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Herlihy M, Sadlier M. Recurrent rash and orogenital ulcers. BMJ 2024; 385:e079717. [PMID: 38936849 DOI: 10.1136/bmj-2024-079717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
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2
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Wei BM, Fox LP, Kaffenberger BH, Korman AM, Micheletti RG, Mostaghimi A, Noe MH, Rosenbach M, Shinkai K, Kwah JH, Phillips EJ, Bolognia JL, Damsky W, Nelson CA. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Part II diagnosis and management. J Am Acad Dermatol 2024; 90:911-926. [PMID: 37516356 DOI: 10.1016/j.jaad.2023.02.073] [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: 09/28/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 07/31/2023]
Abstract
Drug-induced hypersensitivity syndrome, also known as drug reaction with eosinophilia and systemic symptoms, is a severe cutaneous adverse reaction characterized by an exanthem, fever, and hematologic and visceral organ involvement. The differential diagnosis includes other cutaneous adverse reactions, infections, inflammatory and autoimmune diseases, and neoplastic disorders. Three sets of diagnostic criteria have been proposed; however, consensus is lacking. The cornerstone of management is immediate discontinuation of the suspected drug culprit. Systemic corticosteroids remain first-line therapy, but the literature on steroid-sparing agents is expanding. Longitudinal evaluation for sequelae is recommended. Adjunctive tests for risk stratification and drug culprit identification remain under investigation. Part II of this continuing medical education activity begins by exploring the differential diagnosis and diagnosis of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms and concludes with an evidence-based overview of evaluation and treatment.
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Affiliation(s)
- Brian M Wei
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
| | | | - Abraham M Korman
- Department of Dermatology, The Ohio State University, Columbus, Ohio
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arash Mostaghimi
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Megan H Noe
- Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco, California
| | - Jason H Kwah
- Department of Medicine, Section of Rheumatology, Allergy and Immunology, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - William Damsky
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
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3
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Manenzhe SC, Khammissa RAG, Shangase SL, Beetge MM. Exploring the association between erythema multiforme and HIV infection: some mechanisms and implications. AIDS Res Ther 2024; 21:24. [PMID: 38637892 PMCID: PMC11027329 DOI: 10.1186/s12981-024-00607-6] [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: 06/26/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4 + T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8 + T cells against epithelial cells. HIV infection may also trigger EM directly when CD8 + T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8 + T-cells. The hyperactivation of CD8 + T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.
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Affiliation(s)
- Shumani Charlotte Manenzhe
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa
| | - Razia Abdool Gafaar Khammissa
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa.
| | | | - Mia Michaela Beetge
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa
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4
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Alghamdi Y, Abdulghani F, Huwait HF, Abdulghani M, Samarkandy SJ. An Unusual Presentation of Erythema Multiforme Following the Administration of Pfizer-BioNTech COVID-19 mRNA Vaccine in a Pediatric Patient. Cureus 2024; 16:e58450. [PMID: 38765345 PMCID: PMC11100275 DOI: 10.7759/cureus.58450] [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] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused a global calamity that forced emergency use authorization to Pfizer-BioNTech COVID-19 (BNT162b2) vaccine. It is efficacious in preventing symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in seronegative recipients. The safety profile is still unclear; however, commonly reported symptoms post-vaccination are fatigue, headache, muscle pain, chills, and injection-site pain. COVID-19 disease elicits, to some extent, cutaneous side effects like urticaria, morbilliform rash, and chilblain-like eruption. Vaccination against COVID-19 was reported to induce similar dermatologic manifestations, such as urticarial rash, delayed large-local reaction, local injection-site reaction, and morbilliform eruption. Erythema multiforme (EM) is a rare manifestation post-vaccination, and only a few reports implicate it as a culprit in cutaneous eruptions following the BNT162b2 vaccine. This report delineates the presentation of a healthy 14-year-old girl to a dermatology clinic who developed EM post-vaccination with the first dose of BNT162b2. New-onset EM-eruption post-vaccination with BNT162b2 had been reported previously in 14 cases, and one case reported on the flare of preexisting-EM.
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Affiliation(s)
- Yara Alghamdi
- Dermatology, King Abdullah Medical Complex, Ministry of Health, Jeddah, SAU
| | | | | | | | - Sahal J Samarkandy
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Dermatology, King Abdulaziz Medical City (KAMC), Jeddah, SAU
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5
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Shaker N, Sangueza OP, Shaker N, Arthur M, Pradhan D. Erythema Multiforme-Like Fixed Drug Eruption During Azathioprine and Hydroxychloroquine Treatment for Systemic Lupus Erythematosus Mimicking Rowell Syndrome: A Rare and Challenging Clinical Scenario. Int J Surg Pathol 2024:10668969241234316. [PMID: 38494929 DOI: 10.1177/10668969241234316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background. Fixed drug eruption and Rowell syndrome stand as intriguing entities with overlapping clinical and pathological features. Case Presentation. A 32-year-old female patient presented with a tender and pruritic rash on the left upper chest for 3 days. Clinical examination revealed a flaring rash on the chest, under her left eye, tongue, and lips. The patient had a significant past medical history of systemic lupus erythematous with positive (ANA, Sm, dsDNA, ribosomalP, RNP) antibodies, hypocomplementemia, inflammatory arthritis, discoid lupus, leukopenia, thrombocytopenia, and immune thrombocytopenic purpura, and avascular necrosis affecting both hips and her right knee. At the time of presentation, the patient was on azathioprine 150 mg daily and hydroxychloroquine 200 mg twice daily. Skin biopsy of the left upper chest revealed interface dermatitis with necrotic keratinocytes at the dermal-epidermal junction. Superficial and, in some areas, deep perivascular and peri adnexal lymphocytic infiltrates were observed, accompanied by eosinophils. CD123 staining highlighted 16% of the inflammatory cells. Direct Immunofluorescence for IgG, IgA, IgM, C3, and fibrinogen revealed positive linear basement membrane staining for IgG and fibrinogen, with no significant staining for the remaining immunoreactants. Considering the patient's history of medicine usage, and negative SS-A and SS-B antibody, a fixed drug eruption was favored. Discussion. This article discusses the clinical presentations, pathophysiological mechanisms, and diagnostic criteria for fixed drug eruption and Rowell syndrome. Conclusion. Awareness of the distinct clinical and histopathologic features of fixed drug eruption and Rowell syndrome, particularly when sharing cutaneous manifestations, underscores the importance of a comprehensive diagnostic approach and laboratory testing.
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Affiliation(s)
- Nada Shaker
- Pathology and Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Omar P Sangueza
- Departments of Dermatology and Dermatopathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nuha Shaker
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Megan Arthur
- University of Nebraska Medical Center, Omaha, NE, USA
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6
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Koroneos G, Berry W, Sweeney N, Morgan V, Harun NS, Nicolopoulos J. Reactive infectious mucocutaneous eruption secondary to COVID-19 infection: A case report and review of the literature. J Eur Acad Dermatol Venereol 2024; 38:e204-e208. [PMID: 37907274 DOI: 10.1111/jdv.19590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023]
Affiliation(s)
| | - William Berry
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nicola Sweeney
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Vanessa Morgan
- Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
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7
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Makoni GM, Gerspach C, Fischer N, Rosato G, Fabian R, Grest P, Kipar A. Malignant catarrhal fever in a goat: manifestation of virus-induced erythema multiforme. J Vet Diagn Invest 2024; 36:243-247. [PMID: 38212885 DOI: 10.1177/10406387231224906] [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] [Indexed: 01/13/2024] Open
Abstract
Malignant catarrhal fever (MCF), caused by ovine herpesvirus 2 (OvHV2; Orthoherpesviridae, Macavirus ovinegamma2), has sheep as natural hosts. OvHV2 is an important macavirus globally that induces fatal disease in dead-end hosts. Goats, which can be infected subclinically with OvHV2, rarely develop MCF. A 28-wk-old female goat was presented with fever and multifocal crusty skin lesions. Histologic examination of a skin biopsy suggested erythema multiforme (EM), with pyoderma and dermal vasculitis. The doe was euthanized and subjected to postmortem and histologic examination. MCF was suspected and PCR assays for macaviruses were performed, followed by immunohistochemistry (IHC) for OvHV2 latency-associated nuclear antigen (oLANA), RNA in situ hybridization for Ov2.5 mRNA, and IHC to characterize infiltrating leukocytes. The main postmortem finding was severe multifocal ulcerative dermatitis with macrophage- and T cell-mediated arteritis. The latter was also detected in kidney, spleen, heart, and intestinal wall. The PCR assay detected high loads of OvHV2 in tissues. OvHV2 oLANA and Ov2.5 mRNA were expressed within the lesions in leukocytes, endothelial cells, fibroblasts, and/or keratinocytes. Our case confirms that MCF can initially manifest clinically as a skin disease in goats and as EM with confirmed viral etiology.
