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Özhan AK, Demirhan A, Arikoglu T, Karahan F, Satıcı FEG, Tokmeci N, Gündoğan BD, Yalaki Aİ, Akbey V, Karabulut YY, Ünal S, Kuyucu S. Toxic Skin Reactions Should Be Differentiated from Allergic Reactions to Chemotherapeutic Drugs in Children: A Case Series and Review of the Literature. Dermatitis 2024; 35:275-287. [PMID: 38165639 DOI: 10.1089/derm.2023.0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Background: Chemotherapeutic drugs can lead to a wide spectrum of cutaneous findings, ranging from nonimmune toxic reactions to severe immune-mediated hypersensitivity reactions. The aim of this study was to evaluate the clinical, histopathological features, and prognosis of toxic skin reactions to chemotherapeutic drugs and to compare them with characteristics of immune-mediated reactions in children with malignancies. Methods: The medical records of all children with cancer who experienced skin reactions after chemotherapy administration and diagnosed as a toxic skin reaction between 2010 and 2022 were retrospectively analyzed. The diagnosis was re-evaluated and differentiated from other similar disorders by using clinical manifestations, photodocumentation, and histopathological findings. Results: A total of 17 children aged 2-17 years were involved: toxic erythema of chemotherapy (TEC) in 14 children, methotrexate-induced epidermal necrosis in 2 children, and toxic epidermal necrolysis (TEN)-like TEC in 1 child. The most commonly implicated drug was methotrexate. Most patients recovered rapidly after drug cessation and supportive measures. In 10 of the 17 patients, reintroduction of the culprit chemotherapeutic drug at reduced doses or increased dosage intervals was possible without any recurrence. Six patients could not receive further doses since they deceased due to sepsis and other complications. Conclusions: Cutaneous toxic eruptions to chemotherapeutic drugs may present with a severe phenotype resembling Stevens-Johnson syndrome/TEN. An accurate diagnosis prevents potentially harmful therapeutic interventions, withholding of chemotherapy, and erroneous assignment of drug allergies.
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Affiliation(s)
- Aylin Kont Özhan
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ali Demirhan
- Department of Pediatric Allergy and Immunology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Tuğba Arikoglu
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Feryal Karahan
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | | | - Nazan Tokmeci
- Department of Pediatric Allergy and Immunology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Begümhan Demir Gündoğan
- Department of Pediatric Hematology and Oncology, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Aysu İlhan Yalaki
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Veysi Akbey
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | | | - Selma Ünal
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Semanur Kuyucu
- From the Department of Pediatric Allergy and Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey
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2
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Jiang H, Lu J, Wang M. Clinical characteristics of delayed generalized erythema associated with cytarabine. Chronic Dis Transl Med 2024; 10:78-80. [PMID: 38450302 PMCID: PMC10914009 DOI: 10.1002/cdt3.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- He Jiang
- College of PharmacyAnhui University of Chinese MedicineHefeiAnhuiChina
- Department of PharmacyChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Jun Lu
- Department of PharmacyChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
| | - Mei Wang
- College of PharmacyAnhui University of Chinese MedicineHefeiAnhuiChina
- Department of PharmacyChildren's Hospital of Soochow UniversitySuzhouJiangsuChina
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3
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Zhuo S, Dong T, Yue Z, Qian Y, Liu X, Liu W. Association between methotrexate-induced Stevens-Johnson syndrome/toxic epidermal necrolysis and furosemide: a real-world disproportionality analysis. Expert Opin Drug Saf 2024; 23:137-144. [PMID: 37070136 DOI: 10.1080/14740338.2023.2203482] [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: 11/27/2022] [Accepted: 03/15/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and life-threatening skin adverse reactions that are usually induced by drugs. This study aimed to assess the association between methotrexate and SJS/TEN when combined with furosemide. RESEARCH DESIGN AND METHODS Data on suspicious, interactions (PS, SS, I) from the FDA Adverse Event Reporting System database for 2016-2021 were analyzed using the reporting odds ratio (ROR), information component (IC), proportional reporting ratio (PRR) and the Medications and Health Care Products Regulatory Agency (MHRA). RESULTS We identified 28 case reports of TEN associated with the combination of furosemide and methotrexate and 10 reports of SJS associated with furosemide and methotrexate. The association of methotrexate with SJS/TEN was more significant in the entire data set when combined with furosemide than when methotrexate was not combined with furosemide. The association of methotrexate with SJS/TEN remained significant when furosemide was combined with methotrexate in a tumor-based disease context. After sensitivity analysis of the entire dataset as well as all antineoplastic drug datasets, consistent results were observed for TEN. CONCLUSIONS Our study confirmed a significant association between methotrexate and SJS/TEN when combined with furosemide, with an increased risk of SJS/TEN.
