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Kim YR, Kim JH, Kim SW, Lee JM, Bae JS. Linear IgA Bullous Dermatosis in Korea Using the Nationwide Health Insurance Database. J Clin Med 2024; 13:1159. [PMID: 38398470 PMCID: PMC10889246 DOI: 10.3390/jcm13041159] [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: 01/21/2024] [Revised: 02/06/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Linear immunoglobulin A bullous dermatosis (LABD) is a rare autoimmune, subepidermal blistering disease, characterized by linear IgA deposits along the epidermal basement membrane. LABD is idiopathic and is associated with medication and systemic autoimmune diseases. (2) Methods: We investigated the demographic characteristics, disease course, causative agents, and associated diseases in Korean patients with LABD. The Korean Health Insurance Review and Assessment Service database was used to obtain data. We identified 670 LABD cases between 2010 and 2022. (3) Results: The annual incidence of LABD was 1.3 per 100,000 persons, with a higher prevalence in individuals ≥60 years old. The patients were treated with dapsone for 30.7 ± 56.7 days, had 1.3 ± 0.7 hospital visits, and were hospitalized for 19.8 ± 19.7 days. Risk factors, including malignancy, commonly preceded LABD. Antibiotic use, specifically vancomycin and third-generation cephalosporins, was a risk factor. The mean age of LABD diagnosis was 55.9 ± 21.7 years. (4) Conclusion: This is the first published study to assess a nationwide cohort for LABD. The incidence of LABD was higher than that in other studies. Most case reports have linked LABD with the administration of specific antibiotics; however, this study shows there were more associations with other conditions.
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Affiliation(s)
- Yu Rim Kim
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Ji Hyeon Kim
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Sang Won Kim
- Medical Research Center, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Jae Min Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Jacob S. Bae
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
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2
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Philip V, Ogunleye OO, Chukwu N, Rosenblum I, Collins S. Linear IgA Bullous Dermatosis Attributable to the Use of Spironolactone: A Case Report. Cureus 2023; 15:e40690. [PMID: 37485225 PMCID: PMC10358603 DOI: 10.7759/cureus.40690] [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: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Linear IgA bullous dermatosis (LABD) is a rare, idiopathic, or drug-induced vesiculobullous disease caused by IgA autoantibodies in the basement membrane zone. An 84-year-old man was started on spironolactone two weeks before presentation for the management of hypertension and heart failure with preserved ejection fraction. He presented to our hospital for evaluation of worsening lower extremity swelling and a painful pruritic rash that started on the day preceding his presentation. On examination, he had 3+ lower extremity edema and an erythematous, painful, pruritic, bullous rash on all his extremities. He had a significantly elevated IgA level (1033 mg/dL). A lesional skin biopsy demonstrated epidermal ulceration with degenerated collagen fibers. Direct immunofluorescence of the perilesional skin showed linear IgA at the dermal-epidermal junction. The rash resolved following steroid therapy and discontinuation of spironolactone. There have been previous reports of bullous pemphigoid induced by spironolactone. To our knowledge, LABD associated with spironolactone has not previously been reported.
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Affiliation(s)
| | - Olushola O Ogunleye
- Internal Medicine, Vassar Brothers Medical Center/Nuvance Health, Poughkeepsie, USA
| | - Nneka Chukwu
- Internal Medicine, Vassar Brothers Medical Center/Nuvance Health, Poughkeepsie, USA
| | | | - Susan Collins
- Internal Medicine, Vassar Brothers Medical Center/Nuvance Health, Poughkeepsie, USA
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3
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Khan M, Park L, Skopit S. Management Options for Linear Immunoglobulin A (IgA) Bullous Dermatosis: A Literature Review. Cureus 2023; 15:e36481. [PMID: 37090290 PMCID: PMC10115698 DOI: 10.7759/cureus.36481] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is an autoimmune condition with various triggers. Because of the lack of randomized controlled trials on LABD treatment, management options are mostly anecdotal. This paper provides a comprehensive review of treatment options from a literature review of reported treatments to arm clinicians with a guideline for the management of LABD in both pediatric and adult patients as well as those recalcitrant to first-line therapy (dapsone and steroids). We additionally illustrate an algorithm to use for the management of LABD to aid clinicians when faced with unique patient circumstances.
