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Abdelmouttalib A, Meziane M, Senouci K. Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus: two cases report. Pan Afr Med J 2021; 38:236. [PMID: 34046141 PMCID: PMC8140758 DOI: 10.11604/pamj.2021.38.236.27303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 12/04/2022] Open
Abstract
Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus (TEN-like ACLE) is a rare manifestation of systemic lupus erythematosus (SLE). Because of its rarity, little is known about this entity. In this report, we describe a case of two women previously diagnosed with SLE that presented TEN-like skin lesions. The common elements in both patients were the initial disposition of the lesions on the photoexposed areas, the positivity of Nikolsky´s sign, the discrete mucosal attrition compared to that observed during TEN, and the simultaneous appearance of dermatological lesions with an extra-cutaneous flare of lupus disease. The skin biopsy in both cases showed epidermal necrosis with an identification of lupus band on direct immunofluorescence. Systemic corticosteroids were used with a good evolution after 2 weeks. Skin damage is an indicator of disease activity, and careful search for extracutaneous involvement is obligatory to prevent further complications.
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Affiliation(s)
| | - Mariame Meziane
- Dermatology and Venereology Department, Mohammed V University, Rabat, Morocco
| | - Karima Senouci
- Dermatology and Venereology Department, Mohammed V University, Rabat, Morocco
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2
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Nassim JS, Karim SA, Grenier PO, Schmidt B, Jones KM. Infantile toxic epidermal necrolysis: Successful treatment of an 8-week-old with intravenous immunoglobulin and amniotic membrane transplant. Pediatr Dermatol 2021; 38:202-205. [PMID: 33125180 DOI: 10.1111/pde.14376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 12/26/2022]
Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis comprise a spectrum of severe mucocutaneous hypersensitivity reactions. A paucity of data limits current understanding of the etiology, treatment options, and prognosis of this entity in the infantile population compared to that in the adult and pediatric literature. We describe the case of an 8-week-old male with toxic epidermal necrolysis treated successfully with intravenous immunoglobulin and amniotic membrane transplant. This patient is the youngest surviving infant with toxic epidermal necrolysis to be reported.
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Affiliation(s)
- Janelle S Nassim
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sabrina A Karim
- Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Pierre-Olivier Grenier
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Birgitta Schmidt
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts.,Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Krystal M Jones
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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3
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Tsang V, Leung AKC, Lam JM. Cutaneous Lupus Erythematosus in Children. Curr Pediatr Rev 2021; 17:103-110. [PMID: 33655840 DOI: 10.2174/1573396317666210224144416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/22/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The skin is commonly involved in autoimmune diseases, such as lupus erythematous. The cutaneous lupus erythematosus (CLE) can manifest with or without systemic symptoms. It is advantageous from a patient and healthcare system standpoint for early diagnosis and intervention. Prevention of complications is especially important in the pediatric population. OBJECTIVE To familiarize physicians with the clinical presentation, diagnosis, evaluation, and management of pediatric cutaneous lupus. METHODS The search term "cutaneous lupus" was entered into a Pubmed search. A narrow scope was applied to the categories of "epidemiology", "clinical diagnosis", "investigations", "comorbidities", and "treatment". Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. The search was restricted to English literature and children. A descriptive, narrative synthesis of the retrieved articles was provided. RESULTS A variety of innate and adaptive immune responses are being investigated to explain the pathogenesis of CLE. There are a number of variations of cutaneous manifestations varying from localized malar rash as in the case of ACLE lesions and papulosquamous psoriasiform lesions as in the case of SCLE to the multiple subtypes within chronic CLE. First-line pharmacological treatments include topicals, such as typical calcineurin inhibitors and corticosteroids, or oral agents, such as glucocorticoids, antimalarial drugs, and hydroxychloroquine. CONCLUSION CLE is inclusive of a number of subtypes that have varying dermatological manifestations in adult and pediatric populations. The current treatment modalities will change based on the newly understood molecular targets. Ongoing research on the mechanisms underlying CLE is necessary to derive new interventions for pediatric patients.