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Affiliation(s)
- Shengnan Zhuo
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Tu Dong
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Zhongsheng Yue
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Yating Qian
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Xinling Liu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Wei Liu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
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4
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Singh R, Meena M, Patidar A, Mittal A. Toxic Epidermal Necrolysis-Like Lesions as Cutaneous Manifestation of Acute Methotrexate Toxicity. Indian Dermatol Online J 2021; 12:340-341. [PMID: 33959540 PMCID: PMC8088160 DOI: 10.4103/idoj.idoj_256_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/12/2020] [Accepted: 07/17/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Raju Singh
- Department of Dermatology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Manju Meena
- Department of Dermatology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Abhilasha Patidar
- Department of Dermatology, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Asit Mittal
- Department of Dermatology, R.N.T. Medical College, Udaipur, Rajasthan, India
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5
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King LD, Sia H, Anoopkumar‐Dukie S. Trimethoprim‐sulfamethoxazole as
Pneumocystis jiroveci
pneumonia prevention in patients undergoing methotrexate therapy for hematological malignancies: A review of the literature. Hematol Oncol 2020. [DOI: 10.1002/hon.2823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Liam D. King
- Ramsay Pharmacy John Flynn Private Hospital Tugun Queensland Australia
- School of Pharmacy and Pharmacology Griffith University Southport Queensland Australia
| | - Hanlon Sia
- First in Haematology and Oncology Pindara Private Hospital Benowa Queensland Australia
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6
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Li H, Zhang J, Chen Y. Methotrexate-induced toxic epidermal necrolysis in a child undergoing a combination therapy for systemic lupus erythematosus. Ital J Dermatol Venerol 2020; 156:263-264. [PMID: 33034436 DOI: 10.23736/s2784-8671.20.06621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Huotao Li
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, China.,Hexian Memorial Hospital of Panyu District, Guangzhou, China
| | - Jiao Zhang
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yongfeng Chen
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, China -
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7
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Song X, Guo Y, Zhao H, Hu W. Skin and mucosal ulcerations and acute kidney failure due to methotrexate toxicity in a patient with non-Hodgkin's lymphoma. Indian J Cancer 2019; 55:421-422. [PMID: 30829285 DOI: 10.4103/ijc.ijc_195_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Xia Song
- Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Yinyin Guo
- Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Hui Zhao
- Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, QLD, Australia
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8
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Alaya Z, Mokni S, Guerfala M, Salem CB, Sriha B, Nouira R, Bouajina E. Acute severe cutaneous methotrexate toxicity in a patient with rheumatoid arthritis: Report of a rare side effect. EGYPTIAN RHEUMATOLOGIST 2018. [DOI: 10.1016/j.ejr.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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9
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10
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Liang Y, Yang Z, Xu ZG, Ma L. Toxic epidermal necrolysis after dactinomycin and vincristine combination chemotherapy for nephroblastoma. J Zhejiang Univ Sci B 2018; 18:649-652. [PMID: 28681589 DOI: 10.1631/jzus.b1700065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study, we describe a 2-year-old boy patient with nephroblastoma who has developed toxic epidermal necrolysis (TEN) associated with the combination chemotherapy administration of dactinomycin and vincristine. A skin biopsy confirmed the diagnosis of TEN, and with methylprednisolone pulse therapy, intravenous immunoglobulin (IVIG), and supportive care, the patient improved significantly.