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Affiliation(s)
- Madiha Khan
- Department of Dermatology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Lily Park
- Department of Dermatology, Larkin Community Hospital, Miami, USA
- Department of Dermatology, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University (NSU) Florida, Fort Lauderdale, USA
| | - Stanley Skopit
- Department of Dermatology, Larkin Community Hospital, Miami, USA
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4
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Mori F, Saretta F, Liotti L, Giovannini M, Castagnoli R, Arasi S, Barni S, Mastrorilli C, Pecoraro L, Caminiti L, Marseglia GL, Barbaud A, Novembre E. Linear Immunoglobulin a Bullous Dermatosis in Children. Front Pediatr 2022; 10:937528. [PMID: 35874598 PMCID: PMC9304959 DOI: 10.3389/fped.2022.937528] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023] Open
Abstract
Linear Immunoglobulin A Bullous Disease (LABD) is a rare dermatosis whose pathomechanisms are not yet completely understood. LABD has different features characterizing adults and children in terms of potential triggers, clinical manifestations, and prognosis. The aim of the present study is to review all neonatal and pediatric cases of LABD and summarize the major characteristics. Childhood LABD is mainly idiopathic with a benign prognosis. Neonatal cases are difficult to differentiate from infectious diseases and usually have a poor prognosis. Drugs are one of the possible triggers that can activate autoimmune responses through antigen mimicry and epitope spreading as well as different stimuli (e.g., infections, inflammatory diseases, trauma). The gold standard for the diagnosis is based on direct immunofluorescence. Prognosis is generally favorable but often depends on the prompt dermatological diagnosis, treatment and follow-up guaranteed by a multidisciplinary team, including pediatricians for this group of age.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Lucia Liotti
- Department of Pediatrics, Salesi Children's Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age “Gaetano Barresi”, Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Annick Barbaud
- Sorbonne Universités, Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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5
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Ashton R, Fassihi H. Pediatric Autoimmune Bullous Disease: A Literature Review and Update on Management. Pediatr Rev 2022; 43:309-321. [PMID: 35641451 DOI: 10.1542/pir.2021-005125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Pediatric autoimmune bullous disease is a rare group of blistering skin disorders in children that result from autoimmunity against intercellular and basement membrane antigens in the skin and mucous membranes. Most pediatric cases are treated with oral corticosteroids or longer-term immunosuppressants such as azathioprine or mycophenolate mofetil. Immunomodulating drugs such as rituximab are increasingly being considered as options for refractory disease.
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Affiliation(s)
| | - Hiva Fassihi
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, England
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6
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Corrà A, Bonciolini V, Quintarelli L, Verdelli A, Caproni M. Linear IGA bullous dermatosis potentially triggered by vaccination. Int J Immunopathol Pharmacol 2022; 36:20587384211021218. [PMID: 35001680 PMCID: PMC8753231 DOI: 10.1177/20587384211021218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Linear IgA bullous dermatosis (LABD) is a mucocutaneous autoimmune blistering disease affecting both adults and children. It is caused by IgA antibodies targeting multiple antigens along the basement membrane zone, leading to disruption of dermoepidermal junction and development of bullous lesions which often presents in characteristic arrangement. Although most LABD cases have been reported to be idiopathic, different triggers have been described, including several drugs and infection. However, the occurrence of vaccine-induced cases of LABD is not widely known and accepted due to the few reports available. We present two cases of LABD occurred following different triggers, rising the suspicion for a possible pathogenetic role of vaccines.