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Affiliation(s)
- Grace Makanaka Makoni
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Christian Gerspach
- Department of Farm Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nina Fischer
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Giuliana Rosato
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Rosalie Fabian
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Paula Grest
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Anja Kipar
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland. (Makoni, Rosato, Fabian, Grest, Kipar)
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8
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Jeyanthikumari T, Thayumanavan B, Mohideen K, Vinayakam S, Ghosh S, Dhungel S. Oral Manifestation of Viral-Induced Erythema Multiforme Major: A Rare Presentation. Indian J Otolaryngol Head Neck Surg 2024; 76:1164-1167. [PMID: 38440462 PMCID: PMC10908995 DOI: 10.1007/s12070-023-04195-1] [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: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 03/06/2024] Open
Abstract
Erythema multiforme is an acute inflammatory mucocutaneous disease manifested as macules, vesicles, bullae, erosion, and papular lesions. In the present case, a 55-year-old female patient reported painful growth in the oral cavity and difficulty in mastication. The patient gave a history of prodromal symptoms before the onset of lesions On intra-oral examination, elevated plaque-like lesions were present bilaterally on lateral borders of the tongue and buccal mucosa near the retromolar region. Extraoral examination revealed concentric erythematous target (or) bull's eye lesions in palms, forearm, and foot. Based on history, clinical examination, and laboratory investigations, recurrent herpes-associated erythema multiforme was diagnosed. We report a rare clinical presentation of recurrent herpes-associated erythema multiforme manifesting as an extensive plaque-like lesion intra-orally.
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Affiliation(s)
- T Jeyanthikumari
- Government Dental College and Hospital, Chennai, Tamil Nadu India
| | | | - Khadijah Mohideen
- Department of Oral Pathology and Microbiology, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, India
| | - S Vinayakam
- Tamilnadu Government Dental College, Chennai, India
| | - Snehashish Ghosh
- Department of Oral Pathology, College of Medical Sciences, Bharatpur, Nepal
| | - Safal Dhungel
- Department of Oral and Maxillofacial Surgery, College of Medical Sciences, Bharatpur, Nepal
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9
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Wang S, Sun J, Deng S, Wu L, Li W, Ye T, Wu F, Wu Y, Zhou H. Lichen planus pemphigoides induced by anti-PD-1 antibody: A case only involved in oral mucosa with excellent topical treatment efficiency. J Cutan Pathol 2024; 51:114-118. [PMID: 37846754 DOI: 10.1111/cup.14547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
Lichen planus pemphigoides (LPP) is a rare autoimmune subepidermal disease that can occur in patients receiving immune checkpoint inhibitors. Its clinical manifestations are combined with the characteristics of lichen planus with bullous pemphigoid that can occur on either skin or oral mucosa. It should be noted that oral LPP is very rare. Here, we report a novel case of oral LPP induced by an anti-PD-1 agent. The patient presented with typical clinical features in oral mucosa, and the diagnosis was based on histopathology and immunological studies. Given that the patient was receiving an anti-PD-1 agent, topical therapy was chosen, and a nice therapeutic effect was obtained. No significant recurrence was observed after a 2-year follow-up. A good and stable therapeutic effect achieved by rapid and local symptomatic medication suggests that accurate and sensitive diagnosis is necessary.
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Affiliation(s)
- Shimeng Wang
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jun Sun
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Oral Medicine, Stomatological Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Shuzhi Deng
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lanyan Wu
- Department of Oral Pathology, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wei Li
- Department of Dermatology & Rare Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tingpei Ye
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fanglong Wu
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yang Wu
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of General Dentistry, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hongmei Zhou
- Department of Oral Medicine, State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Frontier Innovation Center for Dental Medicine Plus, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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10
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Sudo M, Fujimoto K. Diffusive mediator feedbacks control the health-to-disease transition of skin inflammation. PLoS Comput Biol 2024; 20:e1011693. [PMID: 38236792 PMCID: PMC10796066 DOI: 10.1371/journal.pcbi.1011693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/22/2024] Open
Abstract
The spatiotemporal dynamics of inflammation provide vital insights into the understanding of skin inflammation. Skin inflammation primarily depends on the regulatory feedback between pro- and anti-inflammatory mediators. Healthy skin exhibits fading erythema. In contrast, diseased skin exhibits expanding erythema with diverse patterns, which are clinically classified into five types: circular, annular, arcuate, gyrate, and polycyclic. Inflammatory diseases with expanding erythema are speculated to result from the overproduction of pro-inflammatory mediators. However, the mechanism by which feedback selectively drives the transition from a healthy fading erythema to each of the five types of diseased expanding erythema remains unclear. This study theoretically elucidates the imbalanced production between pro- and anti-inflammatory mediators and prospective treatment strategies for each expanding pattern. Our literature survey showed that eleven diseases exhibit some of the five expanding erythema, thereby suggesting a common spatiotemporal regulation underlying different patterns and diseases. Accordingly, a reaction-diffusion model incorporating mediator feedback reproduced the five observed types of diseased expanding and healthy fading patterns. Importantly, the fading pattern transitioned to the arcuate, gyrate, and polycyclic patterns when the productions of anti-inflammatory and pro-inflammatory mediators were lower and higher, respectively than in the healthy condition. Further depletion of anti-inflammatory mediators caused a circular pattern, whereas further overproduction of pro-inflammatory mediators caused an annular pattern. Mechanistically, the bistability due to stabilization of the diseased state exhibits circular and annular patterns, whereas the excitability exhibits the gyrate, polycyclic, arcuate, and fading patterns as the threshold of pro-inflammatory mediator concentration relative to the healthy state increases. These dynamic regulations of diffusive mediator feedback provide effective treatment strategies for mediator production wherein skins recover from each expanding pattern toward a fading pattern. Thus, these strategies can estimate disease severity and risk based on erythema patterns, paving the way for developing noninvasive and personalized treatments for inflammatory skin diseases.