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Affiliation(s)
- Yuan Liang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Zhou Yang
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Zi-Gang Xu
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Lin Ma
- Department of Dermatology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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11
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Hamid M, Lashari B, Ahsan I, Micaily I, Sarwar U, Crocetti J. A deadly prescription: combination of methotrexate and trimethoprim-sulfamethoxazole. J Community Hosp Intern Med Perspect 2018; 8:149-151. [PMID: 29915656 PMCID: PMC5998292 DOI: 10.1080/20009666.2018.1466598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/12/2018] [Indexed: 10/27/2022] Open
Abstract
Methotrexate (MTX) is a chemotherapeutic synthetic(s) phase cell cycle inhibitor, and its role has evolved as an immunological agent in autoimmune diseases like rheumatoid arthritis, psoriasis, and systemic lupus erythematosus, etc. Trimethoprim-sulfamethoxazole (TS) is one of the most widely prescribed antibiotics commonly used for urinary tract infections, exacerbations of chronic bronchitis, traveler's diarrhea, and pneumocystis pneumonia. Both MTX and TS can have significantly overlapping side effects involving dermatologic, renal, and hematological systems, and the combination of these can be deadly. Our case is about the combination of MTX and TS that leads to mucocutaneous ulceration, leukopenia, and renal insufficiency. The purpose of this case is to increase awareness of potentially significant toxicity from the combination of MTX with TS. Abbreviations: MTX: methotrexate; TS: trimethoprim-sulfamethoxazole; ED: emergency department; IV: intravenous; GI: gastrointestinal; NSAIDs: nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- Mohsin Hamid
- Department of Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Bilal Lashari
- Department of Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Irfan Ahsan
- Department of Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Ida Micaily
- Department of Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Usman Sarwar
- Department of Internal Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA
| | - Joseph Crocetti
- Pulmonary and Critical Care, Abington Hospital-Jefferson Health, Abington, PA, USA
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12
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Anticancer Drugs Induced Severe Adverse Cutaneous Drug Reactions: An Updated Review on the Risks Associated with Anticancer Targeted Therapy or Immunotherapies. J Immunol Res 2018; 2018:5376476. [PMID: 29577050 PMCID: PMC5822766 DOI: 10.1155/2018/5376476] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/29/2022] Open
Abstract
Cutaneous adverse drug reactions are commonly seen in patients with anticancer drug treatment. Anticancer drugs, including chemotherapy, target therapy, and recent immunotherapy causing skin reactions ranging from mild skin rash to life-threatening severe cutaneous adverse reactions (SCARs), such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN) with increase morbidity and mortality while they are receiving cancer treatments, have been proposed to be a result of direct skin toxicity or drug hypersensitivity reactions (these are proposed mechanism, not definite). Differentiating SCARs from other more commonly seen reactions with a better outcome help prevent discontinuation of therapy and inappropriate use of systemic immunosuppressants for presumable allergic reactions, of which will affect the clinical outcome. In this article, we have reviewed published articles from 1950 to August 2017 for SJS/TEN associated with anticancer drugs, including chemotherapy, targeted therapy, and immunotherapy. We aimed to provide an overview of SJS/TEN associated with anticancer drugs to increase clinician recognition and accelerate future studies on the pathomechanism and managements.
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13
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Lepist EI, Ray AS. Renal Transporter-Mediated Drug-Drug Interactions: Are They Clinically Relevant? J Clin Pharmacol 2017; 56 Suppl 7:S73-81. [PMID: 27385181 DOI: 10.1002/jcph.735] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 02/04/2023]
Abstract
The kidney, through the distinct processes of passive glomerular filtration and active tubular secretion, plays an important role in the elimination of numerous endobiotics (eg, hormones, metabolites), toxins, nutrients, and drugs. Renal transport pathways mediating active tubular secretion and reabsorption in the proximal tubule are complex, involving apical and basolateral transporters acting in concert. Detailed studies of the molecular mechanisms of net active tubular secretion have established the involvement of multiple transporters with overlapping substrate specificity mediating competing secretion and reabsorption pathways. Although drug interactions arising from inhibition of renal transporters are rare relative to other mechanisms, they can involve commonly administered drugs (eg, cimetidine, metformin), may be underappreciated due to muted effects on plasma pharmacokinetics relative to tissue levels, can affect narrow-therapeutic-index medications (eg, antiarrhythmic, oncology medications), and may disproportionately affect sensitive populations where polypharmacy is common (eg, the elderly, diabetics). In particular, there is the potential for larger-magnitude interactions in subjects with reduced glomerular filtration rates due to the increased relative contribution of tubular secretion. The assessment of additional endpoints in drug-drug interaction studies including pharmacodynamics, positron emission tomography imaging, and metabolomics promises to expand our understanding of the clinical relevance of renal drug interactions.
