Clindamycin induced Cutaneous Drug Reaction – A Case Report

Adverse drug reactions (ADRs) due to antibiotics is one of the major concern. Hypersensitivity reactions with clindamycin may be immediate or delayed type, but their frequency and severity are relatively rare. We here report a case of a 32-year-old male patient with road traffic accident, who later developed osteomyelitis of occipital bone. After two weeks of therapy and debridement, the patient was on maintenance therapy receiving clindamycin 300 mg q8h, ciprofloxacin 500 mg q12 h and rifampicin 450mg fasting. After six days, he developed erythematous maculopapular rashes, initially on the trunk followed by neck and arm of both upper limbs with limitation of movement, fever, chills and night sweats. The reaction subsided after withdrawal of clindamycin and administering i.v. hydrocortisone 100mg stat followed by tablet promethazine 25mg 12hourly for 3 days. The causality assessment was done as per WHO-UMC scale and it was “probable” in this case. Although the incidence of clindamycin induced drug reaction is rare, the clinicians should be aware of such reactions before prescribing it.

A prospective study of incidence and assessment of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school.

Background: The wide and indiscriminate use of drugs has increased the incidence and the modes of presentation of cutaneous drug reaction. Understanding the nature of ACDRs may help narrow down the search for the offending agent. Aim- The study aimed to evaluate incidence, assessment of causality, severity and preventability of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school. Material and methods: The current survey was executed by the department of Pharmacology in collaboration with Department of Dermatology, MSDS Medical College, Fatehgarh among 7692 patients attending Dermatology OPD during March-December 2014. CDSCO ADR Reporting Form, WHO causality assessment scale, Hartwig and Siegel’s Assessment scale and Modified Schomock and Thronton’s preventability assessment scale were used as study tools. All the doctors, residents, interns and students were encouraged to notify any suspected ACDRs. Patients were screened and recruited if they presented with visible skin lesions suspected to be drug related. As per Modified Schumock and Thornton Scale, 43.5% of ACDRs were ‘Definitely preventable’ followed by ‘Probably preventable’ (30.4%) and ‘Not preventable’ (26.1%). Results: 23 patients (0.3%) were detected to have one or other type of ACDRs. Fixed drug eruption was most common form (34.8%) of ACDRs followed by Acneform eruption and Urticaria in 21.7% and 13% respectively among study subjects. The most common drugs responsible for ACDRs were prednisolone, betamethasone and isoniazid for Fixed drug eruption, while matronidazole, cotrimoxazole and paracetamol for acneform eruption. Antimicrobials, other steroids and NSAIDs were responsible for other spectrum of ACDRs. On assessment of Causality of ACDRs, it was noted that more than half (52.2%) of them fall under probable category. Severity assessment of ACDRs revealed that majority (65.3%) of them was moderate in nature. Conclusion: Awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them. Pharmacovigilance activity is significantly effective in increasing the reporting of ADRs. Study with long-term follow-up and monitoring of the patients with bigger sample size is warranted.

Psoriasis pustulosa generalizada / Generalized pustular psoriasis

Introducción: la psoriasis pustulosa generalizada (PPG) es una forma grave de psoriasis asociada a manifestaciones sistémicas. Es una enfermedad infrecuente y potencialmente letal. En las últimas décadas, se ha avanzado mucho en la comprensión de su fisiopatología, gracias a estudios inmunológicos y genéticos. Objetivo y método: El objetivo de esta revisión es actualizar los conceptos respecto a la fisiopatología, diagnóstico y tratamiento de la PPG. Se realizó una revisión del tema mediante una búsqueda bibliográfica en Pubmed y LILACS en los últimos 10 años, y además se agregaron referencias relevantes que no se encontraran en los resultados. Resultados: La PPG podría comprenderse como una enfermedad del grupo de las enfermedades autoinflamatorias, cuya causa es una mutación en el gen IL36RN, que produciría una falla estructural o una secreción inadecuada del antagonista del receptor de IL36, lo que conduciría a un desbalance en la contra-regulación de las citoquinas pro-inflamatorias de la familia IL-1. Su gatillante más frecuente es la interrupción abrupta del uso de corticoides, aunque existen numerosos factores reportados. El tratamiento de primera línea es la hospitalización, manejo con terapia tópica y sistémica con retinoides o terapia biológica, para luego continuar con un esquema de mantención. Conclusión: Dado los avances en su investigación, la PPG podría considerarse una entidad etiológicamente distinta a la psoriasis común.