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Affiliation(s)
- Maki Sudo
- Department of Biological Sciences, Osaka University, Machikaneyama-cho, Toyonaka, Japan
- Program of Mathematical and Life Sciences, Graduate School of Integrated Sciences for Life, Hiroshima University, Kagamiyama, Higashi-Hiroshima, Japan
| | - Koichi Fujimoto
- Department of Biological Sciences, Osaka University, Machikaneyama-cho, Toyonaka, Japan
- Program of Mathematical and Life Sciences, Graduate School of Integrated Sciences for Life, Hiroshima University, Kagamiyama, Higashi-Hiroshima, Japan
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11
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Song Z, Jia G, Luo G, Han C, Zhang B, Wang X. Global research trends of Mycoplasma pneumoniae pneumonia in children: a bibliometric analysis. Front Pediatr 2023; 11:1306234. [PMID: 38078315 PMCID: PMC10704248 DOI: 10.3389/fped.2023.1306234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia (MPP), attributable to Mycoplasma pneumoniae (MP), represents a predominant form of community-acquired pneumonia in pediatric populations, thereby posing a significant threat to pediatric health. Given the burgeoning volume of research literature associated with pediatric MPP in recent years, it becomes imperative to undertake a bibliometric analysis aimed at delineating the current research landscape and emerging trends, thereby furnishing a framework for subsequent investigations. METHODS A comprehensive literature search targeting pediatric MPP was conducted in the Web of Science Core Collection. After the removal of duplicate entries through Endnote software, the remaining articles were subject to scientometric analysis via Citespace software, VOSviewer software and R language, focusing on variables such as publication volume, contributing nations, institutions and authors, references and keywords. RESULTS A total of 1,729 articles pertinent to pediatric MPP were included in the analysis. China and the United States emerged as the nations with the highest publication output. Italian scholar Susanna Esposito and Japanese scholar Kazunobu Ouchi were the most influential authors in the domain of pediatric MPP. Highly-cited articles primarily focused on the epidemiological investigation of pediatric MPP, the clinical characteristics and treatment of macrolide-resistant MPP, and biomarkers for refractory Mycoplasma pneumoniae pneumonia (RMPP). From the corpus of 1,729 articles, 636 keywords were extracted and categorized into ten clusters: Cluster #0 centered on molecular-level typing of macrolide-resistant strains; Cluster #1 focused on lower respiratory tract co-infections; Clusters #2 and #6 emphasized other respiratory ailments caused by MP; Cluster #3 involved biomarkers and treatment of RMPP; Clusters #4 and #9 pertained to extrapulmonary complications of MPP, Clusters #5 and #7 addressed etiological diagnosis of MPP, and Cluster #8 explored pathogenic mechanisms. CONCLUSIONS The past few years have witnessed extensive attention directed towards pediatric MPP. Research in pediatric MPP principally revolves around diagnostic techniques for MP, macrolide resistance, complications of MPP, treatment and diagnosis of RMPP, and elucidation of pathogenic mechanisms. The present study provides pediatric clinicians and researchers with the research status and focal points in this field, thereby guiding the orientation of future research endeavors.
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Affiliation(s)
- Zhe Song
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangyuan Jia
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangzhi Luo
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chengen Han
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Baoqing Zhang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Wang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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12
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Alrashdan MS, Arzmi MH, Ahmad Kamil WN, Al Kawas S, Leao JC. Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians. Part I. Ital J Dermatol Venerol 2023; 158:408-418. [PMID: 37916401 DOI: 10.23736/s2784-8671.23.07676-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlapping in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover pemphigus vulgaris and mucous membrane pemphigoid, recurrent aphthous stomatitis, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.
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Affiliation(s)
- Mohammad S Alrashdan
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates -
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan -
| | - Mohd H Arzmi
- Kulliyyah of Dentistry, International Islamic University Malaysia, Pahang, Malaysia
- Cluster of Cancer Research Initiative IIUM (COCRII), International Islamic University Malaysia, Pahang, Malaysia
- Jardin Pharma Berhad, Selangor, Malaysia
| | - Wan N Ahmad Kamil
- Kulliyyah of Dentistry, International Islamic University Malaysia, Pahang, Malaysia
- Cluster of Cancer Research Initiative IIUM (COCRII), International Islamic University Malaysia, Pahang, Malaysia
- Faculty of Dentistry, MARA University of Technology (UiTM), Selangor, Malaysia
| | - Sausan Al Kawas
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Jair C Leao
- Department of Clinics and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil
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Zhang X, Xie Y, Wang L. Rare Cutaneous Side Effects of Imiquimod: A Review on Its Mechanisms, Diagnosis, and Management. Dermatol Ther (Heidelb) 2023; 13:1909-1934. [PMID: 37528289 PMCID: PMC10442311 DOI: 10.1007/s13555-023-00978-0] [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: 04/29/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023] Open
Abstract
As an immune-response modifier, imiquimod can bind to Toll-like receptors on immune cells and enhance innate and adaptive immune responses, exerting potential antitumor and antiviral effects, which led to its approval by the US Food and Drug Administration for the treatment of actinic keratosis, superficial basal cell carcinomas, and anogenital warts, and to its off-label use in treating many other benign and malignant dermatoses. Although topical administration of imiquimod has been considered well tolerated, an increasing number of cutaneous and noncutaneous side effects are being reported as its clinical applications expand. This review primarily focuses on rare cutaneous side effects. To the best of our knowledge, this is the first article to summarize the mechanism, diagnosis, and management of rare cutaneous side effects of imiquimod, which may help to heighten awareness among physicians, especially dermatologists, about potential imiquimod-induced cutaneous side effects.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yao Xie
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lin Wang
- Department of Dermatovenereology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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14
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Murata T, Nobukuni Y. Erythema Multiforme Induced by Zonisamide and Triggered by the First Dose of COVID-19 Vaccine (Pfizer-BioNTech). Am J Ther 2023; 30:e261-e265. [PMID: 37278706 DOI: 10.1097/mjt.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Tsukasa Murata
- Kumamoto Seimei Hospital, Kumamoto, Japan. Dr. Nobukuni is now with the Mashiki Hospital. Kamimashiki, Japan
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15
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Lee H, Davoudi J, Vistoso A, Khalifeh M, Sedghizadeh P. Reactivated herpetic gingivostomatitis with secondary herpes‐associated erythema multiforme and oral candidiasis post‐COVID infection: A case report. Clin Case Rep 2023; 11:e7175. [PMID: 37006852 PMCID: PMC10064031 DOI: 10.1002/ccr3.7175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
The presence and reactivation of oral lesions such as herpetic gingivostomatitis, erythema multiforme, and candidiasis in a COVID‐19 recovered patient could be related to COVID‐19s profound role in immune dysregulation or related therapies.
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Affiliation(s)
- Haeseong Lee
- Herman Ostrow School of DentistryUniversity of Southern CaliforniaLos AngelesCalifornia90089USA
| | - Jouliana Davoudi
- Department of Periodontology and Diagnostic Sciences, Herman Ostrow School of DentistryUniversity of Southern CaliforniaLos AngelesCalifornia90089USA
| | - Anette Vistoso
- Department of Periodontology and Diagnostic Sciences, Herman Ostrow School of DentistryUniversity of Southern CaliforniaLos AngelesCalifornia90089USA
| | - Mohammad Khalifeh
- Department of Periodontology and Diagnostic Sciences, Herman Ostrow School of DentistryUniversity of Southern CaliforniaLos AngelesCalifornia90089USA
| | - Parish Sedghizadeh
- Department of Periodontology and Diagnostic Sciences, Herman Ostrow School of DentistryUniversity of Southern CaliforniaLos AngelesCalifornia90089USA
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16
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Al Bshabshe A, Mousa WF, Nor El-Dein N. An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of? Diagnostics (Basel) 2023; 13:diagnostics13071290. [PMID: 37046508 PMCID: PMC10093365 DOI: 10.3390/diagnostics13071290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition.
