ABSTRACT
Methotrexate has been widely used for many years in the treatment of a variety of diseases. Acute pneumonitis and bone marrow suppression are very serious side effects in methotrexate treatment. A 48-year-old man with end-stage renal disease undergoing chronic hemodialysis developed combined acute pneumonitis and pancytopenia after a cumulative dose of 20 mg methotrexate for bullous pemphigoid. Continuous renal replacement therapy (CRRT) can effi ciently decrease serum methotrexate concentration. A rapid improvement of clinical symptoms and resolution of pulmonary opacifi cation were found after CRRT. Blood cell counts returned to normal after component blood transfusion and cytokine supportive therapy. Patients with impaired renal function are at high risk of methotrexate toxicity, and low-dose methotrexate should be prescribed with great caution.
.Subject(s)
Humans , Male , Middle Aged , Dermatologic Agents/adverse effects , Lung Diseases, Interstitial/chemically induced , Methotrexate/adverse effects , Pancytopenia/chemically induced , Pemphigoid, Bullous/drug therapy , Dermatologic Agents/administration & dosage , Kidney Failure, Chronic/therapy , Lung Diseases, Interstitial/therapy , Methotrexate/administration & dosage , Pancytopenia/therapy , Renal Dialysis , Risk Factors , Treatment OutcomeABSTRACT
Malignant atrophic papulosisis is a rare, multisystem obliterative vasculopathy of unknown etiology, occasionally involving the cranial nerve. We describe the first case of malignant atrophic papulosisis with cranial nerve and peripheral nerve involvement in China. A 47-year-old woman presented to our hospital with atrophic porcelain white papules over the trunk and extremities, numbness in the right calf, vision decrease and impaired movement of the right eye. She was diagnosed with malignant atrophic papulosisis, based on characteristic symptoms and histopathologic examination. The patient was treated with dipyridamole and aspirin for 9 months, but later died of gastrointestinal hemorrhage. We reviewed currently available case reports on cranial nerve involvement in malignant atrophic papulosisis and emphasized the importance of skin biopsy in diagnosing this disease.
.Subject(s)
Female , Humans , Middle Aged , Cranial Nerve Diseases/pathology , Malignant Atrophic Papulosis/pathology , Peripheral Nervous System Diseases/pathology , Biopsy , Cranial Nerve Diseases/drug therapy , Fatal Outcome , Malignant Atrophic Papulosis/drug therapy , Peripheral Nervous System Diseases/drug therapy , Skin/pathologyABSTRACT
Allopurinol, a drug commonly used for treating gout and hyperuricemia, is a frequent cause of drug eruptions. Recent investigations suggest that HLA‑B*5801 allele is a very strong marker for allopurinol‑induced cutaneous adverse drug reactions (cADRs). In this article we report two cases of allopurinol‑induced drug eruptions in patients carrying the HLA‑B*5801 allele and review the literature on the association between HLA‑B*5801 and allopurinol‑induced cADRs based on a MEDLINE and PubMed search.