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Affiliation(s)
- Vivian Tsang
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, BC, Canada
| | - Alexander K C Leung
- Department of Pediatrics, University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, AB, Canada
| | - Joseph M Lam
- Department of Paediatrics, Associate Member, Department of Dermatology, University of British Columbia, Vancouver, British Columbia, AB, Canada
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4
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Bhattarai D, Vignesh P, Chaudhary H, Bharadwaj N, Saini L, Gupta K, Rawat A. Epidermal necrolysis as the presenting manifestation of pediatric lupus. Pediatr Dermatol 2020; 37:1119-1124. [PMID: 32770777 DOI: 10.1111/pde.14324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 01/03/2023]
Abstract
Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) represents the spectrum of skin lesions characterized by rashes, exfoliation, and sloughing usually following drug intake. Occasionally, TEN-like cutaneous manifestations have also been described with systemic lupus erythematosus. Recognition of lupus in a child presenting with TEN-like skin changes is clinically challenging and requires a high degree of suspicion. We describe the case of a child who had epidermal necrolysis as the presenting feature of lupus and had severe neurological complications. TEN-like skin changes in association with severe neurological complications in pediatric lupus are uncommon. Lupus must be considered in the differential diagnosis of a child presenting with epidermal necrolysis with no provocative risk factors such as a history of exposure to medications.
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Affiliation(s)
- Dharmagat Bhattarai
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, India
| | - Pandiarajan Vignesh
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, India
| | - Himanshi Chaudhary
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, India
| | - Niteesh Bharadwaj
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, India
| | - Lokesh Saini
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, India
| | - Amit Rawat
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, India
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5
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Rutnin S, Chanprapaph K. Vesiculobullous diseases in relation to lupus erythematosus. Clin Cosmet Investig Dermatol 2019; 12:653-667. [PMID: 31564947 PMCID: PMC6732903 DOI: 10.2147/ccid.s220906] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022]
Abstract
Vesiculobullous lesions in lupus erythematosus (LE) are a rare cutaneous manifestation of cutaneous and/or systemic LE with variable presentation. While the minor forms of LE-associated vesiculobullous disease may cause disfigurement and discomfort, the severe forms can present with hyperacute reaction and life-threatening consequences. Specific LE and aspecific cutaneous LE are defined by the presence or absence of interface change on histopathology that can be applied to vesiculobullous diseases in relation to LE. However, the diagnosis of LE-associated vesiculobullous diseases remains difficult, due to the poorly defined nosology and the similarities in clinical and immunohistopathological features among them. Herein, we thoroughly review the topic of vesiculobullous skin disorders that can be encountered in LE patients and organize them into four groups: LE-specific and aspecific vesiculobullous diseases, LE-related autoimmune bullous diseases, and LE in association to non-autoimmune conditions. We sought to provide an updated overview highlighting the pathogenesis, clinical, histological, and immunopathological features, laboratory findings, and treatments and prognosis among vesiculobullous conditions in LE.
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Affiliation(s)
- Suthinee Rutnin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
PURPOSE OF REVIEW To review recent evidence on cutaneous manifestations of lupus, with a focus on evidence for pediatric patients. RECENT FINDINGS Cutaneous manifestations of SLE are common and may precede signs or symptoms of systemic disease. Early recognition and initiation of therapy improves quality of life by reducing cutaneous disease activity. Antimalarials are first line for moderate-to-severe disease. Photo protection is a critical component of therapy and perhaps the only modifiable risk factor for SLE. Recognition of cutaneous vasculopathy may reduce mortality from vascular occlusion. SUMMARY There is a critical need for better understanding of pathogenesis, risk factors and outcomes in cutaneous lupus to determine optimal treatment and surveillance strategies. Correlation of clinical phenotypes with biomarkers may help to stratify patients, optimize targeted interventions, and influence prognosis.
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Ponvert C. Quoi de neuf en allergologie pédiatrique de fin 2015 à début 2018 ? Anaphylaxie, allergie médicamenteuse et aux venins et salives d’insectes (une revue de la littérature internationale). REVUE FRANCAISE D ALLERGOLOGIE 2018. [DOI: 10.1016/j.reval.2018.02.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered a delayed-type hypersensitivity reaction to drugs. They represent true medical emergencies and an early recognition and appropriate management is decisive for the survival. SJS/TEN manifest with an "influenza-like" prodromal phase (malaise, fever), followed by painful cutaneous and mucous membrane (ocular, oral, and genital) lesions, and other systemic symptoms. The difference between SJS, SJS/TEN overlap, and TEN is defined by the degree of skin detachment: SJS is defined as skin involvement of < 10%, TEN is defined as skin involvement of > 30%, and SJS/TEN overlap as 10-30% skin involvement. The diagnosis of different degrees of epidermal necrolysis is based on the clinical assessment in conjunction with the corresponding histopathology. The mortality rates for SJS and TEN have decreased in the last decades. Today, the severity-of-illness score for toxic epidermal necrolysis (SCORTEN) is available for SJS/TEN severity assessment. Drugs with a high risk of causing SJS/TEN are anti-infective sulfonamides, anti-epileptic drugs, non-steroidal anti-inflammatory drugs of the oxicam type, allopurinol, nevirapine, and chlormezanone. Besides conventional drugs, herbal remedies and new biologicals should be considered as causative agents. The increased risk of hypersensitivity reactions to certain drugs may be linked to specific HLA antigens. Our understanding of the pathogenesis of SJS/TEN has improved: drug-specific T cell-mediated cytotoxicity, genetic linkage with HLA- and non-HLA-genes, TCR restriction, and cytotoxicity mechanisms were clarified. However, many factors contributing to epidermal necrolysis still have to be identified, especially in virus-induced and autoimmune forms of epidermal necrolysis not related to drugs. In SJS/TEN, the most common complications are ocular, cutaneous, or renal. Nasopharyngeal, esophageal, and genital mucosal involvement with blisters, erosions as well as secondary development of strictures also play a role. However, in the acute phase, septicemia is a leading cause of morbidity and fatality. Pulmonary and hepatic involvement is frequent. The acute management of SJS/TEN requires a multidisciplinary approach. Immediate withdrawal of potentially causative drugs is mandatory. Prompt referral to an appropriate medical center for specific supportive treatment is of utmost importance. The most frequently used treatments for SJS/TEN are systemic corticosteroids, immunoglobulins, and cyclosporine A.