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17
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Takeuchi S, Fukuda K, Tanaka R, Funakoshi T, Takahashi H, Amagai M, Tanikawa A. Successful management of tumor necrosis factor‐α inhibitor‐induced erythema multiforme by switching to a Janus kinase inhibitor in a patient with rheumatoid arthritis and ulcerative colitis. J Dermatol 2022; 50:e117-e118. [PMID: 36412225 DOI: 10.1111/1346-8138.16643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Sakiko Takeuchi
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Keitaro Fukuda
- Department of Dermatology Keio University School of Medicine Tokyo Japan
- Laboratory for Skin Homeostasis RIKEN Center for Integrative Medical Sciences Kanagawa Japan
| | - Ryo Tanaka
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Takeru Funakoshi
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Hayato Takahashi
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Masayuki Amagai
- Department of Dermatology Keio University School of Medicine Tokyo Japan
- Laboratory for Skin Homeostasis RIKEN Center for Integrative Medical Sciences Kanagawa Japan
| | - Akiko Tanikawa
- Department of Dermatology Keio University School of Medicine Tokyo Japan
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18
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Abstract
Annular lichenoid diseases encompass a diverse range of pathologies that present as circular, raised, or flat lesions that may vary in size and number. Examples include annular lichenoid dermatitis of youth, annular lichen planus, erythema dyschromicum perstans, erythema multiforme, fixed drug eruption, lichen sclerosus, neonatal lupus, porokeratosis, subacute cutaneous lupus erythematosus, and lichenoid syphilis. Clinical morphology and histopathology can differentiate these entities.
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A Review with Updated Perspectives on the Antiviral Potentials of Traditional Medicinal Plants and Their Prospects in Antiviral Therapy. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081287. [PMID: 36013466 PMCID: PMC9410304 DOI: 10.3390/life12081287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 02/06/2023]
Abstract
Exploration of the traditional medicinal plants is essential for drug discovery and development for various pharmacological targets. Various phytochemicals derived from medicinal plants were extensively studied for antiviral activity. This review aims to highlight the role of medicinal plants against viral infections that remains to be the leading cause of human death globally. Antiviral properties of phytoconstituents isolated from 45 plants were discussed for five different types of viral infections. The ability of the plants’ active compounds with antiviral effects was highlighted as well as their mechanism of action, pharmacological studies, and toxicological data on a variety of cell lines. The experimental values, such as IC50, EC50, CC50, ED50, TD50, MIC100, and SI of the active compounds, were compiled and discussed to determine their potential. Among the plants mentioned, 11 plants showed the most promising medicinal plants against viral infections. Sambucus nigra and Clinacanthus nutans manifested antiviral activity against three different types of viral infections. Echinacea purpurea, Echinacea augustofolia, Echinacea pallida, Plantago major, Glycyrrhiza uralensis, Phyllanthus emblica, Camellia sinensis, and Cistus incanus exhibited antiviral activity against two different types of viral infections. Interestingly, Nicotiana benthamiana showed antiviral effects against mosquito-borne infections. The importance of phenolic acids, alkamides, alkylamides, glycyrrhizin, epicatechin gallate (ECG), epigallocatechin gallate (EGCG), epigallocatechin (EGC), protein-based plant-produced ZIKV Envelope (PzE), and anti-CHIKV monoclonal antibody was also reviewed. An exploratory approach to the published literature was conducted using a variety of books and online databases, including Scopus, Google Scholar, ScienceDirect, Web of Science, and PubMed Central, with the goal of obtaining, compiling, and reconstructing information on a variety of fundamental aspects, especially regarding medicinal plants. This evaluation gathered important information from all available library databases and Internet searches from 1992 to 2022.
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20
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Kahremany S, Hofmann L, Gruzman A, Dinkova-Kostova AT, Cohen G. NRF2 in dermatological disorders: Pharmacological activation for protection against cutaneous photodamage and photodermatosis. Free Radic Biol Med 2022; 188:262-276. [PMID: 35753587 PMCID: PMC9350913 DOI: 10.1016/j.freeradbiomed.2022.06.238] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023]
Abstract
The skin barrier and its endogenous protective mechanisms cope daily with exogenous stressors, of which ultraviolet radiation (UVR) poses an imminent danger. Although the skin is able to reduce the potential damage, there is a need for comprehensive strategies for protection. This is particularly important when developing pharmacological approaches to protect against photocarcinogenesis. Activation of NRF2 has the potential to provide comprehensive and long-lasting protection due to the upregulation of numerous cytoprotective downstream effector proteins that can counteract the damaging effects of UVR. This is also applicable to photodermatosis conditions that exacerbate the damage caused by UVR. This review describes the alterations caused by UVR in normal skin and photosensitive disorders, and provides evidence to support the development of NRF2 activators as pharmacological treatments. Key natural and synthetic activators with photoprotective properties are summarized. Lastly, the gap in knowledge in research associated with photodermatosis conditions is highlighted.
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Affiliation(s)
- Shirin Kahremany
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel; The Skin Research Institute, The Dead Sea and Arava Science Center, Masada, 86910, Israel
| | - Lukas Hofmann
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Arie Gruzman
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, Ramat-Gan, 5290002, Israel
| | - Albena T Dinkova-Kostova
- Jacqui Wood Cancer Centre, Division of Cellular Medicine, School of Medicine, University of Dundee, Dundee, UK; Department of Pharmacology and Molecular Sciences and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Guy Cohen
- The Skin Research Institute, The Dead Sea and Arava Science Center, Masada, 86910, Israel; Ben-Gurion University of the Negev, Eilat Campus, Eilat, 8855630, Israel.
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21
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Wang CC, Li YL, Chiu PY, Chen C, Chen HC, Chen FA. Protective effects of corni fructus extract in mice with potassium oxonate-induced hyperuricemia. J Vet Med Sci 2022; 84:1134-1141. [PMID: 35781421 PMCID: PMC9412062 DOI: 10.1292/jvms.21-0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Corni fructus is consumed as food and herbal medicine in Chinese culture. Studies have
revealed that corni fructus exhibits potent antioxidant activity; however, few studies
have investigated the ability of corni fructus to lower uric acid concentrations. In this
study, the xanthine oxidase (XO) inhibition and uric acid–lowering effect of corni fructus
extract (CFE) were evaluated in mice with potassium oxonate–induced hyperuricemia.
Hyperuricemia is a chronic disease prevalent worldwide and is associated with high
recurrence rates. In addition, drugs used to treat hyperuricemia induce side effects that
discourage patient compliance. Hyperuricemia induces metabolic imbalances resulting in
accumulative uric acid deposition in the joints and soft tissues. Hyperuricemia not only
induces gout but also interrupts hepatic and renal function, thereby trigging severe
inflammation and various complications, including obesity, nonalcoholic fatty liver
disease, diabetes, and metabolic diseases. In this study, the ethyl acetate fraction (EAF)
of CFE resulted in yields of antioxidant photochemical components significantly higher
than those of CFEs formed using other substances. The EAF of CFE exhibited high free
radical scavenging activity and XO inhibition and effectively lowered uric acid
concentrations in the animal model of chemically induced hyperuricemia. The results of
this study can serve as a reference for the prevention of preclinical gout as well as for
functional food research.
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Affiliation(s)
| | - You-Liang Li
- Department of Pharmacy and Master Program, Tajen University
| | - Po-Yen Chiu
- Department of Pharmacy and Master Program, Tajen University
| | - Chun Chen
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University
| | - Hung-Che Chen
- Department of Pharmacy and Master Program, Tajen University
| | - Fu-An Chen
- Department of Pharmacy and Master Program, Tajen University
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22
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Suwarsa O, Dewi IP, Sutedja E, Dharmadji HP, Gunawan H, Pangastuti M. A Case Report: Clinical Efficacy of Combination Treatment of Dexamethasone and Azathioprine in Recurrent Erythema Multiforme. Int Med Case Rep J 2022; 15:355-359. [PMID: 35832787 PMCID: PMC9271803 DOI: 10.2147/imcrj.s364608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Recurrent erythema multiforme (REM) may have frequent episodes over a period of several years and is considered to be a hypersensitivity reaction associated with infection or medication. REM is a mucocutaneous disorder which is characterized by targetoid lesions. Most of the cases are caused by herpes simplex virus infection. Systemic corticosteroid is frequently used to treat REM due to its effects in suppressing the disease. When REM is unresponsive to systemic corticosteroid, steroid-sparing treatment needs to be instituted. We reported a case of REM in a 49-year-old male. There were complaints of burning sensations on the skin lesions, along with swelling on both hands. On physical examination, erythematous macules and targetoid lesions were found on both palms, arms, and legs. During hospitalization, dexamethasone 20 mg was administered in a tapering dose but new skin lesions still appeared. Two days after azathioprine 50 mg twice daily was added to the treatment, skin lesions and swelling on the patient’s hands were diminished and the burning sensation disappeared. No side effects of azathioprine were found in this patient and no recurrence until two weeks after hospitalization. This case report demonstrated the efficacy of combined treatment of dexamethasone and azathioprine for REM cases unresponsive to systemic corticosteroid.
