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Al-Ansari RY, Almuhaish LA, Hassan KA, Fadoul T, Woodman A. A Saudi Woman with Ceftriaxone Induced Fixed Drug Eruption. Case Rep Dermatol Med 2024; 2024:9975455. [PMID: 38523830 PMCID: PMC10959582 DOI: 10.1155/2024/9975455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/24/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024] Open
Abstract
Background A fixed drug eruption (FDE) is an immunological cutaneous adverse reaction, classified as a cutaneous adverse drug reaction (CADR) and characterized by well-defined lichenoid lesions that occur at the same site each time. Ceftriaxone is a third-generation antibiotic of cephalosporin antibiotics of the beta-lactam antibiotic family, which has typical in vitro activity against many Gram-negative aerobic bacteria. This is the first clinical case from Saudi Arabia and the fifth in the world to document a woman's experience with recurrent FDE after repeated ceftriaxone use. Case Report. A 25-year-old Saudi woman with a known case of sickle cell anemia (SCA) with a history of avascular necrosis of the right hip after replacement was hospitalized with a pain crisis triggered by an upper respiratory tract infection. The patient denied having a history of allergy previously. Due to fever, leukocytosis, and active follicular tonsillitis, ceftriaxone was started. However, a few hours later she developed lip edema and a fixed drug eruption measuring 7 × 11 cm on the left side of her back. The lesion reformed over a hyperpigmented lesion (4 × 8 cm) that the patient did not report upon initial examination. It turned out that this was due to the intravenous administration of ceftriaxone, a year ago in another hospital. An allergy to ceftriaxone was considered, and steroids and antihistamines were started. The case was labeled as ceftriaxone induced FDE. Conclusion Ceftriaxone induced FDE is an uncommon type of allergic reaction that has been reported infrequently. Understanding this condition and the mechanism by which FDE becomes recurrent with the same previous fixed lesion is of great importance for both academic and future research purposes.
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Affiliation(s)
- Rehab Y. Al-Ansari
- Adult Hematology Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | | | - Khaled Abdullah Hassan
- General Medicine Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Tawasoul Fadoul
- General Medicine Unit, Internal Medicine Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
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Özkaya E, Kuzugüdenli S, Impram Ntousounous O, Öztürk Sarı Ş. Recurrent large perianal plaque, conjunctivitis, erosive stomatitis, penile erosions and generalized bullous skin lesions. J Dtsch Dermatol Ges 2023; 21:1574-1577. [PMID: 37857559 DOI: 10.1111/ddg.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/01/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Esen Özkaya
- Department of Dermatology and Venereology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Sevgi Kuzugüdenli
- Department of Dermatology and Venereology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Ozgke Impram Ntousounous
- Department of Dermatology and Venereology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Şule Öztürk Sarı
- Department of Pathology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
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Özkaya E, Kuzugüdenli S, Impram Ntousounous O, Öztürk Sarı Ş. Rezidivierende große perianale Plaques, Konjunktivitis, erosive Stomatitis, Peniserosionen und generalisierte bullöse Hautläsionen. J Dtsch Dermatol Ges 2023; 21:1574-1577. [PMID: 38082524 DOI: 10.1111/ddg.15237_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/01/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Esen Özkaya
- Department of Dermatology and Venereology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Sevgi Kuzugüdenli
- Department of Dermatology and Venereology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Ozgke Impram Ntousounous
- Department of Dermatology and Venereology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Şule Öztürk Sarı
- Department of Pathology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
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Line J, Saville E, Meng X, Naisbitt D. Why drug exposure is frequently associated with T-cell mediated cutaneous hypersensitivity reactions. FRONTIERS IN TOXICOLOGY 2023; 5:1268107. [PMID: 37795379 PMCID: PMC10546197 DOI: 10.3389/ftox.2023.1268107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Cutaneous hypersensitivity reactions represent the most common manifestation of drug allergy seen in the clinic, with 25% of all adverse drug reactions appearing in the skin. The severity of cutaneous eruptions can vastly differ depending on the cellular mechanisms involved from a minor, self-resolving maculopapular rash to major, life-threatening pathologies such as the T-cell mediated bullous eruptions, i.e., Stevens Johnson syndrome/toxic epidermal necrolysis. It remains a significant question as to why these reactions are so frequently associated with the skin and what factors polarise these reactions towards more serious disease states. The barrier function which the skin performs means it is constantly subject to a barrage of danger signals, creating an environment that favors elicitation. Therefore, a critical question is what drives the expansion of cutaneous lymphocyte antigen positive, skin homing, T-cell sub-populations in draining lymph nodes. One answer could be the heterologous immunity hypothesis whereby tissue resident memory T-cells that express T-cell receptors (TCRs) for pathogen derived antigens cross-react with drug antigen. A significant amount of research has been conducted on skin immunity in the context of contact allergy and the role of tissue specific antigen presenting cells in presenting drug antigen to T-cells, but it is unclear how this relates to epitopes derived from circulation. Studies have shown that the skin is a metabolically active organ, capable of generating reactive drug metabolites. However, we know that drug antigens are displayed systemically so what factors permit tolerance in one part of the body, but reactivity in the skin. Most adverse drug reactions are mild, and skin eruptions tend to be visible to the patient, whereas minor organ injury such as transient transaminase elevation is often not apparent. Systemic hypersensitivity reactions tend to have early cutaneous manifestations, the progression of which is halted by early diagnosis and treatment. It is apparent that the preference for cutaneous involvement of drug hypersensitivity reactions is multi-faceted, therefore this review aims to abridge the findings from literature on the current state of the field and provide insight into the cellular and metabolic mechanisms which may contribute to severe cutaneous adverse reactions.