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Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Veronica Bonciolini
- Dermatology Unit, Versilia Hospital, USL Toscana Nord-Ovest, Lido di Camaiore, Lucca, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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7
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Tabka M, Gammoudi R, Fathallah N, Ghariani N, Sriha B, Ben Salem C, Denguezli M. Linear IgA bullous dermatosis: A rare manifestation of amoxicillin-clavulanic acid treatment. Dermatol Ther 2020; 33:e14187. [PMID: 32789977 DOI: 10.1111/dth.14187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Meriam Tabka
- Department of Dermatology, University of Sousse, Farhat Hached Hospital, Sousse, Tunisia
| | - Rima Gammoudi
- Department of Dermatology, University of Sousse, Farhat Hached Hospital, Sousse, Tunisia
| | - Neila Fathallah
- Department of Pharmacovigilance, Reference Centre for Cutaneous Adverse Reactions, University of Sousse, Sousse, Tunisia
| | - Nejet Ghariani
- Department of Dermatology, University of Sousse, Farhat Hached Hospital, Sousse, Tunisia
| | - Badreddine Sriha
- Department of Pathology, University of Sousse, Farhat Hached Hospital, Sousse, Tunisia
| | - Chaker Ben Salem
- Department of Pharmacovigilance, Reference Centre for Cutaneous Adverse Reactions, University of Sousse, Sousse, Tunisia
| | - Mohamed Denguezli
- Department of Dermatology, University of Sousse, Farhat Hached Hospital, Sousse, Tunisia
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8
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Linear Immunoglobulin A Bullous Disease (LABD) Triggered by Amoxicillin Clavulanic Acid in a Child. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:1398-1399.e1. [PMID: 31874817 DOI: 10.1016/j.jaip.2019.11.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/24/2022]
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9
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Stamenkovic HM, Lazarevic D, Stankovic T, Vojinovic J, Lekic B, Marinkovic A, Bosic M. Linear IgA dermatosis of the childhood—Report of an amoxicillin‐induced case. Dermatol Ther 2019; 33:e13173. [DOI: 10.1111/dth.13173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | - Branislav Lekic
- Clinic of Dermatology and VenerologyFaculty of Medicine, University of Belgrade Belgrade Serbia
| | | | - Martina Bosic
- Institute of Pathology, School of Medicine, University of Belgrade Belgrade Serbia
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10
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Abstract
Bullous diseases are uncommon in children; however, as they have the potential to affect quality of life, occasionally have long-term side effects in the setting of scarring processes, and carry a rare risk of underlying malignancy [e.g., with paraneoplastic pemphigus (PNP)], knowledge of their clinical presentation and treatment options is essential. Given the rarity of these conditions, our current state of knowledge is largely derived from case reports and case series, with a paucity of evidence-based recommendations. In this review, we discuss the clinical presentation of and treatment options for linear immunoglobulin A disease, dermatitis herpetiformis, pemphigus vulgaris, pemphigus foliaceus, PNP, bullous pemphigoid, mucus membrane pemphigoid, epidermolysis bullosa acquisita, and inherited epidermolysis bullosa. In general, when these conditions, except for PNP, occur in childhood, they have a better prognosis than when they occur in adults. Clinical, histopathological, and immunologic features frequently overlap, but distinct differences have also been reported, most commonly in clinical presentation. Treatment is often similar to that in adults, although specific considerations are necessary for a pediatric population.
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Affiliation(s)
- Brittney Schultz
- Department of Dermatology, University of Minnesota, 240 Phillips-Wangensteen Building, 516 Delaware Street Southeast, Minneapolis, MN, 55455, USA.,Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kristen Hook
- Department of Dermatology, University of Minnesota, 240 Phillips-Wangensteen Building, 516 Delaware Street Southeast, Minneapolis, MN, 55455, USA. .,Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
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11
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Díaz M, Morita L, Ferrari B, Sartori S, Greco M, Sobrevias Bonells L, González-Enseñat M, Vicente Villa M, Larralde M. Dermatosis ampollar IgA lineal: serie de 17 casos. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:673-680. [DOI: 10.1016/j.ad.2018.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/05/2018] [Accepted: 06/03/2018] [Indexed: 10/27/2022] Open
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12
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Díaz M, Morita L, Ferrari B, Sartori S, Greco M, Sobrevias Bonells L, González-Enseñat M, Vicente Villa M, Larralde M. Linear IgA Bullous Dermatosis: A Series of 17 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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13
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Linear IgA Bullous Dermatosis Preceding the Diagnosis of Primary Sclerosing Cholangitis and Ulcerative Colitis: A Case Report. Am J Dermatopathol 2019; 41:498-501. [PMID: 30461424 DOI: 10.1097/dad.0000000000001313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering disorder seen in the pediatric and adult populations that is often linked to a medication, infection, or underlying gastrointestinal, hepatobiliary, or autoimmune disease. In this study, we describe the case of a 23-year-old white man whose presentation and diagnosis of LABD ultimately led to the discovery of underlying primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). His dermatitis resolved with topical steroids and dapsone, and he is undergoing systemic treatment for his UC and PSC. This exceptional case further validates the association between LABD with UC, strengthens that with PSC, and underscores the importance of alerting clinicians to consider conducting a systemic workup in addition to thorough medication history on making the diagnosis of LABD.