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Affiliation(s)
- Eve-Irene Lepist
- Department of Drug Metabolism, Gilead Sciences, Inc, Foster City, California
| | - Adrian S Ray
- Department of Drug Metabolism, Gilead Sciences, Inc, Foster City, California
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14
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Chen TJ, Chung WH, Chen CB, Hui RCY, Huang YH, Lu YT, Wang CW, Wang KH, Yang LC, Hung SI. Methotrexate-induced epidermal necrosis: A case series of 24 patients. J Am Acad Dermatol 2017; 77:247-255.e2. [PMID: 28499754 DOI: 10.1016/j.jaad.2017.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Methotrexate-induced epidermal necrosis (MEN) is a rare but life-threatening cutaneous reaction that mimics Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). OBJECTIVES To investigate the clinicopathology, risk factors, and prognostic factors of MEN. METHODS We enrolled 24 patients with MEN and 150 controls and analyzed the demographics, pathology, and plasma concentrations of methotrexate (MTX). RESULTS Patients with MEN showed extensive skin necrosis (mean, 33.2% total body surface area) but no target lesions. The histopathology displayed keratinocyte dystrophy. Early signs of MEN included painful skin erosions, oral ulcers, and leukopenia/thrombocytopenia. Although 79.2% patients received leucovorin treatment, there was 16.7% mortality. Risk factors for MEN included older age (>60 years), chronic kidney disease, and high initial dosage of MTX without folic acid supplementation. Renal insufficiency delayed MTX clearance. Severe renal disease and leukopenia predicted poor prognosis in MEN, but none of the SCORe of Toxic Epidermal Necrosis criteria were associated with mortality of MEN. LIMITATIONS The study was limited by the small sample size. CONCLUSION MEN exhibited distinct clinicopathologic features from SJS/TEN. Recognition of the early signs and prognostic factors is important, because the rapid institution of leucovorin may be helpful. To reduce the risk of MEN, physicians should avoid prescribing MTX to high-risk patients and titrate the dosage slowly upward with folic acid supplementation.
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Affiliation(s)
- Ting-Jui Chen
- Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rosaline Chung-Yee Hui
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yueh-Tsung Lu
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan
| | - Chang-Wei Wang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan
| | - Kuo-Hsien Wang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University Hospital, Taipei, Taiwan
| | - Li-Cheng Yang
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan
| | - Shuen-Iu Hung
- Department and Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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15
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Acute methotrexate toxicity presenting with bullous lesions: an unusual presentation. Eur J Clin Pharmacol 2016; 73:515-516. [PMID: 27975132 DOI: 10.1007/s00228-016-2179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
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Abstract
The incidences of life-threatening toxicities such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are inconsistently reported. The potential association of anticancer agents with SJS or TEN has not been systematically investigated. We searched the literature (Ovid: 1950 to June 2013 and PubMed: 1948 to June 2013) using terms for SJS/TEN and anticancer therapies. Primary case reports, case series, and clinical trials were included. In addition, MedWatch, the Food and Drug Administration Adverse Event Reporting System (FAERS), was searched (1968 to August 2012) for SJS/TEN reports associated with anticancer therapies. Proportional reporting ratios (PRR>2, N>3), empirical Bayes geometric mean (EBGM>2, N>3), and lower 95% confidence interval (EBGM0.05>2) were used as thresholds to constitute a signal of association between SJS/TEN and anticancer drugs. There were 46 SJS and 37 TEN cases associated with 18 and 22 anticancer drugs in the literature, respectively. Among cases in the FAERS, significant signals were associated with SJS for bendamustine and with TEN for bendamustine, busulfan, chlorambucil, fludarabine, lomustine, and procarbazine. Several drugs reported in the published literature to be associated with SJS/TEN were not found to have significant signals in FAERS. Proactive pharmacovigilance to detect and define safety signals serves to aid oncology practitioners in the recognition of possible, yet uncommon, serious, and/or life-threatening skin reactions.
