyroiditis (41/51=80.4%) including anti-thyroid antibody positive (29/51=56.9%), possible/compatible with Hashimoto's thyroiditis (12/51=23.5%) both in the children (n=12) and adult (n=39), Graves' disease/hyperthyroidism (7/51=13.7%) and non-specific hypothyroidism (3/51=5.9%), respectively. The most common culprit drugs and onset of thyroid dysfunction after DRESS diagnosis in children aged less than 18 years include antiepileptic drugs (phenytoin, phenobarbital, carbamazepine) (range 0-8 months, median 2 months) and sulfa groups (sulfasalazine, sulfamethoxazole, sulfonamide) (range 1-4 months, median 2 months). Data of prevalence, type, and clinical course of thyroid dysfunction from DRESS is important for clinicians to recognize for monitoring its sequelae and provide plans for treatment.
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Affiliation(s)
- Therdpong Tempark
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tawatchai Deekajorndech
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Susheera Chatproedprai
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vichit Supornsilchai
- Division of Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siriwan Wananukul
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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10
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Mizukawa Y, Aoyama Y, Takahashi H, Takahashi R, Shiohara T. Risk of progression to autoimmune disease in severe drug eruption: risk factors and the factor-guided stratification. J Invest Dermatol 2021; 142:960-968.e9. [PMID: 34808234 DOI: 10.1016/j.jid.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/23/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
The identification of risk factors is key not only to uncover the pathogenesis of autoimmune disease but also to predict progression to autoimmune disease. Drug-induced hypersensitivity syndrome (DiHS)/ drug reaction with eosinophilia and systemic symptoms (DRESS) is likely the best prototypic example for analyzing the sequential events. We conducted a retrospective study of 55 patients with DiHS/DRESS followed for the possibility of later development of autoimmune disease ∼18 years after resolution. Nine patients progressed to autoimmune sequelae regardless of treatment. The generation of autoantibodies preceded by 8 years in 8 of the 9 patients. The combination of increases in lymphocyte counts, severe liver damage, a rebound increase in globulin, persistent reactivations of Epstein-Barr virus and human herpesvirus-6, and low interleukin (IL)-2 and IL-4 at the acute/subacute phases, were significant risk factors for the future development of autoimmune disease. Based on these factors, we established a scoring system that can identify high-risk patients. When stratified these patients into three risk categories (low/intermediate/high), occurrence of autoimmune disease was exclusively detected in the high group. Our data represent the new scoring system to identify patients at high-risk of developing autoimmune disease, although a larger study is required to validate the scoring system.
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Affiliation(s)
- Yoshiko Mizukawa
- Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan.
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Ryo Takahashi
- Flow Cytometry Core Facility, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
| | - Tetsuo Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
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11
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Less Known Gastrointestinal Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review of the Literature. J Clin Med 2021; 10:jcm10184287. [PMID: 34575398 PMCID: PMC8467470 DOI: 10.3390/jcm10184287] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life threatening severe cutaneous drug reaction. Most patients develop eosinophilia, a rash, a fever, lymphadenopathy and variable visceral organ involvement 2–6 weeks following exposure to the inciting medication. Unlike other severe cutaneous drug reactions, internal organ involvement that leads to high mortality is a unique feature of DRESS syndrome. While the liver is the most common internal organ involved, literally every other visceral organ can be affected in this syndrome. The lesser-known gastrointestinal manifestations of this syndrome include esophagitis, gastritis, enteritis, colitis, pancreatitis and a late autoimmune sequela due to pancreatic injury such as fulminant type 1 diabetes mellitus, autoimmune type 1 diabetes mellitus and type 2 diabetes mellitus. While these entities are less common, they are associated with equally severe complications and adverse patient outcomes. In this review, we synthetize data on these rare manifestations using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The liver, the most common visceral organ involved, has been described as part of DRESS elsewhere and is not included in the scope of this article.
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12
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Martins AM, Marto JM, Johnson JL, Graber EM. A Review of Systemic Minocycline Side Effects and Topical Minocycline as a Safer Alternative for Treating Acne and Rosacea. Antibiotics (Basel) 2021; 10:antibiotics10070757. [PMID: 34206485 PMCID: PMC8300648 DOI: 10.3390/antibiotics10070757] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023] Open
Abstract
Resistance of Cutibacterium acnes to topical antibiotics historically used to treat acne (topical erythromycin and clindamycin and, more recently, topical azithromycin and clarithromycin) has been steadily increasing and new topical antibiotics are needed. Minocycline is a semisynthetic tetracycline-derived antibiotic currently used systemically to treat a wide range of infections caused by Gram-negative and Gram-positive bacteria. In addition to its antibiotic activity, minocycline possesses anti-inflammatory properties, such as the downregulation of proinflammatory cytokine production, suppression of neutrophil chemotaxis, activation of superoxide dismutase, and inhibition of phagocytosis, among others. These characteristics make minocycline a valuable agent for treatment of dermatological diseases such as acne vulgaris and papulopustular rosacea. However, more frequent or serious adverse effects have been observed upon the systemic administration of minocycline than with other tetracyclines. Examples of serious adverse effects include hypersensitivity syndrome reaction, drug-induced lupus, idiopathic intracranial hypertension, and other autoimmune syndromes that may cause death. Here, we review adverse effects and drug–drug interactions observed with oral administration of minocycline and contrast this with topical minocycline formulations recently approved or under development for effectively treating dermatological disorders with fewer adverse effects and less drug interaction.
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Affiliation(s)
- Ana M. Martins
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal; (A.M.M.); (J.M.M.)
| | - Joana M. Marto
- Research Institute for Medicine (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisbon, Portugal; (A.M.M.); (J.M.M.)
| | - Jodi L. Johnson
- Departments of Pathology and Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Emmy M. Graber
- The Dermatology Institute, Boston, MA 02116, USA
- Northeastern University, Boston, MA 02115, USA
- Correspondence: ; Tel.: +1-857-317-2057
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Rentfro K, Arthur M. The development of mucous membrane epidermolysis bullosa acquisita in a pediatric patient. JAAD Case Rep 2021; 11:3-5. [PMID: 33869704 PMCID: PMC8042421 DOI: 10.1016/j.jdcr.2021.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kathryn Rentfro
- University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska
| | - Megan Arthur
- University of Nebraska Medical Center, Department of Dermatology, Omaha, Nebraska
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Tomani M, Caridi C, Tatarina-Nulman O, Charlot C, Narula P. Complicated Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome History in a 14-Year-Old. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927951. [PMID: 33622999 PMCID: PMC7919229 DOI: 10.12659/ajcr.927951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a drug-induced hypersensitivity reaction that can result in a severe cutaneous adverse drug reaction (SCAR). It is a rare and potentially life-threatening condition that occurs after exposure to sulfonamides, antibiotics, or antiepileptics. Its incidence in children is not established; however, the mortality rate is documented at approximately 10%. DRESS syndrome is believed to result from an interaction between multiple factors, including genetics, abnormalities of metabolism, and reactivation of certain herpes family viruses including EBV and HHV-6. The classic presentation includes fever, rash, and lymphadenopathy. Symptoms begin approximately 3 to 8 weeks after exposure to the offending agent. CASE REPORT We present a unique case of DRESS syndrome in a 14-year-old girl occurring after the ingestion of minocycline and amoxicillin-clavulanic acid (amoxicillin). Identification of the offending agent was complicated by the patient having been on multiple antibiotics within a short timeframe of the initial presentation of symptoms. In addition to swelling and pruritus, the patient experienced vision problems due to papilledema with bilateral hemorrhage. The treatment course was further complicated by a decrease in kidney function, requiring the patient's medication regimen to be adjusted accordingly. CONCLUSIONS This is a unique case of DRESS syndrome demonstrating the potential influence of certain viruses on the severity of its presentation. This case also highlights the need to adjust the steroid regimen to reduce the potentially harmful effects on various organ systems.