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14
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Sarikaya Solak S, Ficicioglu S. Cephalosporin-induced linear IgA dermatosis in a child: Case report and literature review. Dermatol Ther 2019; 32:e12927. [PMID: 30977941 DOI: 10.1111/dth.12927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
Linear IgA dermatosis (LAD) is a rare, subepidermal blistering disease with mucocutaneous involvement. It may be idiopathic or drug induced. We describe a 4-year-old girl who presented with a vesiculobullous eruption after she had been treated with cefixime for urinary tract infection. A diagnosis of drug-induced LAD was made based on clinical, histopathological, and immunofluorescence findings. Naranjo adverse drug reaction algorithm was used to assess imputability resulting with a "probable" association. In literature, cephalosporin antibiotics are rarely reported in association with LAD. To our knowledge, this is the first case of a cefixime-induced LAD among adults and children.
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Affiliation(s)
- Sezgi Sarikaya Solak
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
| | - Sezin Ficicioglu
- Faculty of Medicine, Department of Dermatology, Trakya University, Edirne, Turkey
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15
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Znamenskaya LF, Chikin VV, Nefedova MA. Linear IgA bullous dermatosis. VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-6-42-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Aim: to present a clinical case of linear IgA bullous dermatosis.Materials and methods. A 44 years old patient complaining of skin rashes on the trunk and extremities, accompanied by severe itching was examined. We carried out a morphological investigation of biopsy samples derived from the lesion and apparently unaffected skin areas using the method of indirect immunofluorescence.Results. The patient having rashes in the form of multiple vesicles and small bubbles with a tight cover, which had been grouped into figures resembling pearl necklaces, demonstrated the presence of focal subepidermal cracks (subepidermal bubble in one location), as well as a linear deposition of IgA along the epidermal basement membrane. According to the clinical picture and following the histological and immunofluorescent investigation of skin biopsies, the patient was diagnosed with linear IgA bullous dermatosis. Lesion regression was achieved as a result of systemic therapy with prednisolone at a dose of 50 mg per day.Conclusion. The diagnosis of linear IgA bullous dermatosis should be made on the basis of skin biopsy investigation by the method of indirect immunofluorescence. Systemic glucocorticosteroids are seen as an effective approach to the treatment of such patients.
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Alraddadi BS, Magliah T, Al Otaibi Y. Case Report: Linear IgA Bullous Dermatosis Triggered by Amoxicillin-clavulanic acid. ACTA ACUST UNITED AC 2018. [DOI: 10.32648/2639-3298/1/1/002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Linear IgA bullous dermatosis (LABD) is rare autoimmune disease that can be caused with or without drugs. We present a 32 year old male with LABD secondary to Amoxicillin-clavulanic acid with complete recovery after the antibiotic was discontinued.
Keywords: Linear IgA Bullous disease, Vancomycin, Amoxicillin-clavulanic acid
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Affiliation(s)
| | - Tahani Magliah
- Senior dermatology resident, King abdulaziz medical city, jeddah, Saudi Arabia
| | - Yasser Al Otaibi
- Dermatologist, King fahad armed force hospital, Jeddah, Saudi Arabia
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17
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Swan TB, Kranc DA. Child With Diffuse Bullous Rash. Ann Emerg Med 2018; 71:293-336. [PMID: 29458798 DOI: 10.1016/j.annemergmed.2017.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tricia B Swan
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Florida, Gainesville, FL
| | - D Alexander Kranc
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of Florida, Gainesville, FL
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18
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Konvinse KC, Phillips EJ, White KD, Trubiano JA. Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity. Curr Opin Infect Dis 2016; 29:561-576. [PMID: 27753687 PMCID: PMC5113146 DOI: 10.1097/qco.0000000000000323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Antimicrobials are a leading cause of severe T cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in-vitro, in-vivo, and ex-vivo diagnostics for T cell-mediated ADRs. RECENT FINDINGS Recent literature has evaluated the efficacy of traditional antibiotic allergy management, including patch testing, skin prick testing, intradermal testing, and oral challenge. Although patch and intradermal testing are specific for the diagnosis of immune-mediated ADRs, they suffer from drug-specific limitations in sensitivity. The use of ex-vivo diagnostics, especially enzyme-linked immunospot, has been highlighted as a promising new approach to assigning causality. Knowledge of true rates of antimicrobial cross-reactivity aids empirical antibiotic choice in the setting of previous immune-mediated ADRs. SUMMARY In an era of increasing antimicrobial resistance and use of broad-spectrum antimicrobial therapy, ensuring patients are assigned the correct 'allergy label' is essential. Re-exposure to implicated antimicrobials, especially in the setting of severe adverse cutaneous reaction, is associated with significant morbidity and mortality. The process through which an antibiotic label gets assigned, acted on and maintained is still imprecise. Predicting T cell-mediated ADRs via personalized approaches, including human leukocyte antigen-typing, may pave future pathways to safer antimicrobial prescribing guidelines.