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Affiliation(s)
- Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
- Correspondence: Oki Suwarsa, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62222032426 ext. 3449, Fax +62222032426, Email
| | - Isabella Puspa Dewi
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hartati Purbo Dharmadji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Miranti Pangastuti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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23
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Ivanovskii VA, Antonova IN, Molokova VA. The role of Herpes Simplex Virus type 1 in oral diseases in children. Pediatr Dent 2022. [DOI: 10.33925/1683-3031-2022-22-2-143-151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Relevance. Herpes virus infections are the most common and poorly controllable viral infections. There are many difficulties in herpetic lesion verification and treatment in dental practice.Purpose. The study aimed to present the results of a foreign publication investigation on the role of herpes simplex virus type 1 in the development of oral diseases in children.Material and methods. Foreign scientific articles about the oral HSV-1 infections published from 2018 to 2022 formed the basis for the study. The study searched the publications on PubMed and Google Scholar bases.Results. The article presents the newest data on the prevalence, clinical characteristics and diagnosis of oral HSV infection in children. Primary herpetic gingivostomatitis (PHGS), chronic recurrent herpetic gingivostomatitis, chronic recurrent herpes labialis are the main clinical presentations of herpes infection diagnosed in a dental practice. Primary herpetic gingivostomatitis is very common in children aged six months to fve years and occurs in newborns from 2 to 43 days of life. Modern virology success can improve diagnosis and treatment of oral herpetic lesions.Conclusion. Primary herpetic gingivostomatitis is an acute infectious disease that requires the joint attention of a general practitioner and a dentist to ensure comprehensive treatment.
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24
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Urticarial vasculitis: Clinical and laboratory findings with a particular emphasis on differential diagnosis. J Allergy Clin Immunol 2022; 149:1137-1149. [PMID: 35396080 DOI: 10.1016/j.jaci.2022.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 12/22/2022]
Abstract
Urticarial vasculitis (UV) is a rare cutaneous vasculitis of small vessels characterized by recurrent episodes of wheal-like lesions that tend to last more than 24 hours, healing with a residual ecchymotic postinflammatory hyperpigmentation. The histopathologic pattern of UV is that of leukocytoclastic vasculitis, consisting of fibrinoid necrosis of dermal vessels' walls and neutrophil-rich perivascular inflammatory infiltrates. Although its etiopahogenesis remains still undefined, UV is now regarded as an immune complex-driven disease with activation of the complement cascade, leading to exaggerated production of anaphylatoxins that are responsible for neutrophil recruitment and activation. This condition can be categorized into 2 main entities according to serum complement levels: normocomplementemic UV and hypocomplementemic UV, the latter being associated with circulating anti-C1q autoantibodies and possible extracutaneous manifestations. Systemic multiorgan involvement may be seen particularly in syndromic hypocomplementemic UV, also known as McDuffie syndrome. This review summarizes the clinicopathological and laboratory features as well as the underlying pathophysiological mechanisms of UV. A focus on its main differential diagnoses is provided, that is, chronic spontaneous urticaria, bullous pemphigoid, IgA (Henoch-Schönlein purpura) and IgM/IgG immune complex vasculitis, lupus erythematous tumidus, Wells syndrome, erythema multiforme, cutaneous mastocytosis, cryopyrin-associated periodic syndromes, and coronavirus disease 2019-associated and anti-severe acute respiratory syndrome coronavirus 2-vaccine-associated urticarial eruptions.
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25
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Zaouak A, Daldoul M, Chamli A, Frioui R, Khanchel F, Brahim EB, Fenniche S, Hammami H. Cefixime-induced bullous erythema multiforme major. Int J Dermatol 2022; 61:e280-e282. [PMID: 35141882 DOI: 10.1111/ijd.16119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Anissa Zaouak
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Mouna Daldoul
- Pharmacovigilance Department, University of Medicine of Tunis, Tunis, Tunisia
| | - Amal Chamli
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Refka Frioui
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Fatma Khanchel
- Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Ehsen Ben Brahim
- Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Samy Fenniche
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Houda Hammami
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
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26
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Mohammed JQ, Mahmmod Z, Mathkhor AJ. Adalimumab-Induced Erythema Multiforme in a Patient With Rheumatoid Arthritis: A Case Report. Cureus 2022; 14:e21126. [PMID: 35036238 PMCID: PMC8752112 DOI: 10.7759/cureus.21126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Tumor necrosis factor-alpha (TNF-α) inhibitors are a group of biological medications that revolutionized the treatment of rheumatoid arthritis (RA) and several other inflammatory autoimmune diseases. The wide use of these drugs has been associated with some adverse reactions. Erythema multiforme (EM) is an immune-mediated cutaneous disorder that represents a hypersensitivity reaction to infections, vaccines, and some medications. We present a female patient with EM with characteristic skin lesions following anti-TNF-α medication adalimumab for rheumatoid arthritis.
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27
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Zhu Q, Wang D, Peng D, Xuan X, Zhang G. Erythema multiforme caused by varicella-zoster virus: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221127657. [PMID: 36189457 PMCID: PMC9516419 DOI: 10.1177/2050313x221127657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Erythema multiforme is a widespread hypersensitivity reaction, its pathogenesis is
related to a variety of factors, including drugs and viral and bacterial infections. It is
true that erythema multiforme is often caused by viruses while current studies suggest
that it is mostly associated with herpes simplex virus infection, rarely associated with
varicella-zoster virus infection. Here, we report a 50-year-old man admitted to our
hospital because of rashes on the left rib with pain for 9 days and on limbs and hands for
2 days. Laboratory data showed that varicella-zoster virus (VZV-DNA) test was negative in
blood by qualitative polymerase chain reaction. Herpes zoster virus IgM (VZV-IgM) enzyme
linked immune sorbent assay was negative, and herpes zoster virus IgG (VZV-IgG) enzyme
linked immune sorbent assay was positive. Herpes zoster and erythema multiforme was
diagnosed. After treatment with antiviral, antiallergic, and topical drugs, the rashes was
significantly improved. Our case report contributes to the pathogenesis of erythema
multiforme.