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Affiliation(s)
- Michael Tomani
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Cristina Caridi
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Oksana Tatarina-Nulman
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Cascya Charlot
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Pramod Narula
- Department of Pediatrics, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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15
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Chauhan P, Kakkar AK, Singh H, Gautam CS. Minocycline for the management of multiple sclerosis: repositioning potential, opportunities, and challenges. Expert Rev Neurother 2020; 21:35-43. [PMID: 33059513 DOI: 10.1080/14737175.2020.1838276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic demyelinating inflammatory disorder with variable clinical and pathologic characteristics reflecting multiple underlying pathophysiologic mechanisms. Repositioning of existing drugs for the new indications offers several advantages including significant reduction in the cost and time of drug development and exemption from early phase clinical trials. Minocycline has been reported to exhibit immunomodulation in several pre-clinical and clinical studies through suppression of migratory inflammatory cells, modulation of peripheral immune response, and inhibition of microglial activation within the CNS. AREAS COVERED Here, the authors review the repositioning potential of minocycline for the treatment of MS along with appraisal of the evidence obtained from preclinical and clinical research. The authors also discuss the advantages and potential safety concerns related to the use of minocycline for the management of MS. EXPERT OPINION Minocycline offers several distinct advantages in terms of well-known safety profile, lower cost of therapy, widespread availability, and being available as an oral formulation. The authors call upon the public and private funders to facilitate well designed and adequately powered randomized clinical trials that can provide conclusive evidence regarding the safety and efficacy of minocycline in patients with MS.
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Affiliation(s)
- Prerna Chauhan
- Department of Pharmacology, All India Institute of Medical Sciences , New Delhi, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research , Chandigarh, India
| | - Harmanjit Singh
- Department of Pharmacology, Government Medical College and Hospital , Chandigarh, India
| | - C S Gautam
- Department of Pharmacology, Government Medical College and Hospital , Chandigarh, India
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Kim GY, Anderson KR, Davis DM, Hand JL, Tollefson MM. Drug reaction with eosinophilia and systemic symptoms (DRESS) in the pediatric population: A systematic review of the literature. J Am Acad Dermatol 2020; 83:1323-1330. [DOI: 10.1016/j.jaad.2020.03.081] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 03/11/2020] [Accepted: 03/25/2020] [Indexed: 12/17/2022]
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17
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Prejean R, Haas C. Recalcitrant
minocycline‐induced DRESS
mimicking
HLH. Dermatol Ther 2020; 33:e14104. [DOI: 10.1111/dth.14104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/13/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Rosemary Prejean
- Louisiana State University School of Medicine—Shreveport Shreveport Louisiana USA
| | - Christopher Haas
- Department of Dermatology LSUHSC New Orleans New Orleans Louisiana USA
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18
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Sharifzadeh S, Mohammadpour AH, Tavanaee A, Elyasi S. Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review. Eur J Clin Pharmacol 2020; 77:275-289. [PMID: 33025080 PMCID: PMC7537982 DOI: 10.1007/s00228-020-03005-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
Background Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is a delayed infrequent potentially life-threatening idiosyncratic drug reaction. Aromatic anticonvulsants and allopurinol are the most frequent causative agents. However, various reports of antibiotic-induced DRESS are available. In this review, we try to summarize reports of antibacterial antibiotic-induced DRESS focusing on characteristics of DRESS induced by each antibiotic group. Methods The data were collected by searching PubMed/MEDLINE and ScienceDirect. The keywords used as search terms were “DRESS syndrome,” “drug-induced hypersensitivity syndrome (DIHS),” “antibiotics,” “antimicrobial,” and names of various antimicrobial groups. Finally, 254 relevant cases with a definite or probable diagnosis of DRESS based on RegiSCAR criteria were found until 30 May 2020 and reviewed. Results and conclusion Totally, 254 cases of antibacterial antibiotic-induced DRESS are reported. Most of them are related to antituberculosis drugs, vancomycin, and sulfonamides, respectively. Rash and fever were most frequent clinical findings. Eosinophilia and liver injury were the most reported hematologic and visceral organ involvement, respectively. Most of the patients are managed with systemic corticosteroids. The death occurred in 16 patients which most of them experienced liver or lung involvement. The reactivation of various viruses especially HHV-6 is reported in 33 cases. The mean latency period was 29 days. It is necessary to perform thorough epidemiological, genetic, and immunological studies, also systematic case review and causality assessment, as well as well-designed clinical trials for better management of antibiotic-induced DRESS. Electronic supplementary material The online version of this article (10.1007/s00228-020-03005-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiva Sharifzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box 91775-1365, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box 91775-1365, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ashraf Tavanaee
- Department of Infectious Disease, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box 91775-1365, Mashhad, Iran.
