1
|
Haseeb A, Elhusseiny AM, ElSheikh RH, Tahboub MA, Kwan JT, Saeed HN. Ocular involvement in Mycoplasma induced rash and mucositis: A systematic review of the literature. Ocul Surf 2023; 28:1-10. [PMID: 36396020 DOI: 10.1016/j.jtos.2022.11.007] [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: 10/08/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a relatively newly identified clinical entity which is characterized by mucocutaneous manifestations in the setting of Mycoplasma infection. Though a clinically distinct disease, MIRM exists on a diagnostic continuum with entities including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and the recently described reactive infectious mucocutaneous eruption (RIME). In this systematic review, we discuss published findings on the epidemiology, clinical manifestations, diagnosis, and management of MIRM, with an emphasis on ocular disease. Lastly, we discuss some of the most recent developments and challenges in characterizing MIRM with respect to the related diagnosis of RIME.
Collapse
Affiliation(s)
- Abid Haseeb
- Department of Ophthalmology, Nazareth Hospital, Philadelphia, PA, USA; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Reem H ElSheikh
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mohammad A Tahboub
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - James T Kwan
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA.
| |
Collapse
|
2
|
Dahliana P, Djawad K, Tabri F. Pneumonia Induced Childhood Erythema Multiforme Minor: A Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Erythema multiforme (EM) is an acute mucocutaneous syndrome mediated by hypersensitivity reactions. Symptoms are often mild and self-limiting but have a high recurrency rate. The disease is more prevalent in adolescents and adults, with incidence in childhood often precipitated by infection of herpes simplex virus type 1. However, EM induced by infection of Mycoplasma pneumonia is a rare occurrence. This paper reports a case of pneumonia induced EM in a 5-year-old child with a typical clinical feature supported by laboratory and chest X-ray features that were confirmed with histopathology. The patient showed significant clinical improvements after antibiotic therapy.
Collapse
|
3
|
Jin L, Chen P, Xu Y. Effects of four types of chinese medicines as concomitant drugs with azithromycin for the treatment of mycoplasma pneumonia in children in China: a network meta-analysis. Rev Assoc Med Bras (1992) 2021; 67:395-399. [PMID: 34468604 DOI: 10.1590/1806-9282.20200808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of the use of four concomitant Chinese medicines with azithromycin in the treatment of mycoplasma pneumonia in children (MPC) by using network meta-analysis (NMA) and ranking them according to their performances. METHODS There were a total of 130 randomly controlled trials of four different concomitant Chinese medicines with azithromycin for the treatment of MPC in many databases, and an NMA was conducted in them by using Stata (version 13.0) software to evaluate the odds ratio (OR) and sequence of the different combinations. The included studies were divided into two groups: control group (azithromycin alone) and observation group (one of four azithromycin combinations). RESULTS A total of 13119 cases were included in this study, and the results showed that the pooled OR and 95% confidence interval (CI) of MPC improvement compared with azithromycin alone were 4.76 (3.18-7.14) for azithromycin and Reduning, 5.66 (4.50-7.12) for azithromycin and Tanreqing, 4.84 (3.35-7.01) for azithromycin and Xiyanping, and 4.58 (3.59-5.83) for azithromycin and Yanhuning, respectively. This study shows the significant efficacy of Chinese concomitant drug. The combination of azithromycin with Tanreqing is the best candidate of concomitant drug in terms of clinical efficacy. Its surface under the cumulative ranking (SUCRA) score was 85.5, while the SUCRA score for the azithromycin and Yanhuning combination was the worst, which is 48.4. CONCLUSIONS The combination of azithromycin with Tanreqing is the most promising group among four combinations for the treatment of MPC.