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Affiliation(s)
| | | | | | - Dean Naisbitt
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
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Paulmann M, Reinkemeier F, Lehnhardt M, Mockenhaupt M. Case report: Generalized bullous fixed drug eruption mimicking epidermal necrolysis. Front Med (Lausanne) 2023; 10:1125754. [PMID: 37644986 PMCID: PMC10461315 DOI: 10.3389/fmed.2023.1125754] [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: 12/16/2022] [Accepted: 07/13/2023] [Indexed: 08/31/2023] Open
Abstract
Generalized bullous fixed drug eruption (GBFDE) is the most severe form of fixed drug eruption and can be misdiagnosed as epidermal necrolysis (EN). We report the case of a 42-year-old male patient presenting with more than 50% skin detachment without defined areas of exanthema or erythema and a history of one prior event of EN caused by acetaminophen (paracetamol), allopurinol, or amoxicillin 1.5 years ago. The initial diagnosis was GBFDE or EN. The histology of a skin biopsy was unable to distinguish between the two diseases. The course of the disease, the later clinical presentation, and the medical and medication history, however, were in favor of a diagnosis of GBFDE with two potentially culprit drugs: metamizole and ibuprofen. Moxifloxacin, enoxaparin sodium, hydromorphone, and insulin human were administered concomitantly, which makes them suspicious as well. Unfortunately, the patient received an additional dose of metamizole, one of the possible causative drugs, and he developed another bullous reaction within 1 month. This led to the diagnosis of GBFDE due to metamizole. This report highlights the challenges of distinguishing two rare diseases and elucidates the importance of distinct clinical presentation and detailed medication history.
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Affiliation(s)
- Maren Paulmann
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center—University of Freiburg, Freiburg, Germany
| | - Felix Reinkemeier
- Department of Plastic Surgery and Hand Surgery, Burn Center, Sarcoma Center, Berufsgenossenschaft University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery and Hand Surgery, Burn Center, Sarcoma Center, Berufsgenossenschaft University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Maja Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center—University of Freiburg, Freiburg, Germany
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Hinterseher J, Hertl M, Didona D. Autoimmune skin disorders and SARS-CoV-2 vaccination - a meta-analysis. J Dtsch Dermatol Ges 2023; 21:853-861. [PMID: 37218538 DOI: 10.1111/ddg.15114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/31/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND OBJECTIVES The coronavirus SARS-CoV-2, which is the cause of COVID-19 disease in infected patients, has led to an ongoing worldwide pandemic. Although SARS-CoV-2 vaccination had a dramatic positive effect on the course of COVID-19, there has been increasing evidence of adverse effects after SARS-CoV-2 vaccination. This meta-analysis highlights the association between SARS-CoV-2 vaccination and de novo induction or aggravation of inflammatory and autoimmune skin diseases. MATERIAL AND METHODS A systematic meta-analysis of the literature on new onset or worsening of inflammatory and autoimmune diseases after SARS-CoV-2 vaccination was performed according to the PRISMA guidelines. The search strategy included following terms: "COVID-19/SARS-CoV-2 vaccine bullous pemphigoid/pemphigus vulgaris/systemic lupus erythematosus/dermatomyositis/lichen planus/leukocytoclastic vasculitis." Moreover, we describe representative cases from our dermatology department. RESULTS The database-search in MEDLINE identified 31 publications on bullous pemphigoid, 24 on pemphigus vulgaris, 65 on systemic lupus erythematosus, nine on dermatomyositis, 30 on lichen planus, and 37 on leukocytoclastic vasculitis until June 30th, 2022. Severity and response to treatment varied among the described cases. CONCLUSIONS Our meta-analysis highlights a link between SARS-CoV-2 vaccination and new onset or worsening of inflammatory and autoimmune skin diseases. Moreover, the extent of disease exacerbation has been exemplified by cases from our dermatological department.