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19
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Chung M, Chung L. Management of Calcinosis Associated with Dermatomyositis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00134-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Pulmonary Manifestations of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7863815. [PMID: 31662996 PMCID: PMC6778864 DOI: 10.1155/2019/7863815] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
Background The syndrome of drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, yet potentially fatal hypersensitivity reaction, most commonly associated with anticonvulsants, sulfonamides, and allopurinol. The reaction commonly manifests as a febrile skin eruption with lymphadenopathy and malaise between two and eight weeks following drug exposure. Internal organ involvement occurs in close to 90 percent of patients, and multiple organs may be involved in approximately half of those affected (most commonly the liver, kidney, and lung). Its long latency period and its variable clinical pattern of presentation have earned it the moniker of “the great mimicker,” with delays in diagnosis leading to higher morbidity and mortality. Although less commonly affected in DRESS syndrome, lung involvement is associated with more severe clinical course and potentially worse outcome. Pulmonary symptoms may precede development of the other more common symptoms and signs of the syndrome, or they might develop later in the course of the disease. Lung involvement in DRESS presents with a plethora of manifestations from mild cough or dyspnea with nonspecific interstitial changes on chest imaging to acute respiratory distress syndrome (ARDS) with life-threatening hypoxic respiratory failure. Methods We performed a systematic review of literature from the PubMed database and selected cases of definite DRESS syndrome as defined by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) with a score of 6 or more who also had pulmonary involvement. Demographic data, pattern of lung involvement, culprit medication, latency period, laboratory findings, therapy, and outcome were described and compared with the literature. Results The most common pulmonary radiographic findings in DRESS were interstitial infiltrates in 50% of cases, followed by acute respiratory distress syndrome (ARDS) 31%. Symptoms of cough and shortness of breath (SOB) were present in 72% of patients at the time of presentation. SOB was the more common presenting symptom (81%) compared to cough (19%). In 95% of cases, another visceral organ was involved (most commonly liver or kidneys). 45% of cases were initially misdiagnosed as pneumonia and were treated with empiric antimicrobials. In a multivariate regression, a latency of 30 days or less and an age of 60 or less were associated with development of ARDS. Gender and eosinophil count were not associated with severity of pulmonary manifestations. All patients recovered, and in the vast majority of cases (95%), parenteral steroids were used for treatment in addition to supportive care and symptomatic management. Conclusion Albeit rare, DRESS is a potentially life-threatening syndrome which may present with a myriad of pulmonary signs and symptoms. Pulmonary manifestations are less common but are typically seen in more severe cases. Pulmonary manifestations may be a presenting sign of DRESS, and timely recognition is important in order to stop offending medication and decrease morbidity and mortality.
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Hamilton LA, Guarascio AJ. Tetracycline Allergy. PHARMACY 2019; 7:E104. [PMID: 31382572 PMCID: PMC6789857 DOI: 10.3390/pharmacy7030104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/25/2019] [Accepted: 07/30/2019] [Indexed: 01/23/2023] Open
Abstract
Despite the widespread use of tetracycline antibiotics since the late 1940s, tetracycline hypersensitivity reactions have rarely been described in the literature. A comprehensive PubMed search was performed, including allergic and serious adverse reactions attributed to the tetracyclines class of antibiotics. Of the evaluated tetracycline analogs, minocycline was attributed to the greatest overall number and severity of serious adverse events reported in the literature, with notable reactions primarily reported as respiratory and dermatologic in nature. Reactions to tetracycline have also been well described in the literature, and although dermatologic reactions are typically less severe in comparison with minocycline and doxycycline, various reports of anaphylactic reactions exist. Although doxycycline has been noted to have had the fewest reports of severe allergic reactions, rare descriptions of life-threatening reactions are still reported in the literature. Allergic reactions regarding tetracyclines are rare; however, adverse reaction type, severity, and frequency among different tetracycline analogs is somewhat variable. A consideration of hypersensitivity and adverse reaction incidence should be performed prior to the selection of individual tetracycline entities.
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Affiliation(s)
- Leslie A Hamilton
- Department of Clinical Pharmacy and Translational Science, the University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN 37909, USA
| | - Anthony J Guarascio
- Division of Pharmacy Practice, Duquesne University School of Pharmacy, 600 Forbes Avenue, Pittsburgh, PA 15282, USA.
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22
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Zhu B, Wu J, Chen G, Yang Y, Yi C. Fulminant Type 1 Diabetes Mellitus Caused by Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): A Case Report and Review of the Literature. Front Endocrinol (Lausanne) 2019; 10:474. [PMID: 31379742 PMCID: PMC6646467 DOI: 10.3389/fendo.2019.00474] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022] Open
Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS) is a rare, severe cutaneous adverse drug reaction characterized by fever, skin rashes, lymphadenopathy, leukocytosis with eosinophilia, and/or atypical lymphocytosis, and multiple visceral organ involvement. Moreover, patients with DRESS are at risk of developing autoimmune diseases including thyroiditis, diabetes mellitus (DM), and systemic lupus erythematosus (SLE), etc. several weeks or months after the initial resolution. We described a 9-month boy who was admitted to our hospital because of severe pneumonia and developed DRESS 3 weeks later. After the withdrawal of suspicious drug and administration of systemic corticosteroids, the patient's condition improved gradually. Nevertheless, hyperglycemia was detected 20 days after the initial onset of DRESS, and subsequent fulminant type 1 diabetes mellitus (F1DM) was diagnosed requiring continuous intravenous insulin infusion. After 13 months of follow-up, the blood glucose levels are now well-controlled. Literature research in PubMed for diabetes mellitus associated with DRESS showed 16 articles and 27 related case reports. Of 27 patients with DM related to DRESS, 11 were male, 16 were female. The mean age was 46 years. The duration from the onset of DRESS to the development of DM was 21 days on average. F1DM was diagnosed in 21 patients, T1DM was confirmed in 5 patients, and T2DM was only defined in 1 patient. Glutamic acid decarboxylase antibodies (GAD) were detected in 4 cases. Of 22 cases in which virus examination was carried out, evidence of virus reactivation was established in 16 cases (72.7%). Of patients with F1DM, 16 (88.9%) cases were evidenced by reactivation of herpes virus. A high frequency of HLA genotype and haplotype were found in 11 cases. DM was concomitant with acute pancreatitis in 3 patients and thyroiditis in 2 patients. No patients died from the disease. This work aims to raise awareness of long-term autoimmune sequelae in patients with DRESS.
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Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come? Am J Clin Dermatol 2019; 20:217-236. [PMID: 30652265 DOI: 10.1007/s40257-018-00416-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is an uncommon severe adverse reaction to medications. It is important to recognize it as it is potentially fatal and can cause significant morbidity. From the first reports of drug reactions related to certain anticonvulsants characterized by fever, liver enzyme elevation, and skin changes, our continuously growing understanding of this entity has allowed us to describe its physiopathology and clinical features even further. The relationship of genetic factors, viral activation, and specific drug exposure is now known to play a role in this disease. There is still not a widely accepted marker for DReSS/DiHS, but the spectrum of clinical and laboratory features has now been better outlined. The mainstay of treatment is the use of systemic corticosteroids, but other options such as intravenous immunoglobulin, cyclosporine, mycophenolate mofetil, rituximab, and cyclophosphamide have been described. We present a comprehensive review of the literature on DReSS/DiHS, focusing on its history, etiopathogenesis, diagnosis, therapeutic approach, and outcome.