Collapse
Affiliation(s)
- Lairun Jin
- Yijishan Hospital of Wannan Medical College, Office of Educational Administration - Wuhu (Anhui), China
| | - Ping Chen
- Yijishan Hospital of Wannan Medical College, Office of Educational Administration - Wuhu (Anhui), China
| | - Yan Xu
- Yijishan Hospital of Wannan Medical College, Office of Educational Administration - Wuhu (Anhui), China
| |
Collapse
|
4
|
Giraud-Kerleroux L, Bellon N, Welfringer-Morin A, Leclerc-Mercier S, Costedoat I, Coquin J, Brun A, Roguedas-Contios AM, Bernier C, Milpied B, Tétart F, Du Thanh A, Cordel N, Bensaid B, Fargeas C, Tauber M, Renolleau S, Boralevi F, Ingen-Housz-Oro S, Bodemer C. Childhood epidermal necrolysis and erythema multiforme major: a multicentre French cohort study of 62 patients. J Eur Acad Dermatol Venereol 2021; 35:2051-2058. [PMID: 34157175 DOI: 10.1111/jdv.17469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The distinction between epidermal necrolysis [EN; including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and overlap syndrome] and erythema multiforme major (EMM) in children is confusing. We aimed to better describe and compare these entities. MATERIALS AND METHODS This French retrospective multicentre study included children ≤18 years old referred for EN or EMM between 1 January 2008 and 1 March 2019. According to pictures, children were reclassified into TEN/overlap, SJS or EMM/unclassified (SJS/EMM) groups and compared for epidemiological and clinical data, triggers, histology and follow-up. RESULTS We included 62 children [43 boys, median age 10 years (range 3-18)]: 16 with TEN/overlap, 11 SJS and 35 EMM. The main aetiologies were drugs in EN and infections (especially Mycoplasma pneumoniae) in EMM (P < 0.001), but 35% of cases remained idiopathic (TEN/overlap, 47%; SJS, 24%; EMM, 34%). The typical target lesions predominated in EMM (P < 0.001), the trunk was more often affected in EN (P < 0.001), and the body surface area involved was more extensive in EN (P < 0.001). Mucosal involvement did not differ between the groups. Two patients with idiopathic TEN died. Histology of EMM and EN showed similar features. The recurrence rate was 42% with EMM, 7% with TEN/overlap and 0 with SJS (P < 0.001). Sequelae occurred in 75% of EN but involved 55% of EMM. CONCLUSION Clinical features of EN and EMM appeared well demarcated, with few overlapping cases. Idiopathic forms were frequent, especially for EN, meaning that a wide and thorough infectious screening, repeated if needed, is indicated for all paediatric cases of EN/EMM without any trigger drug. We propose a comprehensive panel of investigations which could be a standard work-up in such situation. Sequelae affected both EN and EMM.
Collapse
Affiliation(s)
- L Giraud-Kerleroux
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Dermatology Department, AP-HP, CHU Henri Mondor, Créteil, France
| | - N Bellon
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - A Welfringer-Morin
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| | - S Leclerc-Mercier
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Pathology Department, AP-HP, CHU Necker-Enfants Malades, Paris, France
| | - I Costedoat
- Dermatology Department, CHU Pellegrin-Enfants, Bordeaux, France
| | - J Coquin
- Dermatology Department, CHU Charles Nicolle, Rouen, France
| | - A Brun
- Dermatology Department, CHU Charles Nicolle, Rouen, France
| | - A-M Roguedas-Contios
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHRU Morvan, Brest, France
| | - C Bernier
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Hôtel-Dieu, Nantes, France
| | - B Milpied
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Pellegrin-Enfants, Bordeaux, France
| | - F Tétart
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Charles Nicolle, Rouen, France
| | - A Du Thanh
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Saint-Eloi, Montpellier, France
| | - N Cordel
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe.,Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France
| | - B Bensaid
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Edouard Herriot, Lyon, France
| | - C Fargeas
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France
| | - M Tauber
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Dermatology Department, CHU Larrey, Toulouse, France
| | - S Renolleau
- Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Intensive Care Unit, CHU Necker-Enfants Malades, Paris, France
| | - F Boralevi
- Dermatology Department, CHU Pellegrin-Enfants, Bordeaux, France
| | - S Ingen-Housz-Oro
- Dermatology Department, AP-HP, CHU Henri Mondor, Créteil, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France.,Univ Paris Est Creteil EpidermE, Créteil, France
| | - C Bodemer
- Dermatology Department, AP-HP, CHU Necker-Enfants Malades, Paris Centre University, Paris, France.,Reference Centre for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, AP-HP, Hôpital Henri-Mondor, UPEC, Créteil, France