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Aiempanakit K, Chiratikarnwong K, Juthong S, Auepemkiate S. Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis. Lupus 2018; 27:1860-1863. [PMID: 30028256 DOI: 10.1177/0961203318789766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 60-year-old female was diagnosed with progressive systemic sclerosis and interstitial lung disease of two months' duration. The patient was treated for Raynaud phenomenon with aspirin, nifedipine, colchicine, and naproxen. Two weeks after treatment, she developed widespread erythematous patches with blistering eruptions on the face, torso, and extremities, and also had erosion on the oral mucosa. Skin biopsy for histopathology and direct immunofluorescent studies were suggestive of lupus erythematosus. To the best of our knowledge, this is the first case of toxic epidermal necrolysis-like acute cutaneous lupus erythematosus in a patient with progressive systemic sclerosis.
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Affiliation(s)
- K Aiempanakit
- 1 Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - K Chiratikarnwong
- 1 Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S Juthong
- 2 Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S Auepemkiate
- 3 Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Liu RF, Chung WH, Yang CY, Wang FY, Chen CB. Neonatal lupus erythematosus presenting as Stevens-Johnson syndrome. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Marija S, Ivana B, Nina R, Dragan N, Zlatko B, Branislav J, Jelena P, Dusica S. Toxic epidermal necrolysis in a child with lupus-associated pancreatitis. Rheumatol Int 2017; 37:1221-1226. [PMID: 28239770 DOI: 10.1007/s00296-017-3677-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatological conditions that are characterized by mucosal erosions, epidermal detachments and erosions. The most common causes of SJS and TEN are drugs; other causes such as systemic lupus erythematosus (SLE), vaccinations and infections have been rarely implicated. We present the case of a 14-year-old female patient with acute pancreatitis as an initial manifestation of systemic lupus erythematosus, complicated by the toxic epidermal necrolysis with a fatal outcome. She initially presented with abdominal pain, fever, vomiting, and intolerance to oral intake and elevated pancreatic enzyme levels. Systemic lupus erythematosus was diagnosed secondary when her condition has been already complicated by the toxic epidermal necrolysis. The administration of corticosteroids and high doses of intravenous immunoglobulin did not lead to positive effects in the treatment of our patient.
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Affiliation(s)
- Stevic Marija
- Department of Anesthesia, Faculty of Medicine, University of Belgrade, Tirsova 10, Belgrade, Serbia.
| | - Budic Ivana
- Department of Anesthesia, Faculty of Medicine, Clinical Centre Nis, University of Nis, Bulevar dr Zorana Djindjica 81, Nis, Serbia
| | - Ristic Nina
- Department of Gastroenterology, University Children's Hospital, Svetogorska 11, Belgrade, Serbia
| | - Nenadic Dragan
- Department of Anesthesia, Royal Victoria Hospital, 274 Grosnor RD, Belfast, BT, 12 6BA, UK
| | - Bokun Zlatko
- Department of Minimally Invasive Surgery, Zvezdara University Center, Dimitrija Tucovica 161, Belgrade, Serbia
| | - Jovanovic Branislav
- Department of Abdominal surgery, University Children's Hospital, Tirsova 10, Belgrade, Serbia
| | - Pejanovic Jelena
- Department of Abdominal surgery, University Children's Hospital, Tirsova 10, Belgrade, Serbia
| | - Simic Dusica
- Department of Anesthesia, Faculty of Medicine, University of Belgrade, Tirsova 10, Belgrade, Serbia
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