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In Vitro Priming and Hyper-Activation of Brain Microglia: an Assessment of Phenotypes. Mol Neurobiol 2019; 56:6409-6425. [DOI: 10.1007/s12035-019-1529-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/15/2019] [Indexed: 12/27/2022]
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Millington K, Charrow A, Smith J. Case Series: Minocycline-Associated Thyroiditis. Horm Res Paediatr 2019; 92:276-283. [PMID: 31533103 PMCID: PMC7078063 DOI: 10.1159/000502843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Minocycline, a member of the tetracycline class of antibiotics, has been associated with benign thyroid pigmentation but reports of thyroid dysfunction are sparse. METHODS Cases were selected via an inquiry of the electronic medical records for patients with thyroid dysfunction and the use of a tetracycline antibiotic. Non-autoimmune thyroiditis was defined as abnormally low or suppressed thyroid-stimulating hormone (TSH, <0.3 µIU/mL), elevated free thyroxine or total thyroxine, and undetectable antithyroid antibodies. RESULTS Nine cases of thyroiditis without autoimmunity were identified out of 423 reviewed patients. Cases of thyroiditis occurred in adolescents ages 14-17 years who had been taking minocycline for 6 months to 4 years. In all cases, minocycline was prescribed for the treatment of acne. Four of the 9 received treatment for thyrotoxicosis with a β-blocker (in 3 cases) and/or antithyroid drug (in 2 cases). Thyroiditis was symptomatic in all but one individual who presented with painless goiter. All thyroiditis was transient and resolved after a median of 4.5 months (range 2-5 months). In one case, thyroiditis was followed by transient hypothyroidism. DISCUSSION Minocycline is known to cause thyroid abnormalities, although it has not been definitively linked to thyroid dysfunction. Here, we report 9 cases of non-autoimmune thyroiditis in adolescents receiving minocycline for acne. We recommend that minocycline exposure be considered in the differential diagnosis for thyroiditis and that patients receiving minocycline be counseled regarding the risk of thyroid dysfunction.
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Affiliation(s)
- Kate Millington
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA,
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Jessica Smith
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts, United States
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Deng M, Wu H, Yu M, Tian Y, Li Y, Xiao X. Co-Occurrence of Multiple Endocrine Abnormalities Induced by the DIHS/DRESS. Int J Endocrinol 2019; 2019:7959615. [PMID: 31687021 PMCID: PMC6794963 DOI: 10.1155/2019/7959615] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/14/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is a severe adverse reaction caused by specific drugs. However, little information is available about sequelae following DIHS/DRESS resolution from an endocrinologist's perspective. This study aimed to investigate the endocrine sequelae following DIHS/DRESS, from clinical feature to etiology. METHODS We retrospectively analyzed the patients diagnosed with DIHS/DRESS in Peking Union Medical College Hospital (PUMCH) during the period of 1 January 2012 to 31 December 2017, and those who developed endocrine disorders after DIHS/DRESS were further examined. We also reviewed the literature, from 1 January 2000 to 31 December 2017, on involvement of endocrine glands in DIHS/DRESS patients. RESULTS Three patients developed both autoimmune thyroid disease (AITD) and type 1 diabetes (T1DM)/fulminant type 1 diabetes (FT1DM) of the 45 patients. Seven cases involving more than two endocrine glands were reported in the literature. Our results indicated that DIHS/DRESS is a potential etiological factor of autoimmune polyendocrine syndrome (APS), especially APS III. CONCLUSIONS Patients require careful long-term follow-up after DIHS/DRESS. Involvement of endocrine glands, especially FT1DM, should always be monitored in patients with a history of DIHS/DRESS. This study indicated that DIHS/DRESS could lead to APS, especially APS III, providing novel insights into the etiological factors of APS.
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Affiliation(s)
- Mingqun Deng
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Han Wu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Miao Yu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yi Tian
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xinhua Xiao
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
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27
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Alexis A, Del Rosso JQ, Desai SR, Downie JB, Draelos ZD, Feser C, Forconi R, Fowler JF, Gold M, Kaufman-Janette J, Lain E, Lee M, Ling M, Shamban AT, Werschler WP, Daniels A. BPX-01 Minocycline Topical Gel Shows Promise for the Treatment of Moderate-to-severe Inflammatory Acne Vulgaris. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2018; 11:25-35. [PMID: 30588271 PMCID: PMC6303111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Background and objectives: Acne vulgaris is a highly prevalent and multifactorial skin disorder that can adversely impact health-related quality of life. Factors that contribute to the pathogenesis of acne include pilosebaceous proliferation of proinflammatory Propionibacterium acnes (P. acnes) bacteria, presence of circulating androgens, excess sebum production, abnormal follicular keratinization, and multiple inflammatory cascades. Oral tetracyclines-especially doxycycline and minocycline-are frequently prescribed for the treatment of moderate-to-severe acne, given their anti-inflammatory properties and their effect on P. acnes reduction. Notwithstanding their established efficacy in the management of acne vulgaris, there is a desire to limit systemic exposure to antibiotics given growing concerns regarding bacterial resistance as well as the potential for serious side effects. This report describes outcomes of two randomized, vehicle-controlled trials (Phases IIa and IIb) of BPX-01, a topical minocycline gel, in the treatment of moderate-to-severe acne. Methods: In Study 1 (NCT02709096), at a single center, 33 subjects with highly fluorescing facial skin were randomized 2:1 to BPX-01 1% or vehicle control once-daily treatment for four weeks. Changes in P. acnes quantitative bacteriological cultures were assessed, as well as cutaneous tolerance to the study drug by both subjects and the investigator. In Study 2 (NCT02815332), subjects with moderate-to-severe inflammatory nonnodular acne (n=226) at 15 centers were randomized 1:1:1 to treatment with BPX-01 1%, BPX-01 2%, or vehicle control once-daily for 12 weeks. The primary endpoint was reduction in the number of inflammatory lesions; other endpoints included the number of noninflammatory lesions, Investigator's Global Assessment (IGA) of severity, and subjective ratings (investigator and subject) of acne. In both studies, cutaneous tolerability and safety were assessed, and plasma minocycline levels were tracked with a highly sensitive assay. Results: In Study 1, BPX-01 treatment reduced P. acnes colonization by 90.9 percent, which exceeded the reduction in the vehicle control group (65.53%; p=0.020). In Study 2, treatment with BPX-01 2% reduced the number of inflammatory lesions by 58.5 percent, exceeding the reduction in the vehicle control group (43.8%; p=0.0256). Trends toward an improvement preferential to BPX-01 2% were observed in the other endpoints. Across both studies, BPX-01 treatment was well-tolerated, with no photosensitivity, postinflammatory hyperpigmentation, or skin discoloration reported. A single subject (out of 259 study participants ) was identified to have detectable levels of plasma minocycline at low levels (42ng/mL) after 12 weeks of treatment but had no signs or symptoms associated with systemic administration of minocycline. Conclusion: BPX-01 appears to exhibit an effectiveness profile for reduction of inflammatory (nonnodular) acne lesions similar to that of oral minocycline formulations. However, because BPX-01 is topical and exhibits negligible systemic exposure, the likelihood of adverse events associated with oral minocycline use is much lower. These results demonstrate effectiveness of BPX-01 topical minocycline gel in reducing P. acnes colonization, suggesting that the BPX-01 2% formulation is a promising treatment for moderate-to-severe nonnodular, inflammatory acne vulgaris in both reduction of inflammatory lesions and also overall improvement in facial acne according to IGA.