| |
Collapse
|
5
|
Chen Z, Shi Q, Peng Y, Chen Y, Cao L, Pang B, Ji Z, Liu C, Zhang J. Traditional Chinese Medicine Oral Liquids Combined With Azithromycin for Mycoplasma pneumoniae Pneumonia in Children: A Bayesian Network Meta-Analysis. Front Pharmacol 2021; 12:652412. [PMID: 34122075 PMCID: PMC8194818 DOI: 10.3389/fphar.2021.652412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background:Mycoplasma pneumoniae pneumonia (MPP) causes flu-like symptoms in children, increasing the burden on the health and education systems. In China, traditional Chinese medicine oral liquids (TCMOLs) combined with azithromycin (TCMOLs + Azithromycin) is commonly used to treat MPP in children. However, TCMOLs with the optimal clinical applicability remain unknown. Here, we evaluated the clinical effectiveness and safety of TCMOLs + Azithromycin in children with MPP. Methods: We searched PubMed, Embase, Cochrane Library, Ovid, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP information resource integration service platform databases for eligible randomized controlled trials (RCTs) published from database inception to October 2020. Two reviewers independently performed data extraction and risk of bias assessment. After Bayesian random effect modeling and surface under the cumulative ranking curve (SUCRA) scoring, we ranked each intervention. We assessed heterogeneity using multivariate meta-regression for potential modifiers and used the Grading of Recommendations, Assessment, Development, and Evaluation to rate pooled evidence’s certainty. Results: In the 63 included RCTs with 6,410 children, five different TCMOLs were combined with azithromycin. TCMOLs + Azithromycin had significantly better primary outcomes than did azithromycin alone. Of all TCMOLs, Xiaoer Xiaoji Zhike (XEXJZK)+Azithromycin showed the best effectiveness with respect to the response rate (odds ratio [OR] = 6.5, 95% credible interval [CrI] = 4.3–10; low certainty) and pulmonary rales disappearance time (mean difference [MD] = −2.1, 95% CrI: −2.9 to −1.2; low certainty) with SUCRA 85 and 80%, respectively. Pudilan Xiaoyan + Azithromycin showed the highest effectiveness with respect to cough disappearance time (MD = −2.6, 95% CrI: −3.4 to −1.7; very low certainty) and fever disappearance time (MD = −1.8, 95% CrI: −2.3 to −1.3; very low certainty) with SUCRA 87 and 87%, respectively. The difference in the adverse effects between TCMOLs + Azithromycin and azithromycin alone was nonsignificant. Conclusion: Of the different TCMOLs, XEXJZK may be the best option to combine with azithromycin to treat children with MPP. However, our results should be interpreted with caution due to the low certainty of evidence. In general, TCMOLs’ safety remains unclear because of a lack of evidence. More high-quality RCTs are needed to further evaluate efficacy and safety of these TCMOLs.
Collapse
Affiliation(s)
- Zhe Chen
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qingyang Shi
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yingying Peng
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Statistic, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lujia Cao
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bo Pang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhaochen Ji
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunxiang Liu
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| |
Collapse
|
6
|
Liccioli G, Filippeschi C, Giovannini M, Capone M, Oranges T, Barni S, Sarti L, Parronchi P, Mori F. Mycoplasma pneumoniae-associated mucocutaneous disease in children: A case series with allergy workup in a tertiary care paediatric hospital. Clin Exp Allergy 2021; 51:740-744. [PMID: 33675565 DOI: 10.1111/cea.13861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Giulia Liccioli
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Cesare Filippeschi
- Dermatologic Division, Department of Health Science, Meyer Children's Hospital, Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Teresa Oranges
- Dermatologic Division, Department of Health Science, Meyer Children's Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Paediatrics, Meyer Children's Hospital, Florence, Italy
| |
Collapse
|
7
|
Guo W, Qian G. Maculopapular eruptions and vesicles on the limbs and buttocks. BMJ 2020; 371:m4349. [PMID: 33268338 DOI: 10.1136/bmj.m4349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Wu Guo
- Department of Dermatology, Children's Hospital affiliated to Zhengzhou University, 450053 Zhengzhou, China
| | - Ge Qian
- Department of Dermatology, Children's Hospital affiliated to Zhengzhou University, 450053 Zhengzhou, China
| |
Collapse
|
8
|