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17
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Gogia A, Pathania S, Das P, Gupta YK, Bakhshi S. Methotrexate-induced toxic epidermal necrolysis in a child. Indian J Dermatol 2013; 58:161. [PMID: 23716841 PMCID: PMC3657251 DOI: 10.4103/0019-5154.108094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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18
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Al-Quteimat OM, Al-Badaineh MA. Methotrexate and trimethoprim-sulphamethoxazole: extremely serious and life-threatening combination. J Clin Pharm Ther 2013; 38:203-5. [DOI: 10.1111/jcpt.12060] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/04/2013] [Indexed: 11/29/2022]
Affiliation(s)
- O. M. Al-Quteimat
- Pharmaceutical Care Department; King Abdullah Medical City; Makkah Saudi Arabia
| | - M. A. Al-Badaineh
- Pharmaceutical Care Department; King Abdullah Medical City; Makkah Saudi Arabia
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19
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Al Mebayadh M, Cosnes A, Ortonne N, Valeyrie-Allanore L. Toxidermies au méthotrexate : deux observations. Ann Dermatol Venereol 2012; 139:472-6. [DOI: 10.1016/j.annder.2012.04.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 03/08/2012] [Accepted: 04/16/2012] [Indexed: 11/16/2022]
Affiliation(s)
- M Al Mebayadh
- Service de dermatologie, centre de référence des maladies bulleuses immunologiques et toxiques, université Paris-Est Créteil (UPEC), hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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20
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Breneman DL, Storer TJ, Breneman JC, Mutasim DF. Methotrexate-induced cutaneous ulceration in patients with erythrodermic mycosis fungoides. Ther Clin Risk Manag 2011; 4:1135-41. [PMID: 19209294 PMCID: PMC2621414 DOI: 10.2147/tcrm.s1155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Methotrexate-induced cutaneous ulceration has rarely been reported in patients with mycosis fungoides. We report 4 patients with mycosis fungoides who developed cutaneous ulceration as an initial manifestation of methotrexate toxicity. Methotrexate dose at the time of ulceration ranged from 10–60 mg. All 4 patients were erythrodermic, which may have predisposed them to this toxic effect. It is important to recognize cutaneous ulceration as an uncommon, but potentially serious, side effect of methotrexate in these patients, and to differentiate it from ulceration due to progressive lymphoma.
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Affiliation(s)
- Debra L Breneman
- University of Cincinnati Medical Center, Dept of Dermatology, Cincinnati, Ohio, USA
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21
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Weyers W, Metze D. Histopathology of drug eruptions - general criteria, common patterns, and differential diagnosis. Dermatol Pract Concept 2011; 1:33-47. [PMID: 24396718 PMCID: PMC3881081 DOI: 10.5826/dpc.0101a09] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/18/2011] [Indexed: 02/06/2023] Open
Abstract
Drug eruptions are among the most common inflammatory diseases of the skin and also among those biopsied most often. Yet, the value of histopathologic examination of drug eruptions has often been disputed. One reason is that the spectrum of histopathologic changes in drug eruptions is broad. Nevertheless, each histopathologic pattern assumed by drug eruptions has a limited number of differential diagnoses, and numerous criteria and clues are available to distinguish drug eruptions from other diseases associated with those patterns. By recognition of common patterns, consideration of differential diagnoses, and attention to distinct clues, a histopathologic diagnosis of drug eruption can usually be made with confidence.
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Affiliation(s)
| | - Dieter Metze
- Department of Dermatology, University of Münster, Münster, Germany
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Hague JS, Kaur MR, Hafiji J, Carr RA, Lewis H, Charles-Holmes R, Heagerty A, Orpin SD. Two cases of pustular toxic epidermal necrolysis. Clin Exp Dermatol 2010; 36:42-5. [PMID: 20497187 DOI: 10.1111/j.1365-2230.2010.03848.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Toxic epidermal necrolysis (TEN) is a life-threatening, immune-mediated reaction, characterized by severe cutaneous and mucosal blisters and erosions. It often presents with flu-like symptoms, followed by a maculopapular, urticarial, purpuric or erythema multiforme-like eruption, which then evolves into blisters and sheet-like erosions. Presentation with pustules, however, is not well described in the English literature, and may lead to delayed diagnosis. We present two unusual cases of TEN that initially presented with pustular lesions.
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Affiliation(s)
- J S Hague
- South Warwickshire General Hospitals NHS Trust, Warwick Hospital, Warwick, UK.