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Affiliation(s)
- Andrew Alexis
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - James Q Del Rosso
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Seemal R Desai
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Jeanine B Downie
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Zoe Diana Draelos
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Christina Feser
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Rion Forconi
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Joseph F Fowler
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Michael Gold
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Joely Kaufman-Janette
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Edward Lain
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Mark Lee
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Mark Ling
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Ava T Shamban
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Wm Philip Werschler
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
| | - Annamarie Daniels
- Dr. Alexis is with Mount Sinai St. Luke's in New York, New York
- Dr. Del Rosso is with JDR Dermatology Research in Las Vegas, Nevada
- Dr. Desai is with ACRC Trials/Innovative Dermatology in Plano, Texas
- Dr. Downie is with Image Dermatology in Montclair, New Jersey
- Dr. Draelos is with Dermatology Consulting Services in High Point, North Carolina. Drs. Feser and Forconi are with International Clinical Research in Sanford, Florida
- Dr. Fowler is with DS Research in Louisville, Kentucky
- Dr. Gold is with the Tennessee Clinical Research Center in Nashville, Tennessee
- Dr. Kaufman-Janette is with the Skin Research Institute in Coral Gables, Florida
- Dr. Lain is with the Austin Institute for Clinical Research in Heatherwilde, Texas
- Dr. Lee is with Progressive Clinical Research in San Antonio, Texas
- Dr. Ling is with MedaPhase in Newnan, Georgia
- Dr. Shamban is with Medical and Cosmetic Dermatology in Santa Monica, California
- Dr. Werschler is with Premier Clinical Research in Spokane, Washington. Ms. Daniels is with BioPharmX in Menlo Park, California
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Morita C, Yanase T, Shiohara T, Aoyama Y. Aggressive treatment in paediatric or young patients with drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with future development of type III polyglandular autoimmune syndrome. BMJ Case Rep 2018; 2018:bcr-2018-225528. [PMID: 30368475 PMCID: PMC6214396 DOI: 10.1136/bcr-2018-225528] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We experienced a 6-year-old case of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) with subsequent development autoimmune thyroiditis (Hashimoto's thyroiditis), type 1 diabetes with antithyroglobulin, thyroid peroxidase, insulinoma-associated antigen and anti-insulin antibodies at 4 months, alopecia at 7 months, vitiligo, uveitis due to Vogt-Koyanagi-Harada disease at 8 months after clinical resolution of the DiHS/DRESS. He was diagnosed as type III polyglandular autoimmune syndrome (PASIII) after DiHS/DRESS. Prompted by this case, we sought to determine which triggering factors were responsible for later development of PASIII in previously published cases with autoimmune sequelae. In the literature review, five patients with DIHS/DRESS were found to develop autoimmune sequelae consistent with PASIII. All cases with PASIII were much younger than those without them. Four out of the five patients were treated with intravenous immunoglobulin or pulsed prednisolone in the acute stage, although effective in short-term outcomes.
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Affiliation(s)
- Chiyo Morita
- Dermatology, Onomichi General Hospital, Onomichi, Hiroshima, Japan.,Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Tetsuji Yanase
- Dermatology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Tetsuo Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Altman K, Shinohara M. A case of Vogt-Koyanagi-Harada disease as a sequela of drug reaction with eosinophilia and systemic symptoms. JAAD Case Rep 2018; 4:863-865. [PMID: 30306111 PMCID: PMC6172437 DOI: 10.1016/j.jdcr.2018.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Cuestas D, Forero Y, Galvis I, Peñaranda E, Cortes C, Motta A, Mora S, Pérez C, Velasquez O, Puentes J. Drug reaction with eosinophilia and systemic symptoms (DRESS) and multiple organ dysfunction syndrome (MODS): one more reason for a new effective treatment against leishmaniasis. Int J Dermatol 2018; 57:1304-1313. [PMID: 30156263 DOI: 10.1111/ijd.14126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 05/15/2018] [Accepted: 06/08/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced reaction associated with eosinophilia and systemic manifestations. Anticonvulsants, sulfonamides, and antivirals are the most related and described drugs in DRESS syndrome. METHODS AND CASE We present a case of severe multiple organ dysfunction syndrome (MODS) with the risk of death associated with DRESS syndrome due to antileishmanial pentavalent antimonial drug and its simultaneous toxicity. Consequently, a comprehensive review of the main clinical problems and comparative discussion of both clinical conditions was made. DISCUSSION The overlap of DRESS syndrome and antileishmanial pentavalent antimonial drug toxicity can be life-threatening. Both conditions represent a true clinical, diagnostic, and therapeutic challenge. We exposed specific clinical and laboratory results with rare occurrence. CONCLUSION Any physician and dermatologists should keep in mind the broad spectrum of clinical manifestations and laboratory findings associated with the use of pentavalent antimonial drugs. The clinical suspicion, an early diagnosis, and aggressive treatment are essential to prevent complications and death.
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Affiliation(s)
- Daniel Cuestas
- Dermatology Program, El Bosque University, Bogotá, Colombia
| | - Yency Forero
- Internal Medicine Department, University Hospital of the Samaritan ESE, Bogotá, Colombia.,Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - Ingrid Galvis
- Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia.,Rheumatology Department, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - Elkin Peñaranda
- Dermatology Department, University Hospital of the Samaritana ESE, Bogotá, Colombia
| | - Carolina Cortes
- Dermatology Department, University Hospital of the Samaritana ESE, Bogotá, Colombia
| | - Adriana Motta
- Dermatology Program, El Bosque University, Bogotá, Colombia
| | - Sergio Mora
- Head of the Rheumatology Department, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - Carlos Pérez
- Infectious Diseases Department, Hospital of the Samaritana, Bogotá, Colombia
| | - Oscar Velasquez
- Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia
| | - José Puentes
- Advanced Training in Medicine & Postgraduate Medical Residency, University Hospital of the Samaritan ESE, Bogotá, Colombia
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31
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Shiohara T, Mizukawa Y. The importance of considering skin diseases from a temporal perspective: Special emphasis on the effects of corticosteroids and virally induced diseases. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2018. [DOI: 10.1002/cia2.12026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tetsuo Shiohara
- Department of Dermatology; Kyorin University School of Medicine; Tokyo Japan
| | - Yoshiko Mizukawa
- Department of Dermatology; Kyorin University School of Medicine; Tokyo Japan
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Chiang A, Shiu J, Elsensohn AN, Chapman LW, de Feraudy S, Smith J. Classic autoimmune type 1 diabetes mellitus after a case of drug reaction with eosinophilia and systemic symptoms (DRESS). JAAD Case Rep 2018; 4:295-297. [PMID: 29693052 PMCID: PMC5911778 DOI: 10.1016/j.jdcr.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Audris Chiang
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | - Jessica Shiu
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | - Ashley N Elsensohn
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | - Lance W Chapman
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | - Sebastien de Feraudy
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
| | - Janellen Smith
- Department of Dermatology, University of California, Irvine School of Medicine, Irvine, California
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Otsuka Y, Watanabe H, Kano Y, Tatebe N, Sunahori-Watanabe K, Kawabata T, Sada KE, Wada J. Occurrence of Dermatomyositis Immediately after Mastectomy Subsequent to Severe Chemotherapeutic Drug Eruption. Intern Med 2017; 56:3379-3383. [PMID: 29249766 PMCID: PMC5790732 DOI: 10.2169/internalmedicine.9194-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/24/2017] [Indexed: 12/18/2022] Open
Abstract
We herein report a patient with breast cancer who developed dermatomyositis (DM) immediately after mastectomy. She had a history of severe drug eruption during neoadjuvant chemotherapy six months previously. Within a month after the operation, myalgia and rash, including Gottron's papules, developed, and skeletal-muscle enzymes elevated, so she was diagnosed with probable DM according to the Bohan and Peter criteria. In many neoplastic DM cases, the course of the disease parallels the course of the malignancy. Possible mechanisms were suggested to explain the development of DM in the present case and offer new insight into autoimmune diseases.