Introduction: generalized pustular psoriasis (GPP) is a severe form of psoriasis associated with systemic manifestations. It is a rare and potentially lethal disease. In recent decades, much progress has been made in understanding its pathophysiology, thanks to immunological and genetic studies. Objective and Methods: The aim of this review is to update the concepts regarding the pathophysiology, diagnosis and treatment of GPP. A review was performed by searching in PubMed and LILACS databases in the last 10 years, also relevant references that were not in the results were aggregated. Results: GPP could be understood as a disease of the group of autoinflammatory diseases, caused by a mutation in the gene IL36RN that produce structural failure or an inadequate secretion of IL36 receptor antagonist, leading to an imbalance in the counter-regulation of the pro-inflammatory cytokines from the IL-1 family. Its most common trigger is the abrupt discontinuation of corticosteroids, although there are numerous factors reported. The first line treatment is hospitalization, management with topical and systemic retinoid therapy or biological therapy, and continue with a scheme of maintenance afterwards. Conclusion: Due to the progress in its investigation, GPP could be regarded as an etiologically distinct entity to psoriasis vulgaris.

Clonazepam induced maculopapular rash: a case report.

Clonazepam is a benzodiazepine with prominent anticonvulsant action than other members of the group at equisedating doses. It especially blocks pentylenetetrazole-induced seizures. Other important actions include anxiolysis. Common adverse effects to Clonazepam include drowsiness and lethargy. In this submission we report a case of Clonazepam induced maculopapular rash in a 30 year old female treated for panic disorder.

Manifestaciones cutáneas en pacientes portadores de tumores sólidos sometidos a quimioterapia, Hospital Clínico Universidad de Chile 2011 / Cutaneous manifestations in patients with solid tumors undergoing chemotherapy at Clinical Hospital University of Chile 2011

Introducción: La incidencia de la toxicidad dermatológica de la quimioterapia no es bien conocida. Objetivo: Determinar la presencia de manifestaciones cutáneas secundarias a la quimioterapia en portadores de tumores sólidos atendidos en el servicio de Oncología del Hospital Clínico Universidad de Chile durante los meses de Febrero a Octubre de 2011. Metodología: Estudio de tipo observacional descriptivo. El universo estudiado fueron todos los pacientes portadores de algún tumor sólido que comenzaron su quimioterapia entre los meses señalados. Los pacientes fueron entrevistados y examinados utilizando un cuestionario en el cual se registraban las diferentes manifestaciones cutáneas. Resultados: 62,2 por ciento presentó alguna reacción adversa. Las más frecuentes fueron la Hiperpigmentación y xerosis con un 20,8 por ciento cada una. Efluvio anágeno se presentó en el 16,7 por ciento. 5-Fluoruracilo fue el fármaco más frecuentemente involucrado con un 35,4 por ciento. Conclusiones: Las reacciones cutáneas a la quimioterapia son frecuentes. El reconocerlas apropiadamente es un desafío que tiene por finalidad lograr una terapia antitumoral exitosa con un máximo confort del paciente.

Introduction: Incidence and severity of chemotherapy- induce dermatological toxicity is not well known. Objective: To determine the presence of chemotherapy- induce dermatological toxicity in patients with solid tumors treated at the Oncology department of the Clinical Hospital University of Chile from February to October 2011. Methods: Descriptive observational study was conducted on patients with any solid tumor who started chemotherapy between the months of February to October 2011. Patients were interviewed and examined using a questionnaire which recorded dermatological diseases. Results: 45 patients enrolled, 24 women (53.3 percent) and 21 men (46.7 percent). 62.2 percent of patients had a chemotherapy induced dermatological toxicity. The most common reactions were hyperpigmentation and xerosis (20.8 percent each). Anagen effluvium was seen in 16.7 percent of patients. 5-fluorouracil was the drug most frequently involved in all skin reactions (35,4 percent). Conclusions: Chemotherapy induced dermatological diseases are frequent. Properrecognition and management is a challenge that aims to achieve a successful antitumor therapy with maximum patient comfort.

Adverse Cutaneous Drug Reactions in a Tertiary Care Center Patients: a Prospective Analysis.

In the dermatology department of a tertiary care centre patients were scrutinized for adverse cutaneous drug reaction and 100 cases of certain and probable causality assessment were studied for type of reaction and their causative agent. Most common morphological pattern observed was maculopapular drug reaction (23%), followed by fixed drug eruption and urticaria 14% and 13% each respectively. Stevens-johnson and toxic epidermal necrolysis accounted for 25%. Pityriasiform, lupus erythematosus like eruption, acute generalized exanthematous pustulosis and dapsone syndrome each accounted for 1%. Most common causative agent observed was NSAID (24%) followed by antibiotics and antiepileptic each in (22%) cases. Other drug responsible for ADR were antiretroviral (6%), antiprotozoals (5%); antimalarials, antitubercular and antihypertensive; each were 4%. It is our contention that the use of high risk drug should be carefully prescribed, monitored and awareness should be created by treating physician so that the morbidity and mortality by the use of the drug should be decreased.