Eshtiaghi P, Weinstein M. Where in the World Did You Get That Rash? Pediatr Rev 2020; 41:184-195. [PMID: 32238547 DOI: 10.1542/pir.2018-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Panteha Eshtiaghi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
9
|
Affiliation(s)
| | - Cynthia Christy
- Division of Pediatric Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, NY.,Rochester General Hospital, Rochester, NY
| |
Collapse
|
10
|
Mocanu A, Ivanov A, Alecsa M, Lupu VV, Lupu A, Starcea IM, Miron OT, Gavrilovici C, Miron IC. Uncommon erythema multiforme in small children: experience of a single Romanian pediatric unit: Two case reports. Medicine (Baltimore) 2019; 98:e17895. [PMID: 31725635 PMCID: PMC6867757 DOI: 10.1097/md.0000000000017895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Erythema multiforme (EM) is an immune-mediated disease with mucocutaneous localization and plurietiologic determinism. The term "multiforme" refers to the variety of aspects that the lesions can take from patient to patient and during evolution in a single patient. PATIENT CONCERNS We have selected 2 cases of small children diagnosed with different etiology of EM to illustrate the importance of a correct and fast diagnosis. Case 1 involves a 2-year-old girl from a rural area who presented with fever and pruritic erythematous papular eruption. The onset of the symptoms was 3 days before presentation with fever and ulcerative lesions on the oral and labial mucosa, followed by the appearance of erythematous macular lesions, with progressive confluence to intense pruritic patches. The 2nd involves a 2-year-old boy with fever, loss of appetite, productive cough, and petechiae. He had corticosensible immune thrombocytopenia from the age of 6 months, with many recurrences. The patient received treatment with ampicillin/sulbactam and symptomatics for an erythemato-pultaceous angina. During the 2nd day of treatment the patient developed an erythematous macular eruption on the face, scalp, trunk, and limbs, with bullae formation. DIAGNOSES The 1st patient was diagnosed based on biologic findings: positive inflammatory syndrome, elevated level of anti-Mycoplasma pneumoniae immunoglobulin M antibodies and immunoglobulin E. Histopathologic examination described papillary dermal edema, inflammatory infiltrate, and lymphocyte exocytosis. In the 2nd case, the hemoleucogram identified 12,000/mm platelets and the medulogram aspect was normal. Serology for Epstein-Barr virus was negative. The diagnosis was EM secondary to M pneumoniae infection in case 1 and secondary to administration of ampicillin/sulbactam in case 2. INTERVENTIONS In both cases, etiopathogenic treatment consisting of steroidal antiinflammatory drugs, antihistamines was administered. Because of specific etiology, the 1st case received antibiotics. OUTCOMES The evolution was favorable in 10 to 14 days; the patients were discharged after etiopathogenic treatment consisting of steroidal antiinflammatory drugs, antihistamines, and/or antibiotics. LESSONS Performing a detailed clinical examination, medical history of drug use, infection or general diseases can establish a good diagnosis of EM. Histopathologic examination can help. The treatment is etiologic, pathogenic, and symptomatic. EM usually has a self-limited evolution.
Collapse
Affiliation(s)
- Adriana Mocanu
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- IVth Pediatric Department
| | - Anca Ivanov
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- IVth Pediatric Department
| | - Mirabela Alecsa
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- IVth Pediatric Department
| | - Vasile Valeriu Lupu
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- IVth Pediatric Department
| | - Ancuta Lupu
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- Vth Pediatric Department, Sf. Maria Emergency Hospital for Children, Iasi, Romania
| | - Iuliana Magdalena Starcea
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- IVth Pediatric Department
| | - Oana Tatiana Miron
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
| | - Cristina Gavrilovici
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- IVth Pediatric Department
| | - Ingrith Crenguta Miron
- Department of Pediatrics, University of Medicine and Pharmacy “Grigore T. Popa”
- IVth Pediatric Department
| |
Collapse
|
11
|
Triggers, clinical manifestations, and management of pediatric erythema multiforme: A systematic review. J Am Acad Dermatol 2019; 81:813-822. [PMID: 31331726 DOI: 10.1016/j.jaad.2019.02.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/20/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants. OBJECTIVE To investigate the triggers, clinical manifestations, and treatment of pediatric EM. METHODS Systematic literature review of pediatric EM. RESULTS After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children. LIMITATIONS Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias. CONCLUSION Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition.