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Affiliation(s)
- Yuki Otsuka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
- Okayama University Medical School, Japan
| | - Haruki Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuzuki Kano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Noriko Tatebe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Katsue Sunahori-Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tomoko Kawabata
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Fan Y, Hu L, Zhu S, Han Y, Liu W, Yang Y, Li Q. Paeoniflorin attenuates postoperative pain by suppressing Matrix Metalloproteinase‐9/2 in mice. Eur J Pain 2017; 22:272-281. [DOI: 10.1002/ejp.1116] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Y.‐x. Fan
- Jiangsu Provincial Key Lab of Cardiovascular Diseases and Molecular Intervention Department of Pharmacology Nanjing Medical University China
- Department of Pharmacy Sir Run Run Shaw Hospital Affiliated to Nanjing Medical University China
| | - L. Hu
- Jiangsu Provincial Key Lab of Cardiovascular Diseases and Molecular Intervention Department of Pharmacology Nanjing Medical University China
| | - S.‐h. Zhu
- Jiangsu Provincial Key Lab of Cardiovascular Diseases and Molecular Intervention Department of Pharmacology Nanjing Medical University China
| | - Y. Han
- Jiangsu Province Key Laboratory of Anesthesiology School of Anesthesiology Xuzhou Medical University China
| | - W.‐t. Liu
- Jiangsu Provincial Key Lab of Cardiovascular Diseases and Molecular Intervention Department of Pharmacology Nanjing Medical University China
| | - Y.‐j. Yang
- Jiangsu Key Laboratory of Oral Disease Nanjing Medical University China
| | - Q.‐p. Li
- Jiangsu Provincial Key Lab of Cardiovascular Diseases and Molecular Intervention Department of Pharmacology Nanjing Medical University China
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35
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Matta JMR, Flores SM, Cherit JD. Drug reaction with eosinophilia and systemic symptoms (DRESS) and its relation with autoimmunity in a reference center in Mexico. An Bras Dermatol 2017; 92:30-33. [PMID: 28225953 PMCID: PMC5312175 DOI: 10.1590/abd1806-4841.20175190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/21/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms is a severe adverse drug reaction, with a reported mortality of 10%. Long-term outcomes involve organic failure and autoimmune diseases in some populations. OBJECTIVE: To evaluate the clinical prognosis of patients with drug reaction with eosinophilia and systemic symptoms. METHODS: We conducted a retrospective review at a referral hospital in Mexico City in a period of 22 years (1992-2013), looking up for records with diagnosis of DRESS according to RegiSCAR criteria. Clinical characteristics, organ failures, culprit drugs, treatment, and short and long-term sequelae were analyzed. RESULTS: We found 11 patients with diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome, 7 female and 4 male, with a median age of 22 years-old; 9 had maculopapular rash and 2 were erythrodermic. Affected organs were liver (8/11), kidney (6/11) and hematologic disorders (8/11). The most common culprit drugs were antiepileptic (63%). Systemic corticosteroids were given to 8 patients, being pyelonephritis (1/8) and pneumonia (2/8) the adverse events of this therapy. Long-term sequelae were 1 patient with renal failure, 1 patient with chronic anemia; and 2 patients developed autoimmune diseases (one autoimmune thyroid disease and another one with autoimmune thyroid disease and autoimmune hemolytic anemia). Study limitations: The retrospective nature of the study and the limited number of patients with drug reaction with eosinophilia and systemic symptoms. CONCLUSIONS: Drug reaction with eosinophilia and systemic symptoms syndrome has been linked to the development of chronic organ failure. We found two young patients who developed autoimmune diseases in the short term. Patients with drug reaction with eosinophilia and systemic symptoms should have a long-term monitoring for signs or symptoms suggestive of an autoimmune disease.
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Affiliation(s)
- Juan Manuel Ruiz Matta
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán - Mexico Distrito Federal, Mexico
| | - Silvia Méndez Flores
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán - Mexico Distrito Federal, Mexico
| | - Judith Domínguez Cherit
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán - Mexico Distrito Federal, Mexico
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36
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Starobin D, Guller V, Gurevich A, Tal S. Minocycline induced lupus with yellow colored chylous exudative pleural effusion. Respir Med Case Rep 2017; 22:113-116. [PMID: 28761807 PMCID: PMC5524223 DOI: 10.1016/j.rmcr.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 11/03/2022] Open
Abstract
Ninety years old male was admitted to hospital due to breathlessness. The prominent findings were extensive blue-grey skin pigmentation and large left chylothorax. Drug induced lupus was diagnosed due to either minocycline chronic treatment or no alternative illness to explain his sub-acute disease. Minocycline therapy was stopped with gradual improvement of pleural effusion and skin discoloration. This case is the first presentation of minocycline induced lupus with chylothorax.
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Affiliation(s)
- Daniel Starobin
- Pulmonary Institute, Kaplan Medical Center, Affiliated with The Hebrew University of Jerusalem, Israel, Rehovot, Israel
| | - Vladimir Guller
- Geriatrics Department, Kaplan Medical Center, Affiliated with The Hebrew University of Jerusalem, Israel, Rehovot, Israel
| | - Alexander Gurevich
- Harzfeld Hospital, Kaplan Medical Center, Affiliated with The Hebrew University of Jerusalem, Israel, Rehovot, Israel
| | - Sari Tal
- Geriatrics Department, Kaplan Medical Center, Affiliated with The Hebrew University of Jerusalem, Israel, Rehovot, Israel
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37
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Doña I, Torres MJ, Montañez MI, Fernández TD. In Vitro Diagnostic Testing for Antibiotic Allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:288-298. [PMID: 28497915 PMCID: PMC5446943 DOI: 10.4168/aair.2017.9.4.288] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/18/2017] [Accepted: 02/05/2017] [Indexed: 12/21/2022]
Abstract
Allergy to antibiotics is an important worldwide problem, with an estimated prevalence of up to 10% of the population. Reaction patterns for different antibiotics have changed in accordance with consumption trends. Most of the allergic reactions to antibiotics have been reported for betalactams, followed by quinolones and macrolides and, to a lesser extent, to others, such as metronidazole clindamycin and sulfonamides. The diagnostic procedure includes a detailed clinical history, which is not always possible and can be unreliable. This is usually followed by in vivo, skin, and drug provocation tests. These are not recommended for severe, potentially lifethreaten reactions or for drugs that are known to produce a high rate of false positive results. Given the limitations of in vivo tests, in vitro test can be helpful for diagnosis, despite having suboptimal sensitivity. The most highly employed techniques for diagnosing immediate reactions to antibiotics are immunoassays and basophil activation tests, while lymphocyte transformation tests are more commonly used to diagnose non-immediate reactions. In this review, we describe different in vitro techniques employed to diagnose antibiotic allergy.