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Affiliation(s)
- Katherine C Konvinse
- aDepartment of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA bInstitute for Immunology and Infectious Diseases, Murdoch University, Western Australia, Australia cDepartment of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA dDepartment of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA eDepartment of Infectious Diseases, Austin Hospital, Victoria, Australia fDepartment of Infectious Diseases, Alfred Hospital, Victoria, Australia gDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, Victoria, Australia hDepartment of Medicine, University of Melbourne, Victoria, Australia
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19
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Abstract
Bullous disorders in children are challenging as they encompass a wide range of entities. The etiologies range from inherited to acquired disorders. Some of the more common acquired forms include allergic reactions, infections, autoimmune-mediated conditions, and toxin-mediated conditions. Some eruptions are self-limited, whereas others can be life-threatening. Obtaining a careful history, performing a detailed morphologic examination, recognizing when a skin scraping, biopsy, or culture is indicated, and having an understanding of the associated pathophysiology allows one to narrow the differential and ultimately arrive at the correct diagnosis. This review discusses the more commonly acquired bullous eruptions and how to differentiate them.
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20
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Chanal J, Ingen-Housz-Oro S, Ortonne N, Duong TA, Thomas M, Valeyrie-Allanore L, Lebrun-Vignes B, André C, Roujeau JC, Chosidow O, Wolkenstein P. Linear IgA bullous dermatosis: comparison between the drug-induced and spontaneous forms. Br J Dermatol 2014; 169:1041-8. [PMID: 23815152 DOI: 10.1111/bjd.12488] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering skin disorder characterized by linear deposits of IgA along the dermoepidermal junction, visualized by direct immunofluorescence (DIF). It is usually spontaneous and drug induced. OBJECTIVES To compare the clinical and histological forms of LABD. METHODS This retrospective single-centre cohort study concerned 28 patients diagnosed with LABD between 1 January 1995 and 31 December 2010. Imputability, determined according to the French imputability method (modified Bégaud score) and Naranjo score, enabled classification into drug-induced and spontaneous LABD groups. Clinical and histological features were compared by blinded analysis of images and histological patterns. RESULTS Sixteen patients had spontaneous LABD and 12 had drug-induced LABD. Nikolsky sign and large erosions were significantly more frequent in drug-induced than spontaneous LABD (P = 0.003 and P = 0.03, respectively), with no between-group differences for erythematous plaques, target or target-like lesions, string of pearls, location, mucosal involvement or histological features. CONCLUSIONS Drug-induced LABD was more severe than the spontaneous form, with lesions mimicking toxic epidermal necrolysis. Because LABD may be polymorphic and sometimes life threatening, DIF assay is recommended for all patients with Nikolsky sign and large erosions.
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Affiliation(s)
- J Chanal
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Henri-Mondor, 51 Avenue du Maréchal-de-Lattre-de-Tassigny, 94010, Créteil, France
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Noguera-Morel L, Hernández-Martín Á, Torrelo A. Cutaneous drug reactions in the pediatric population. Pediatr Clin North Am 2014; 61:403-26. [PMID: 24636653 DOI: 10.1016/j.pcl.2013.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cutaneous adverse drug reactions (ADRs) constitute a major pediatric health problem frequently encountered in clinical practice, and represent a diagnostic challenge. Children are more susceptible than adults to errors in drug dosage because of their smaller body size; moreover, ADRs can mimic other skin diseases of children, especially viral exanthems. Most ADRs with cutaneous involvement are mild and resolve on withdrawal of the causative drug. The most common forms of cutaneous ADRs, maculopapular exanthems and urticarial reactions, have excellent outcomes. Less frequent but more severe reactions may incur a risk of mortality.
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Affiliation(s)
- Lucero Noguera-Morel
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain
| | - Ángela Hernández-Martín
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain
| | - Antonio Torrelo
- Department of Dermatology, University Hospital of the Infant Jesus, Avda. Menéndez Pelayo 65, Madrid 28009, Spain.