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Affiliation(s)
- Qing Zhu
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongxue Wang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dandan Peng
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaomei Xuan
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoqiang Zhang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
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28
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Senger B, Memar SA, Ahmann A, Houser JJ, Doughty-McDonald L. Dermatologic and Ophthalmologic Treatment of Erythema Multiforme Major: A Case Report. Cureus 2021; 13:e20854. [PMID: 35111489 PMCID: PMC8795857 DOI: 10.7759/cureus.20854] [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] [Accepted: 12/28/2021] [Indexed: 11/05/2022] Open
Abstract
Erythema multiforme major (EMM) is a rare type IV cytotoxic reaction targeting keratinocytes of the mucosal surfaces and the dermis. Dusky, targetoid lesions with central clearing are classically present, which may become blistered and rupture. The disease is usually self-limited and managed with supportive care and treatment of the underlying condition. The most common triggering factors are adverse reactions to medications, herpes simplex virus (HSV), and Mycoplasma pneumoniae. Rapid recognition of EMM is essential to avoid long-term complications. This case presents a 39-year-old male with a unique history of recent non-steroidal anti-inflammatory drug (NSAID) use, past infection with HSV-1, and an acute Mycoplasma pneumoniae infection. The patient developed painful lesions on the skin, oral mucosa, ocular surfaces, and urethra. The painful lesions caused complications with feeding and voiding. Initially, the triggering event was unclear. Supportive care was started. NSAIDs were discontinued and similarly-structured drugs were avoided. Treatments targeting Mycoplasma pneumoniae and HSV-1 were initiated while lab results were pending. Once the results returned, the treatment regimen of corticosteroids for inflammation, acyclovir for HSV-1, and azithromycin for Mycoplasma pneumoniae was continued. Vaseline was applied to open lesions. The patient was also treated with mouthwash consisting of aluminum (Al) hydroxide/magnesium (Mg) hydroxide/simethicone (400 mg/400 mg/40 mg). Topical 2% lidocaine gel with applicator was used to assist with urinary discomfort during voiding. Fentanyl was used for pain control. The patient successfully recovered and was discharged to follow-up with ophthalmology. Long-term sequelae including trichiasis, symblepharon, and punctal stenosis were noted during follow-up appointments.
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29
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Bromley M, Marsh S, Layton A. Life-threatening skin conditions presenting to critical care. BJA Educ 2021; 21:376-383. [PMID: 34567792 DOI: 10.1016/j.bjae.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - S Marsh
- Harrogate District Hospital, Harrogate, UK
| | - A Layton
- Harrogate District Hospital, Harrogate, UK
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30
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Klein BA, Alves FA, de Santana Rodrigues Velho J, Vacharotayangul P, Hanna GJ, LeBoeuf NR, Shazib MA, Villa A, Woo SB, Sroussi H, Sonis S, Treister NS. Oral manifestations of immune-related adverse events in cancer patients treated with immune checkpoint inhibitors. Oral Dis 2021; 28:9-22. [PMID: 34265157 DOI: 10.1111/odi.13964] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/13/2021] [Accepted: 07/08/2021] [Indexed: 12/24/2022]
Abstract
Immunotherapy with immune checkpoint inhibitors (ICIs) has transformed cancer treatment over the past decade, improving survival rates in numerous advanced cancers. Immune-related adverse events (irAEs) are common and can affect any organ system, with many of these toxicities being well-characterized with clear grading criteria and management approaches. There has been less emphasis on oral manifestations of irAEs. This review provides an overview of oral manifestations of irAEs, including mucosal and salivary gland toxicities, and proposes a grading system and management guidelines. irAEs are common treatment-related toxicities in patients treated with ICIs. Oral irAEs can range from asymptomatic white reticulations to life-threatening mucocutaneous reactions requiring aggressive management with corticosteroids and/or permanent discontinuation of ICIs. Oral healthcare providers should be prepared to identify and manage oral irAEs in collaboration with oncologists and other specialists.
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Affiliation(s)
- Brittany A Klein
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Fábio Abreu Alves
- A.C. Camargo Cancer Center, São Paulo, Brazil.,University of São Paulo School of Dentistry, São Paulo, Brazil
| | | | - Piamkamon Vacharotayangul
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Glenn J Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Center for Cutaneous Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Muhammad Ali Shazib
- Division of Craniofacial and Surgical Care, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, NC, USA
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Hervé Sroussi
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
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31
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Peden KS, Peters-Kennedy J, Clark MD, Miller JE. Erythema multiforme complicated by bacterial folliculitis in a 3-year-old Nubian goat. Vet Dermatol 2021; 32:389-e111. [PMID: 34033160 DOI: 10.1111/vde.12979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
Erythema multiforme is a rare hypersensitivity reaction that is reported in several domestic animal species, and not in goats. This case report describes the clinical and histopathological features of erythema multiforme and secondary bacterial skin infection in a goat.
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Affiliation(s)
- Kaitlyn S Peden
- Departments of, Department of, Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Jeanine Peters-Kennedy
- Departments of, Department of, Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA.,Department of, Biomedical Sciences (Section of Anatomic Pathology), College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Mitzi D Clark
- Departments of, Department of, Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Julia E Miller
- Departments of, Department of, Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
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32
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Erythema Multiforme Attributable to Herpes Simplex Virus: Clinical Aspects and Treatment. Case Rep Dent 2021; 2021:6692495. [PMID: 34055423 PMCID: PMC8131160 DOI: 10.1155/2021/6692495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/18/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022] Open
Abstract
Erythema multiforme is an acute mucocutaneous hypersensitivity reaction with various etiological factors, including herpes simplex virus, medications, autoimmune diseases, and malignancies, but the most common cause is infection by herpes simplex virus. The most characteristic feature is the presence of “target lesions.” There are no specific diagnostic tests for EM, and the diagnosis is based on clinical signs and symptoms and biopsy if required. We report a case of recurrent herpes-associated erythema multiforme managed with prophylactic acyclovir for 6 months: a 17-year-old boy had recurrent cutaneous lesions as well as lesions in the oral cavity and lips. Positive serology for herpes simplex virus and histopathological examination confirmed the diagnosis.
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33
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Clinical Manifestations and Epigenetic Regulation of Oral Herpesvirus Infections. Viruses 2021; 13:v13040681. [PMID: 33920978 PMCID: PMC8071331 DOI: 10.3390/v13040681] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/20/2022] Open
Abstract
The oral cavity is often the first site where viruses interact with the human body. The oral epithelium is a major site of viral entry, replication and spread to other cell types, where chronic infection can be established. In addition, saliva has been shown as a primary route of person-to-person transmission for many viruses. From a clinical perspective, viral infection can lead to several oral manifestations, ranging from common intraoral lesions to tumors. Despite the clinical and biological relevance of initial oral infection, little is known about the mechanism of regulation of the viral life cycle in the oral cavity. Several viruses utilize host epigenetic machinery to promote their own life cycle. Importantly, viral hijacking of host chromatin-modifying enzymes can also lead to the dysregulation of host factors and in the case of oncogenic viruses may ultimately play a role in promoting tumorigenesis. Given the known roles of epigenetic regulation of viral infection, epigenetic-targeted antiviral therapy has been recently explored as a therapeutic option for chronic viral infection. In this review, we highlight three herpesviruses with known roles in oral infection, including herpes simplex virus type 1, Epstein–Barr virus and Kaposi’s sarcoma-associated herpesvirus. We focus on the respective oral clinical manifestations of these viruses and their epigenetic regulation, with a specific emphasis on the viral life cycle in the oral epithelium.
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34
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Zengin HB, Pukhalskaya T, Smoller BR. Role of CD123 (+) Plasmacytoid Dendritic Cells in Etiologically Different Variants of Erythema Multiforme: A Monocentric Retrospective Study. Dermatopathology (Basel) 2021; 8:89-96. [PMID: 33916862 PMCID: PMC8167774 DOI: 10.3390/dermatopathology8020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Plasmacytoid dendritic cells (pDCs) constitute a subset of dendritic cells known to be the “professional” interferon type I (IFN-I) producers. pDCs play an important role in antiviral immunity, as well as linking innate and adaptive immunity. Under normal conditions pDCs are not present in skin. They are shown to be a part of the inflammatory infiltrate in different skin conditions including erythema multiforme (EM). This condition is considered to be a cell-mediated immune reaction to a wide variety of agents, most commonly herpes simplex virus. Nevertheless, the pathophysiology of EM still remains unclear. In this study, we grouped 32 biopsies from 30 patients diagnosed with EM, based on their etiology and analyzed the density and distribution of CD123 positive pDCs. In all cases we observed a greatly increased number of pDCs in the dermal inflammatory infiltrate. Virally-induced EM (by herpes simplex virus (HSV) and other viruses) was more likely to have a significantly higher number of pDCs compared to non-virally associated EM. Hence, we think that pDCs play a key role in the pathogenesis of EM independent of etiology and may play an increased role in virally-associated cases. Further studies on pDCs would clarify their importance in EM and improve our understanding of the pathophysiology of this disease.