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Affiliation(s)
- Inmaculada Doña
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Maria J Torres
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | - Maria I Montañez
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Tahia D Fernández
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
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38
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Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist. Curr Rheumatol Rep 2017; 19:3. [DOI: 10.1007/s11926-017-0626-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Takehara A, Aoyama Y, Kurosawa M, Shirafuji Y, Umemura H, Kamiya K, Ushigome Y, Kano Y, Shiohara T, Iwatsuki K. Longitudinal analysis of antibody profiles against plakins in severe drug eruptions: emphasis on correlation with tissue damage in drug-induced hypersensitivity syndrome and drug reaction with eosinophilia and systemic symptoms. Br J Dermatol 2016; 175:944-952. [DOI: 10.1111/bjd.14677] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/17/2022]
Affiliation(s)
- A. Takehara
- Department of Dermatology; Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Y. Aoyama
- Department of Dermatology; Kawasaki Medical School; Kurashiki Japan
- Department of Dermatology; Kawasaki Hospital; 2-1-80 Nakasange Kitaku Okayama City Okayama 700-8505 Japan
| | - M. Kurosawa
- Department of Epidemiology and Environmental Health; Juntendo University Graduate School of Medicine; Tokyo Japan
| | - Y. Shirafuji
- Department of Dermatology; Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - H. Umemura
- Department of Dermatology; Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - K. Kamiya
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Y. Ushigome
- Department of Dermatology; Kyorin University School of Medicine; Tokyo Japan
| | - Y. Kano
- Department of Dermatology; Kyorin University School of Medicine; Tokyo Japan
| | - T. Shiohara
- Department of Dermatology; Kyorin University School of Medicine; Tokyo Japan
| | - K. Iwatsuki
- Department of Dermatology; Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama Japan
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40
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Lonowski S, Hau J, Worswick S. Vitiligo: a potential autoimmune sequela of DRESS syndrome. Br J Dermatol 2016; 175:642-4. [DOI: 10.1111/bjd.14625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- S. Lonowski
- Department of Medicine; Division of Dermatology; David Geffen School of Medicine; University of California Los Angeles; BOX 951750, 200 Medical Plaza, Suite 450 Los Angeles CA 90095-1750 U.S.A
| | - J. Hau
- Department of Medicine; Division of Dermatology; David Geffen School of Medicine; University of California Los Angeles; BOX 951750, 200 Medical Plaza, Suite 450 Los Angeles CA 90095-1750 U.S.A
| | - S. Worswick
- Department of Medicine; Division of Dermatology; David Geffen School of Medicine; University of California Los Angeles; BOX 951750, 200 Medical Plaza, Suite 450 Los Angeles CA 90095-1750 U.S.A
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41
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Pollock AJ, Seibert T, Allen DB. Severe and Persistent Thyroid Dysfunction Associated with Tetracycline-Antibiotic Treatment in Youth. J Pediatr 2016; 173:232-4. [PMID: 27059913 PMCID: PMC4884496 DOI: 10.1016/j.jpeds.2016.03.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
Thyroid dysfunction in adolescents treated with minocycline for acne has been previously described as transient effect and/or associated with autoimmune thyroiditis. We report nonimmune-mediated thyroid dysfunction associated with minocycline/doxycycline in 3 adolescents whose clinical courses suggest an adverse effect that may be more common, serious, and persistent than realized previously.
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Affiliation(s)
- Allison J Pollock
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Tasa Seibert
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - David B Allen
- University of Wisconsin School of Medicine & Public Health, Madison, WI
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42
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A severe case of minocycline-induced DRESS resulting in liver transplantation and autoimmune sequelae. Ann Allergy Asthma Immunol 2016; 116:367-8. [PMID: 26782675 DOI: 10.1016/j.anai.2015.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022]
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43
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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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44
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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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45
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Sato M, Mizuno Y, Matsuyama K, Shu E, Kanoh H, Suwa T, Seishima M. Drug-Induced Hypersensitivity Syndrome Followed by Subacute Thyroiditis. Case Rep Dermatol 2015; 7:161-5. [PMID: 26351424 PMCID: PMC4560312 DOI: 10.1159/000437251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Drug-induced hypersensitivity syndrome (DIHS) is a severe multiorgan system adverse drug reaction with reactivation of human herpesviruses (HHVs) such as HHV-6, HHV-7, cytomegalovirus (CMV) and Epstein-Barr virus. Various complications, including autoimmune diseases, sometimes appear during the course of DIHS. We report a case of salazosulfapyridine-induced DIHS associated with HHV-6 reactivation. Two and a half months after the onset of DIHS, subacute thyroiditis occurred, possibly associated with CMV reactivation. Prednisolone (20 mg/day) was effective for subacute thyroiditis. Long-term follow-up is needed in patients with DIHS because of the possible onset of autoimmune diseases.
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Affiliation(s)
- Mika Sato
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuki Mizuno
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kanako Matsuyama
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - En Shu
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroyuki Kanoh
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Suwa
- Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
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46
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Del Rosso JQ. Oral Doxycycline in the Management of Acne Vulgaris: Current Perspectives on Clinical Use and Recent Findings with a New Double-scored Small Tablet Formulation. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2015; 8:19-26. [PMID: 26029331 PMCID: PMC4445892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Oral antibiotics have been used for the treatment of acne vulgaris for six decades. Among dermatologists, tetracyclines represent at least three-fourths of the oral antibiotics prescribed in clinical practice. Unlike other specialties, antibiotic use in dermatology is predominantly for the treatment of noninfectious disorders, such as acne vulgaris and rosacea, which usually involves prolonged therapy over several weeks to months as compared to short courses used to treat cutaneous infections. At the present time, doxycycline and minocycline are the most commonly prescribed tetracyclines in dermatology, used primarily for treatment of acne vulgaris with a long overall favorable track record of effectiveness and safety. Although both are commonly used, doxycycline may be chosen by clinicians more readily as there is a lower risk of rare yet potentially serious adverse reactions, although doxycycline does warrant preventative measures to reduce the risks of esophagitis and phototoxicity reactions. This article reviews data with a new double-scored small 150mg tablet of doxycycline hyclate that has proven functional scoring, exhibits bioavailability similar to enteric-coated doxycycline, and has been shown to be associated with a low potential for gastrointestinal adverse reactions very comparable to what is achieved with enteric-coated tablets.