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Affiliation(s)
- Julia Hinterseher
- Department of Dermatology and Allergology, Philipps-University Marburg, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-University Marburg, Marburg, Germany
| | - Dario Didona
- Department of Dermatology and Allergology, Philipps-University Marburg, Marburg, Germany
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Alzahrani AH. Fixed Drug Eruptions With Flavoured Liquid Formulations of Over-the-Counter Analgesics: A Case Report. Cureus 2023; 15:e43436. [PMID: 37711934 PMCID: PMC10499053 DOI: 10.7759/cureus.43436] [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: 08/12/2023] [Indexed: 09/16/2023] Open
Abstract
Type 4 hypersensitivity reactions convey a number of conditions that include fixed drug eruptions (FDEs). They share similar pathophysiologic backgrounds and sometimes presentation but can have very variable prognostications. Drugs are amongst the possible causes with acetaminophen and other NSAIDs being reported very frequently. We present a case of a patient reacting to flavoured oral ibuprofen and acetaminophen formulations, exhibiting FDEs with bullae formation. We describe our successful challenge to non-flavoured acetaminophen and ibuprofen. We briefly discuss FDEs in regard to their incidence, pathophysiology, and management.
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Affiliation(s)
- Ali H Alzahrani
- Allergy and Immunology, King Abdulaziz University, Jeddah, SAU
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Hinterseher J, Hertl M, Didona D. Autoimmunerkrankungen der Haut und SARS-CoV-2-Impfung - eine Metaanalyse. J Dtsch Dermatol Ges 2023; 21:853-862. [PMID: 37574683 DOI: 10.1111/ddg.15114_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/31/2023] [Indexed: 08/15/2023]
Abstract
ZusammenfassungHintergrund und ZieleDas Coronavirus SARS‐CoV‐2, welches bei infizierten Patienten die COVID‐19‐Erkrankung auslöst, führte zu einer weltweiten Pandemie. Obwohl die SARS‐CoV‐2‐Impfung einen stark positiven Einfluss auf den Verlauf von COVID‐19 hatte, mehren sich die Hinweise auf Nebenwirkungen nach der SARS‐CoV‐2‐Impfung. Diese Metaanalyse unterstreicht den Zusammenhang zwischen der SARS‐CoV‐2‐Impfung und der Neuentstehung oder Verschlechterung von entzündlichen und autoimmunen Hauterkrankungen.Materialien und MethodikEine systematische Metaanalyse der Literatur über das Neuauftreten oder die Verschlechterung von entzündlichen und autoimmunen Hauterkrankungen nach der SARS‐CoV‐2‐Impfung wurde gemäß den PRISMA‐Richtlinien durchgeführt. Die Suchstrategie umfasste folgende Begriffe: „COVID‐19/SARS‐CoV‐2 vaccine bullous pemphigoid/pemphigus vulgaris/systemic lupus erythematosus/dermatomyositis/lichen planus/leukocytoclastic vasculitis“ Außerdem beschreiben wir repräsentative Fälle aus unserer dermatologischen Abteilung.ErgebnisseDie Datenbanksuche in MEDLINE ergab bis zum 30.06.2022 31 Veröffentlichungen über bullöses Pemphigoid, 24 über Pemphigus vulgaris, 65 über systemischen Lupus erythematodes, neun über Dermatomyositis, 30 über Lichen planus und 37 über leukozytoklastische Vaskulitis. Schweregrad und Ansprechen auf die Behandlung waren bei den beschriebenen Fällen unterschiedlich.SchlussfolgerungenUnsere Metaanalyse zeigt einen Zusammenhang zwischen der SARS‐CoV‐2‐Impfung und dem Neuauftreten oder der Verschlechterung von entzündlichen und autoimmunen Hauterkrankungen. Darüber hinaus wurde das Ausmaß der Krankheitsverschlechterung anhand von Fällen aus unserer dermatologischen Abteilung veranschaulicht.
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Affiliation(s)
- Julia Hinterseher
- Abteilung für Dermatologie und Allergologie, Philipps-Universität Marburg
| | - Michael Hertl
- Abteilung für Dermatologie und Allergologie, Philipps-Universität Marburg
| | - Dario Didona
- Abteilung für Dermatologie und Allergologie, Philipps-Universität Marburg
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Buhl T, Forkel S. The flood of drug allergy cases. J Dtsch Dermatol Ges 2022; 20:1283-1284. [DOI: 10.1111/ddg.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Buhl T, Forkel S. Die Flut der Fälle bei Arzneimittelallergien. J Dtsch Dermatol Ges 2022; 20:1283-1284. [DOI: 10.1111/ddg.14939_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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