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35
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Brazel D, Kulp B, Bautista G, Bonwit A. Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM? J Pediatric Infect Dis Soc 2021; 10:220-224. [PMID: 32275058 DOI: 10.1093/jpids/piaa028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/13/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM. CASE PRESENTATION A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered. DISCUSSION Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient's symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options.
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Affiliation(s)
| | - Brooke Kulp
- Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Geoanna Bautista
- Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois, USA
| | - Andrew Bonwit
- Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois, USA
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36
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Ishikawa-Nishimura M, Kondo M, Matsushima Y, Habe K, Yamanaka K. A Case of Pruritic Urticarial Papules and Plaques of Pregnancy: Pathophysiology and Serum Cytokine Profile. Case Rep Dermatol 2021; 13:18-22. [PMID: 33613229 PMCID: PMC7879330 DOI: 10.1159/000511494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/08/2020] [Indexed: 01/22/2023] Open
Abstract
We report a case of pruritic urticarial papules and plaques of pregnancy (PUPPP) starting with target lesions on both forearms at the end of second pregnancy. The patient's target lesions became generalized itchy edematous eczema lesions especially on her abdomen extended by pregnancy, which immediately disappeared postpartum. The mechanism PUPPP has not been elucidated so far; however, the typical target lesion was the initial phenotype in the current case. To approach the pathophysiology of PUPPP, we examined the cytokine profile in the patient's serum before and after delivery. The upregulated Th2 cytokine profile including IL-9 and IL-33, and the reaction against skin-resident bacteria and fungus might be involved in PUPPP.
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Affiliation(s)
| | - Makoto Kondo
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshiaki Matsushima
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koji Habe
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
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37
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Croitoru D, Brooks SG, Piguet V, MacGillivray L. Cetirizine-induced psychosis in a young adult with erythema multiforme. BMJ Case Rep 2021; 14:e241393. [PMID: 33547112 PMCID: PMC7871271 DOI: 10.1136/bcr-2020-241393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
Abstract
We describe a case of a young man, taking no other routine medications, presenting with erythema multiforme and cetirizine-induced psychosis with re-challenge evidence. On retrospective elicitation of history, it was found that he had been involved in a motor vehicle collision 4 months prior and was a daily cannabis user; there were no objective abnormalities by MRI and neurological evaluations. Although rare, cetirizine-induced psychosis is an important adverse drug reaction that warrants the attention of healthcare practitioners.
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Affiliation(s)
- David Croitoru
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Lindsey MacGillivray
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
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38
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Fan X, Luo Y, Lu J, Xu J, Chen Q, Guo H, Jin P. Erythema Multiforme Major Associated With Community-Acquired Pneumonia: Lessons From a Case Report. Front Pediatr 2021; 9:698261. [PMID: 34395342 PMCID: PMC8358431 DOI: 10.3389/fped.2021.698261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Erythema multiforme (EM) is an acute immune-mediated inflammatory mucinous skin disorder. The etiology of pediatric EM involves infections, medications, autoimmune diseases, and genetic factors. Case Report: An 8-year-old girl with Mycoplasma pneumoniae (MP) associated community-acquired pneumonia developed erythema target-like symptoms 1 week after azithromycin administration. The erythema quickly spread throughout the body involving the oral and ocular mucous membranes, the trunk, and the extremities, and eventually developed into erythema multiform major (EMM). Through drug withdrawal and specific treatment including systemic corticosteroids and supportive care, her clinical symptoms were improved. After 31 days, most of the mucocutaneous symptoms were relieved, except pigmentation. Human leukocyte antigen (HLA) gene sequencing was performed and 20 HLA genotypes were identified. The patient follow-up lasted for 18 months. Rashes appeared on her trunk when receiving azithromycin orally after discharge and then disappeared after azithromycin withdrawal. Conclusions: Pediatric EM is a rare disease and recognition of its etiology is important for EM management. In this case, azithromycin and HLA-DQB1 * 03:01 genotype may contribute to EMM. Lesson: For drug-induced EM, rapid identification and withdrawal of the causative drugs is critical. Re-exposure to the same drug or exposure to drugs with similar chemical structures should also be avoided. Patient education and rational use of medicines are essential for pediatric patients.
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Affiliation(s)
- Xiaomei Fan
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Yong Luo
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Jieluan Lu
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Jinji Xu
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Qing Chen
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Huijuan Guo
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
| | - Ping Jin
- Shenzhen Baoan Women's and Children's Hospital, Jinan University, Shenzhen, China
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39
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Haitz K, Morrison B. Erythema multiforme associated with Entamoeba histolytica. JAAD Case Rep 2020; 7:36-37. [PMID: 33319000 PMCID: PMC7727291 DOI: 10.1016/j.jdcr.2020.10.017] [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: 11/26/2022] Open
Affiliation(s)
- Karyn Haitz
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Brian Morrison
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
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40
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Bucciol G, Delafontaine S, Moens L, Corveleyn A, Morren MA, Meyts I. Pathogenic TLR3 Variant in a Patient with Recurrent Herpes Simplex Virus 1-Triggered Erythema Multiforme. J Clin Immunol 2020; 41:280-282. [PMID: 33174085 DOI: 10.1007/s10875-020-00907-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Giorgia Bucciol
- Laboratory of Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Leuven University Hospitals, Leuven, Belgium
| | - Selket Delafontaine
- Laboratory of Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Department of Pediatrics, Leuven University Hospitals, Leuven, Belgium
| | - Leen Moens
- Laboratory of Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Anniek Corveleyn
- Center for Human Genetics, Leuven University Hospitals, Leuven, Belgium
| | - Marie-Anne Morren
- Department of Dermatology, Leuven University Hospitals, Leuven, Belgium.,Pediatric Dermatology Unit, Department of Pediatrics and Dermato-Venereology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Isabelle Meyts
- Laboratory of Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium. .,Department of Pediatrics, Leuven University Hospitals, Leuven, Belgium.
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41
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42
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Frizzell M, Nguyen NM, Parikh SA, Sinai M, Goldberg L. Erythema multiforme following exposure to the herbicide atrazine. Proc AMIA Symp 2020; 34:91-92. [PMID: 33456156 DOI: 10.1080/08998280.2020.1829935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Erythema multiforme is an acute hypersensitivity eruption with sharply demarcated papules and plaques. It has many known causes, from herpes simplex virus and drugs to malignancy and environmental factors. Although other herbicides have been linked to erythema multiforme, no previous reports have described a link with atrazine. We present a 24-year-old man with difficulty breathing, bilateral eye pain with redness, and a diffuse rash consistent with erythema multiforme following occupational exposure to atrazine.
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Affiliation(s)
| | - Nhan M Nguyen
- DermSurgery Associates, Houston Methodist, Houston, Texas
| | - Sonal A Parikh
- DermSurgery Associates, Houston Methodist, Houston, Texas
| | - Maya Sinai
- DermSurgery Associates, Houston Methodist, Houston, Texas
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43
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Gandelman JS, Kim EY, Grzegorczyk AM, Zejnullahu K, Edson RS. Mycoplasma pneumoniae-Induced Rash and Mucositis in a Previously Healthy Man: A Case Report and Brief Review of the Literature. Open Forum Infect Dis 2020; 7:ofaa437. [PMID: 33094121 PMCID: PMC7568429 DOI: 10.1093/ofid/ofaa437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/11/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
We describe a case of a 33-year-old-male with Mycoplasma pneumoniae-induced rash and mucositis and review the literature on this newly described syndrome.