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Affiliation(s)
- James Q Del Rosso
- Touro University College of Osteopathic Medicine, Henderson, Nevada; Las Vegas Dermatology, Las Vegas, Nevada; Las Vegas Dermatology Research Center, Las Vegas, Nevada
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47
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Kano Y, Tohyama M, Aihara M, Matsukura S, Watanabe H, Sueki H, Iijima M, Morita E, Niihara H, Asada H, Kabashima K, Azukizawa H, Hashizume H, Nagao K, Takahashi H, Abe R, Sotozono C, Kurosawa M, Aoyama Y, Chu CY, Chung WH, Shiohara T. Sequelae in 145 patients with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: survey conducted by the Asian Research Committee on Severe Cutaneous Adverse Reactions (ASCAR). J Dermatol 2015; 42:276-82. [PMID: 25623158 DOI: 10.1111/1346-8138.12770] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/04/2014] [Indexed: 12/14/2022]
Abstract
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is a severe adverse drug reaction caused by specific drug. It is characterized by visceral organ involvement and reactivation of various human herpesviruses. Although sporadic reports have documented certain conditions that appear after the resolution of DIHS/DRESS, little information is available on sequelae after resolution of DIHS/DRESS in a large patient population. The Asian Research Committee on Severe Cutaneous Adverse Reactions, comprised of doctors from Japan and Taiwan, conducted a survey on sequelae and deterioration of the underlying disease in patients with DIHS/DRESS. This was achieved by directly interviewing patients who had been followed-up by experts or through a questionnaire mailed to patients. Questions were asked about new onset cardiovascular disease, collagen disease or autoimmune disease, gastrointestinal disease, renal disease, respiratory disease, neoplasms, and other diseases such as herpes zoster and diabetes mellitus, as well as deterioration of the underlying disease. A total of 145 patients were analyzed in this study. The following newly developed diseases after recovery from DIHS/DRESS were observed: Graves' disease (n = 2), Hashimoto's disease (n = 3), painless thyroiditis (n = 2), fulminant type 1 diabetes mellitus (n = 5), and infectious diseases (n = 7). Several DIHS/DRESS patients with pre-existing renal dysfunction required lifelong hemodialysis. DIHS/DRESS is a condition that increases the risk of new onset of disease. Long-term observation of DIHS/DRESS can provide an opportunity to investigate substantial diseases from onset to the full-blown stage. Patients with DIHS/DRESS require careful long-term follow-up.
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Affiliation(s)
- Yoko Kano
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
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Ishida T, Kano Y, Mizukawa Y, Shiohara T. The dynamics of herpesvirus reactivations during and after severe drug eruptions: their relation to the clinical phenotype and therapeutic outcome. Allergy 2014; 69:798-805. [PMID: 24749495 PMCID: PMC4112819 DOI: 10.1111/all.12410] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 12/05/2022]
Abstract
Background Drug‐induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms (DIHS/DRESS) and Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) represent contrasting poles of severe drug eruptions, and sequential reactivations of several herpesviruses have exclusively been demonstrated in the former. No previous studies, however, were extended beyond the acute stage. We sought to investigate whether herpesvirus reactivations could also be observed in SJS/TEN and beyond the acute stage of both diseases. Methods Patients with SJS (n = 16), SJS/TEN overlap (n = 2), TEN (n = 10), and DIHS/DRESS (n = 34) were enrolled. We performed a retrospective analysis of Epstein–Barr virus (EBV), human herpesvirus 6 (HHV‐6), and cytomegalovirus (CMV) DNA loads sequentially determined by real‐time polymerase chain reaction during a 2‐year period after onset. Results Persistently increased EBV loads were detected in SJS during the acute stage and long after resolution, but not in others. In contrast, high HHV‐6 loads were exclusively detected in DIHS/DRESS during the acute stage. The dynamics of herpesvirus reactivation varied in DIHS/DRESS according to the use of systemic corticosteroids: While EBV loads were higher in patients not receiving systemic corticosteroids, CMV and HHV‐6 loads were higher in those receiving them. Conclusions Distinct patterns of herpesvirus reactivation according to the pathological phenotype and to the use of systemic corticosteroids were observed during the acute stage and follow‐up period, which may contribute, at least in part, to the difference in the clinical manifestations and long‐term outcomes. Systemic corticosteroids during the acute stage may improve the outcomes in DIHS/DRESS.
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Affiliation(s)
- T. Ishida
- Department of Dermatology Kyorin University School of Medicine Mitaka Tokyo Japan
| | - Y. Kano
- Department of Dermatology Kyorin University School of Medicine Mitaka Tokyo Japan
| | - Y. Mizukawa
- Department of Dermatology Kyorin University School of Medicine Mitaka Tokyo Japan
| | - T. Shiohara
- Department of Dermatology Kyorin University School of Medicine Mitaka Tokyo Japan
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Abstract
Acne is a common skin condition in adolescents. It is not uncommon in childhood and it persists into adulthood. A broad range of acne treatments are available and have been shown to be safe and effective in adolescents and adults. However, there is limited literature regarding acne treatment in childhood and its available therapeutic options. It seems reasonable to extrapolate findings of the various studies reported on treatment of acne in the adolescent and adult age group, with the exclusion of the use of tetracycline derivatives. As clinicians, we must be more familiar with the clinical presentation of acne and available treatment options in our younger patients. Early recognition of acne with prompt and appropriate initiation of therapy in childhood will help prevent severe scarring in children.
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Morito H, Ogawa K, Fukumoto T, Kobayashi N, Morii T, Kasai T, Nonomura A, Kishimoto T, Asada H. Increased ratio of FoxP3+ regulatory T cells/CD3+ T cells in skin lesions in drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms. Clin Exp Dermatol 2014; 39:284-91. [DOI: 10.1111/ced.12246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- H. Morito
- Department of Dermatology; Nara Medical University School of Medicine; Nara Japan
| | - K. Ogawa
- Department of Dermatology; Nara Medical University School of Medicine; Nara Japan
| | - T. Fukumoto
- Department of Dermatology; Nara Medical University School of Medicine; Nara Japan
| | - N. Kobayashi
- Department of Dermatology; Nara Medical University School of Medicine; Nara Japan
| | - T. Morii
- Second Department of Internal Medicine; Nara Medical University School of Medicine; Nara Japan
| | - T. Kasai
- Department of Diagnostic Pathology; Nara Medical University School of Medicine; Nara Japan
| | - A. Nonomura
- Department of Diagnostic Pathology; Nara Medical University School of Medicine; Nara Japan
| | - T. Kishimoto
- Department of Psychiatry; Nara Medical University School of Medicine; Nara Japan
| | - H. Asada
- Department of Dermatology; Nara Medical University School of Medicine; Nara Japan
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