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Abstract
Cutaneous drug reactions account for a large proportion of adverse drug reactions. Cutaneous drug reactions can be very challenging to diagnose. They can mimic many other skin diseases; this is especially evident during childhood, when viral exanthems are commonplace. Also, if a patient is taking numerous medications, establishing causality to a specific drug can be multifaceted and difficult. The purpose of this review is to highlight an approach to the diagnosis of a suspected cutaneous drug reaction in a child. We have classified different types of drug eruptions by morphology: exanthematous, urticarial, pustular, and bullous. Within each of these groups we have divided them into simple, benign, or non-febrile and complex or febrile reactions. We also include a miscellaneous group to ensure a methodical review.
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Ferrandiz-Pulido C, Garcia-Patos V. A review of causes of Stevens-Johnson syndrome and toxic epidermal necrolysis in children. Arch Dis Child 2013; 98:998-1003. [PMID: 23873883 DOI: 10.1136/archdischild-2013-303718] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threatening conditions almost exclusively attributed to drugs. The incidence in children is lower than in adults and has a better outcome. Mycosplama pneumoniae infection may be involved in some cases of paediatric SJS. The main etiologic factors for both SSJ and TEN are sulphonamides and anticonvulsants, followed by penicillins and non-steroidal anti-inflammatory drugs. In rare instances, paracetamol is the only suspected drug. By contrast with adults, allopurinol, oxicams and nevirapine are not identified as causative agents in children, probably due to differences in drug prescriptions. The only aspects of treatment that have been proved to improve survival are the rapid withdrawal of the suspected offending drugs and an optimal supportive therapy with emphasis in nutritional support, accompanied by management of denuded skin areas. The use of specific therapies remains controversial.
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Affiliation(s)
- Carla Ferrandiz-Pulido
- Facultat de Medicina, Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, , Barcelona, Spain
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Abstract
A 58-year-old woman presented with a 3-week history of a pruritic rash, which had started a week after commencing treatment with amlodipine. On physical examination, large, well-demarcated erythematous plaques, surrounded by small clusters of clear vesicles, were seen on the patient's torso. Subepidermal blisters with neutrophils and eosinophils were seen in a skin biopsy, and direct immunofluorescence showed deposition of IgA along the basement membrane, in keeping with a diagnosis of linear IgA dermatosis (LAD). Amlodipine was discontinued, and the patient was started on prednisolone 30 mg, supplemented shortly afterwards by dapsone, which resulted in prompt resolution of the rash. Only a few cases of drug-induced LAD have been reported, mostly in association with vancomycin. To our knowledge, this is the first reported case precipitated by amlodipine.
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Affiliation(s)
- L Low
- Department of Dermatology, Mint Wing A, St Mary's Hospital, London, UK.
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Monia K, Aida K, Amel K, Ines Z, Becima F, Ridha KM. Linear IgA bullous dermatosis in tunisian children: 31 cases. Indian J Dermatol 2011; 56:153-9. [PMID: 21716539 PMCID: PMC3108513 DOI: 10.4103/0019-5154.80406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Linear IgA bullous dermatosis (LAD) of children is relatively frequent in Africa. Aim: We undertook this study to evaluate the frequency of this disease among autoimmune bullous diseases (AIBDs) in Tunisian children. Materials and Methods: We present a 32-year retrospective study (January 1976 to December 2007). Children with chronic acquired bullous diseases seen at the Charles Nicolle Hospital of Tunis and for who direct immunofluorescence (DIF) of the perilesional skin demonstrated linear IgA immunoglobulin deposits were included in the study population. Results: Thirty-one children with LAD were selected representing 65.9% of all AIBDs of children selected in the same period, with a mean age of 5.5 years and a sex ratio (M/F) of 2.4. Most of the children had generalized eruption (28/31), more profuse on the face, pelvic region, buttocks and limbs. Mucosal lesions happened in only four children (12.9%). The mean duration of the disease was 14 months. DIF demonstrated linear IgA deposits along the dermal–epidermal junction in all patients. IgG, IgM, and complement were also seen (20/31). Indirect immunofluorescence was negative in 67% of cases. Eight patients responded to dapsone; however, prednisone had to be added in seven children to control the disease and erythromycin in four others. A long-term remission period was achieved in 76.1% of patients. Conclusion: This study confirms that LAD is the most common AIBD in children in Tunisia which frequently occurs in preschool-aged males. Independently of the used drug, a long-term remission is frequently observed.