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Affiliation(s)
- Jocelyn S Gandelman
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, California, USA
| | - Elizabeth Y Kim
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, California, USA
| | - Anne M Grzegorczyk
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, California, USA
- Division of Hospital Medicine, California Pacific Medical Center, San Francisco, California, USA
| | - Kreshnik Zejnullahu
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, California, USA
- Division of Hospital Medicine, California Pacific Medical Center, San Francisco, California, USA
| | - Randall S Edson
- Department of Internal Medicine, California Pacific Medical Center, San Francisco, California, USA
- Division of Infectious Diseases, California Pacific Medical Center, San Francisco, California, USA
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44
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Bau JT, Cooper CL. Erythema multiforme major associated with Mycoplasma pneumoniae infection. CMAJ 2020; 191:E1195. [PMID: 31659061 DOI: 10.1503/cmaj.190850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jason T Bau
- Divisions of General Internal Medicine (Bau) and Infectious Diseases (Cooper), Department of Medicine, University of Ottawa, Ottawa, Ont.
| | - Curtis L Cooper
- Divisions of General Internal Medicine (Bau) and Infectious Diseases (Cooper), Department of Medicine, University of Ottawa, Ottawa, Ont
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45
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Trčko K. Imiquimod-Associated Erythema Multiforme. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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46
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De Luigi G, Zgraggen L, Kottanattu L, Simonetti GD, Terraneo L, Vanoni F, Terrani I, Bianchetti MG, Lava SAG, Milani GP. Skin and Mucous Membrane Eruptions Associated with Chlamydophila Pneumoniae Respiratory Infections: Literature Review. Dermatology 2020; 237:230-235. [PMID: 32222707 DOI: 10.1159/000506460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia is sometimes associated with skin or mucous membrane eruptions. Available reviews do not address the association of Chlamydophila pneumoniae pneumonia with skin eruptions. We therefore conducted a systematic review of the literature addressing this issue. The National Library of Medicine, Excerpta Medica, and Web of Science databases were employed. SUMMARY In two reports, skin lesions and especially urticaria were more common (p < 0.05) in atypical pneumonia caused by C. pneumoniae as compared with M. pneumoniae. We found 47 patients (<18 years, n = 16; ≥18 years, n = 31) affected by a C. pneumoniae atypical pneumonia, which was associated with erythema nodosum, erythema multiforme minus, erythema multiforme majus, isolated mucositis, or cutaneous vasculitis. We also found the case of a boy with C. pneumoniae pneumonia and acute generalized exanthematous pustulosis. We did not find any case of C. pneumoniae respiratory infection associated with either Gianotti-Crosti syndrome, pityriasis lichenoides et varioliformis acuta Mucha-Habermann, or varicella-like skin eruptions.
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Affiliation(s)
| | - Lorenzo Zgraggen
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Giacomo D Simonetti
- Università della Svizzera Italiana, Lugano, Switzerland.,Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Luisa Terraneo
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Federica Vanoni
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Isabella Terrani
- Department of Dermatology Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Mario G Bianchetti
- Università della Svizzera Italiana, Lugano, Switzerland.,Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland,
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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47
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Forouzan P, Riahi RR, Cohen PR. Atorvastatin-induced Lichenoid Drug Eruption: A Case Report and Review of Statin-associated Cutaneous Adverse Events. Cureus 2020; 12:e7155. [PMID: 32257699 PMCID: PMC7108677 DOI: 10.7759/cureus.7155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Statin medications [3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors] are generally used to treat hypercholesterolemia. Lichenoid drug eruptions are a potential cutaneous side effect of medications including antibiotics, antimalarials, and statins. This drug eruption can mimic features of idiopathic lichen planus in clinical presentation and pathology. We describe the case of a 73-year-old man who developed a lichenoid drug eruption secondary to atorvastatin. His clinical features, in addition to histological findings, helped to establish the diagnosis. The cutaneous eruption resolved one month after the cessation of atorvastatin and with corticosteroid therapy. Statins have been associated with adverse events including bullous dermatosis, eosinophilic fasciitis, lichenoid drug eruption, and phototoxicity. Lichenoid drug eruption associated with statin therapy requires discontinuation of the statin medication; an alternative class of medication for the treatment of hypercholesterolemia is usually necessary.
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Affiliation(s)
- Parnia Forouzan
- Dermatology, University of Texas Medical School, Houston, USA
| | - Ryan R Riahi
- Dermatology, DermSurgery Associates, Sugar Land, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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48
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Kaide CG, San Miguel CE. Stevens Johnson Syndrome – “Steven Who? And Why I Should Care About His Johnson?”. CASE STUDIES IN EMERGENCY MEDICINE 2020. [PMCID: PMC7122494 DOI: 10.1007/978-3-030-22445-5_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosing rashes in the emergency department can be challenging. If the rash is extensive and targetoid, include Stevens-Johnson Syndrome (SJS) on your differential and be sure to obtain a thorough history to identify possible offending agents. Additionally, prioritize supportive care and obtaining a dermatology/burn consult to coordinate appropriate care.
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Affiliation(s)
- Colin G. Kaide
- Wexner Medical Center, Ohio State University, Columbus, OH USA
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Thong BYH, Lucas M, Kang HR, Chang YS, Li PH, Tang MM, Yun J, Fok JS, Kim BK, Nagao M, Rengganis I, Tsai YG, Chung WH, Yamaguchi M, Rerkpattanapipat T, Kamchaisatian W, Leung TF, Yoon HJ, Zhang L, Latiff AHA, Fujisawa T, Thien F, Castells MC, Demoly P, Wang JY, Pawankar R. Drug hypersensitivity reactions in Asia: regional issues and challenges. Asia Pac Allergy 2020; 10:e8. [PMID: 32099830 PMCID: PMC7016324 DOI: 10.5415/apallergy.2020.10.e8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022] Open
Abstract
There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.
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Affiliation(s)
- Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Michaela Lucas
- Department of Immunology, Pathwest and Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Perth, Australia
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Department of Internal Medicine, Seoul National University College of Medicine, Drug Safety Center, Seoul National University Hospital, Seoul, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | | | - James Yun
- Faculty of Medicine and Health, The University of Sydney, Division of Medicine, Nepean Hospital, Sydney, Australia
| | - Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Byung-Keun Kim
- Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Mizuho Nagao
- Allergy Center of Mie National Hospital, Tsu, Japan
| | - Iris Rengganis
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yi-Giien Tsai
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung and Linkou Branches, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Masao Yamaguchi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ticha Rerkpattanapipat
- Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Kamchaisatian
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | | | | | - Francis Thien
- Eastern Health, Melbourne; Monash University, Melbourne, Australia
| | - Mariana C Castells
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France
| | - Jiu-Yao Wang
- Graduate Institute of Medical Sciences, China Medical University, Taichung, Taiwan
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
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50
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Maxfield L, Gaston D, Peck A, Hansen K. Topical Imiquimod and Subsequent Erythema Multiforme. J Osteopath Med 2019; 120:2757847. [PMID: 31841130 DOI: 10.7556/jaoa.2020.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Topical imiquimod is commonly used in the nonsurgical management of actinic keratosis and superficial basal cell carcinoma. Although adverse effects have been limited primarily to local irritation, another rare adverse reaction is erythema multiforme. We present a case of erythema multiforme involving the oral mucosa, trunk, and extremities that followed broad application of topical imiquimod for the management of suspected superficial basal cell skin cancers and actinic keratosis. The patient had used imiquimod previously without complication. Cessation of use and systemic corticosteroids resulted in prompt clearance.
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