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Teraki Y, Izaki S. Salazosulfapyridine-induced hypersensitivity syndrome triggered by methotrexate. Clin Exp Dermatol 2009; 34:e287-8. [DOI: 10.1111/j.1365-2230.2009.03212.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Wegener's granulomatosis (WG) is the most common pulmonary granulomatous vasculitis and was a uniformly fatal disease prior to the identification of efficacious pharmacological regimens. The pathogenesis of WG remains elusive but proteinase 3-specific anti-neutrophil cytoplasmic antibodies may be involved. Histologically, WG is defined by the triad of small vessel necrotising vasculitis, 'geographic' necrosis and granulomatous inflammation. Organ involvement characteristically includes the upper and lower respiratory tracts and kidney, but virtually any organ can be involved. The severity of the disease varies, ranging from asymptomatic disease to fulminant, fatal vasculitis. Similarly, the degree of organ involvement is highly variable; WG may be limited to a single organ (typically the lungs or upper respiratory tract), or may be systemic. Currently, a regimen consisting of daily cyclophosphamide and corticosteroids, which induces complete remission in the majority of patients, is considered standard therapy. Since approximately 50% of patients experience a relapse following discontinuation of therapy, alternative regimens designed to maintain remissions after using cyclophosphamide and corticosteroids are usually necessary. This 'induction maintenance' approach to treatment has emerged as a central premise in planning therapy for patients with WG.A number of trials have evaluated the efficacy of less toxic immunosuppressants (e.g. methotrexate, azathioprine, mycophenolate mofetil) and antibacterials (i.e. cotrimoxazole [trimethoprim/sulfamethoxazole]) for treating patients with WG, resulting in the identification of effective alternative regimens to induce or maintain remissions in certain sub-populations of patients. Given the efficacy of methotrexate (for early systemic WG) and cotrimoxazole (in WG limited solely to the upper airways) to induce remissions, and the relatively decreased associated morbidity compared with cyclophosphamide, these alternative regimens are preferred in appropriate patients. Similarly, therapeutic options to maintain disease remission that are less toxic than cyclophosphamide should be offered following induction of remission unless a specific contraindication exists. By following this premise, the development of cyclophosphamide-induced morbidities (e.g. haemorrhagic cystitis, uroepithelial cancers and prolonged myelosuppression) may be minimised. Recent investigation has focussed on other immunomodulatory agents (tumour necrosis factor-alpha inhibitors [infliximab and etanercept] and anti-CD20 antibodies [rituximab]) for treating patients with WG. However, the current data are conflicting and difficult to interpret. As a result, these newer agents cannot be recommended for routine use until vigorous clinical study confirms their efficacy.
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Affiliation(s)
- Eric S White
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.
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Houtman PM, Jansen TL, Blanken R. Anaphylactic Reaction in a Patient With Rheumatoid Arthritis: A Rare Side Effect of Methotrexate With Etanercept as a Provoking Factor? J Clin Rheumatol 2006; 12:321-2. [PMID: 17149070 DOI: 10.1097/01.rhu.0000250298.57783.b5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Green MR, Chowdhary S, Lombardi KM, Chalmers LM, Chamberlain M. Clinical utility and pharmacology of high-dose methotrexate in the treatment of primary CNS lymphoma. Expert Rev Neurother 2006; 6:635-52. [PMID: 16734512 DOI: 10.1586/14737175.6.5.635] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Primary CNS non-Hodgkin lymphoma (PCNSL) has been shown to be increasing in incidence. This appears to be a consequence of the increasing population of those older than 65 years of age in whom PCNSL occurs most often. PCNSL often has a favorable response to treatment and aggressive management may result in extended survival and, in a proportion of patients less than 65 years of age, cure. The majority of neuro-oncologist's advocate utilizing high-dose methotrexate (HD-MTX) as a platform for the chemotherapy treatment of these neoplasms. In this review, the literature regarding HDHMTX as a treatment for PCNSL is summarized as are the pharmacological principles of HD-MTX.
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Affiliation(s)
- Myke R Green
- University of South Florida, Department of Interdisciplinary Oncology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, Florida 33611, USA.
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Blanes M, Silvestre JF, Albares MP, Pascual JC, Pastor N. Erythema multiforme due to methotrexate reproduced with patch test. Contact Dermatitis 2005; 52:164-5. [PMID: 15811037 DOI: 10.1111/j.0105-1873.2005.0548f.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Blanes
- Department of Dermatology, Hospital General Universitario of Alicante, Alicante, Spain.
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29
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2001; 10:69-84. [PMID: 11417072 DOI: 10.1002/pds.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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