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Affiliation(s)
- Kharfi Monia
- Department of Dermatology, Charles Nicolle Hospital, Tunis, Tunisia
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28
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Pierchalla A, Bruch-Gerharz D, Homey B, Reifenberger J. Lineare IgA-Dermatose im Kindesalter. Hautarzt 2011; 62:262-4. [DOI: 10.1007/s00105-011-2152-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ingen-Housz-Oro S. Dermatose à IgA linéaire : revue de la littérature. Ann Dermatol Venereol 2011; 138:214-20. [DOI: 10.1016/j.annder.2011.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
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Nantel-Battista M, Al Dhaybi R, Hatami A, Marcoux D, DesRoches A, Kokta V. Childhood linear IgA bullous disease induced by trimethoprim-sulfamethoxazole. J Dermatol Case Rep 2010; 4:33-5. [PMID: 21886746 PMCID: PMC3157814 DOI: 10.3315/jdcr.2010.1053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Accepted: 12/05/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Linear IgA bullous disease (LABD) is a rare mucocutaneous autoimmune subepidermal blistering disease that can affect children mostly of pre-school age. As many as two-thirds of LABD are related to drug ingestion, particularly certain antibiotics, non-steroidal anti-inflammatory drugs and diuretics. MAIN OBSERVATION We describe a 3-year-old boy who presented a CMV infection followed by LABD induced by trimtheporim-sulfametoxazole. To our knowledge, this is the first reported case of trimethoprim-sulfamethoxazole that was confirmed by a rechallenge. CONCLUSIONS Most cases of drug-induced LABD are patients being treated with multiple systemic drugs that could induce the LABD. In the lack of suitable alternative treatment, the identification of the causative drug can be achieved by a rechallenge under close medical surveillance.
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Affiliation(s)
- Mélissa Nantel-Battista
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Rola Al Dhaybi
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
- Department of Pathology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Afshin Hatami
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Danielle Marcoux
- Division of Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Anne DesRoches
- Department of Immunology and Allergy, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Victor Kokta
- Department of Pathology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
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Lorette G, Georgesco G. Dermatose bulleuse à IgA linéaires. Presse Med 2010; 39:1076-80. [DOI: 10.1016/j.lpm.2010.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 03/28/2010] [Accepted: 03/31/2010] [Indexed: 10/19/2022] Open
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Panasiti V, Rossi M, Devirgiliis V, Curzio M, Bottoni U, Calvieri S. Amoxicillin-clavulanic acid-induced linear immunoglobulin A bullous dermatosis: case report and review of the literature. Int J Dermatol 2009; 48:1006-10. [DOI: 10.1111/j.1365-4632.2009.04104.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Atzori L, Pinna AL, Pilloni L, Ferreli C, Pau M, Aste N. Bullous skin eruption in an HIV patient during antiretroviral drugs therapy. Dermatol Ther 2008; 21 Suppl 2:S30-4. [PMID: 18837731 DOI: 10.1111/j.1529-8019.2008.00230.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dermo-epidermal blistering is an uncommon presentation of adverse drug reactions. Several drugs are associated to such eruptions, but review of current knowledge does not list antiretroviral drugs. A 37-year-old Caucasian HIV-positive woman presented with a 6-week history of diffuse annular blistering affecting the trunk and limbs. Lesions appeared both on erythematous and normal-appearing skin. The patient was in treatment with antiretroviral (lamivudine + didanosine + nelfinavir) for 2 years. A history of previous adverse reactions to betalactams, nonsteroidal anti-inflammatory drugs, and a nevirapine-induced hepatitis was also referred. Histopathology showed a dermo-epidermal blister; direct immunofluorescence was positive for IgG, C3c at the basement membrane zone; enzyme-linked immunosorbent assay was positive for BP180 antigen. Oral prednisone 1 mg/kg daily for 20 days led to poor improvement. Discontinuation of the antiretrovirals was followed by a rapid healing. Blisters reappeared at first re-introduction essay 1 month later. Awareness of iatrogenic dermo-epidermal blistering is necessary to suspect the diagnosis and avoid long-term immunosuppressant treatment. Complete spontaneous recovery after withdrawal of the responsible drug and relapse at rechallenge are the main criteria for the diagnosis. Factors related to the state of the HIV infection, and/or immunodeficiency may have contributed in precipitating the reaction in the present authors' case.
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Affiliation(s)
- Laura Atzori
- Dermatology Department, University of Cagliari, Italy.
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