Collapse
|
12
|
Ashton R, Wong KW, Weinstein M. Pediatric Lip Adhesion Following Bullous Erythema Multiforme and Review of Similar Oral Complications. J Cutan Med Surg 2018; 22:427-430. [DOI: 10.1177/1203475418761038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Erythema multiforme (EM) is a mucocutaneous disease most often associated with preceding herpes simplex virus or Mycoplasma pneumoniae infection. It is characterized by targetoid lesions occurring on the limbs and head and neck. Mucosal involvement can be extensive. Objective: We report a case of lip adhesion as a complication of EM in a child who required corrective surgery and review similar oral commissure complications. Methods: We completed a review of the literature for similar cases using PubMed and Medline. Conclusions and Relevance: We present the youngest report of lip adhesion due to striking mucositis related to EM. Sequelae of erythema multiforme can be significant, in our case requiring surgery. Meticulous oral hygiene should be encouraged when mucosal lesions are identified.
Collapse
Affiliation(s)
- Rosalind Ashton
- King’s College London, St John’s Institute of Dermatology, London, UK
| | - Karen W. Wong
- Division of Plastic Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Miriam Weinstein
- Division of Paediatric Medicine, Section of Dermatology, Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
13
|
Lebrun-Vignes B, Guy C, Jean-Pastor MJ, Gras-Champel V, Zenut M. Is acetaminophen associated with a risk of Stevens-Johnson syndrome and toxic epidermal necrolysis? Analysis of the French Pharmacovigilance Database. Br J Clin Pharmacol 2017; 84:331-338. [PMID: 28963996 DOI: 10.1111/bcp.13445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022] Open
Abstract
AIM Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe mostly drug-induced cutaneous reactions. Acetaminophen is an over-the-counter drug used worldwide to treat pain and reduce fever. In 2013, the US Food and Drug Administration informed the public that acetaminophen was associated with a rare risk of SJS/TEN. The aim of the present retrospective study was to analyse reports of acetaminophen as a possible suspect in the development of SJS/TEN from the French Pharmacovigilance Database (FPDB). METHODS Cases of TEN/SJS with acetaminophen as a suspect drug registered in the FPDB, collected from January 2002 to December 2013, were analysed by an expert group. The algorithm of drug causality for epidermal necrolysis (ALDEN) was used as a reference tool for SJS/TEN to assess the causality of each suspect drug. RESULTS After exclusion of 16 nonvalidated cases, 112 cases (47 TEN, 51 SJS, 14 SJS/TEN overlaps) involving 574 suspected drugs (5⋅1/case) were analysed. In 80 cases, the acetaminophen ALDEN score was inferior or equal to that of other drugs, associated with a higher suspicion for causality. In 32 cases, acetaminophen had the highest score but matched with a 'very unlikely' or 'unlikely' causality in 12 cases. For the 20 remaining cases with a 'possible' or ' probable' causality, a protopathic or a confounding bias was likely in 14 cases. CONCLUSIONS After analysis of the French pharmacovigilance data using the ALDEN algorithm, we found no obvious SJS/TEN risk related to the use of acetaminophen in this large national series.
Collapse
Affiliation(s)
- Bénédicte Lebrun-Vignes
- Centre Régional de Pharmacovigilance, Hôpitaux Universitaires Pitié-Salpêtrière Charles-Foix, AP-HP, 47-83, Boulevard de l'Hôpital, 75651 Cedex 13, Paris, France
| | - Claire Guy
- Centre Régional de Pharmacovigilance, CHU - Hôpital Nord, Avenue Albert Raimond, 42055 Cedex 02, Saint-Etienne, France
| | - Marie-Josèphe Jean-Pastor
- Centre Régional de Pharmacovigilance Marseille - Provence - Corse, Hôpital Sainte-Marguerite, AP-HM, 270 Boulevard de Saint-Marguerite, 13009 Cedex 9, Marseille, France
| | - Valérie Gras-Champel
- Centre Régional de Pharmacovigilance, CHU Amiens Sud, 80054 Cedex 1, Amiens, France
| | - Marie Zenut
- Centre Régional de Pharmacovigilance, CHU - Centre de Biologie, EA 4681 PEPRADE, Université d'Auvergne, 58 Rue Montalembert -BP 69, 63003 Cedex 1, Clermont-Ferrand, France
| | | |
Collapse
|