Study of pattern and time-reaction sequence for adverse drug reactions reported to antiretroviral drugs

Background: Adverse drug reactions (ADRs) to antiretroviral drugs have a varied pattern and wide spectrum of severity from mild to very serious. The lack of a pre-established time-reaction sequence hampers the causality assessment of ADRs. Recognition of pattern of ADRs to antiretroviral drugs in a particular setup might sensitize the reporters to report ADRs, especially in setups dependent on spontaneous reporting. Aim and Objectives: The study of pattern and time-reaction sequence for ADRs reported to antiretroviral drugs. Materials and Methods: Retrospective study was conducted at a first-line antiretroviral therapy (ART) center after obtaining approval from the Institutional Ethics Committee. Pattern of ADRs associated with ART was done by analyzing the type of ADRs, severity, and outcome of ADRs reported to antiretroviral drugs. Mean duration of time lapse between administration of drug to onset of adverse drug reaction was calculated. Descriptive statistics was used for data analysis. Results: There were 73 adverse reactions reported. Most common type of adverse reaction was cutaneous (53.42%) followed by anemia (31%). Causality assessment of most ADRs was concluded as possible (60.27%). Most ADRs were of moderate severity and 12% were severe reactions. Reactions such as anemia and neuropsychiatric ADRs often occurred late, while maculopapular rash usually occurred within 30 days of drug administration. Conclusions: ADRs to ART include an array of reactions ranging from mild rash to psychosis or severe anemia. Most of these reactions are of moderate severity and have a favorable outcome. Many of these reactions actually occur almost a month after initiating a drug regime suggesting the need for intensive monitoring around this time.

Enfermedad de Kawasaki. Reporte de un caso infrecuente en el adulto / Kawasaki disease. Report of a rare case in an adult

RESUMEN La enfermedad de Kawasaki forma parte de un grupo heterogéneo de afecciones de baja frecuencia que se caracterizan por la presencia de inflamación y necrosis de la pared vascular, que generan diversas manifestaciones clínicas y patológicas, las cuales comprometen medianos vasos, y que afectan principalmente a la población pediátrica. Presentamos el caso de un hombre de 36 arios de edad, sin antecedentes patológicos previos, con cuadro febril de 4 días de evolución asociado a cefalea, náuseas y odinofagia, con posterior aparición de múltiples lesiones maculopapulares generalizadas, las cuales se resolvieron con descamación en pulpejos, palmas y plantas. Se documenta conjuntivitis no supurativa bilateral, además de compromiso de la mucosa oral y los labios. La biopsia de piel reportó vasculitis linfocítica asociada a compromiso renal, hepático y cardiaco (miocardiopatía dilatada con fracción de eyección deprimida); se configuró el diagnóstico de enfermedad de Kawasaki completa del adulto con manifestaciones atípicas. Recibió tratamiento con metilprednisolona, ácido acetilsalicílico 100mg/día, una dosis única de inmunoglobulina IgG intravenosa 2 g/kg y terapia dialítica interdiaria, logrando una recuperación completa.

ABSTRACT Kawasaki disease is part of a heterogeneous group of low frequency diseases that are characterized by the presence of inflammation and necrosis of the vascular wall, generating various clinical and pathological manifestations, which compromise medium vessels, and mainly affecting the pediatric population. The case is presented of a 36-year-old man with no relevant past medical history, with a febrile episode of 4 days of onset, together with headache, nausea, and odynophagia with subsequent onset of multiple generalized maculopapular lesions. These resolved with subsequent desquamation of fingers, palms and soles of feet. Non-suppurative bilateral conjunctivitis is documented, as well as involvement of oral mucosa and lips. Skin biopsy reported lymphocytic vasculitis, associated with renal, hepatic and cardiac involvement (dilated cardiomyopathy with depressed ejection fraction). A diagnosis of complete adult Kawasaki disease with atypical manifestations was established. He was treated with methylprednisolone, acetylsalicylic acid 100 mg per day, and a single dose of intravenous IgG immunoglobulin 2 g/kg, and daily dialysis therapy to achieve complete recovery.

A study on epidemiological and clinical characteristics of measles patients admitted to Sir Ronald Ross institute of tropical and communicable diseases, Hyderabad, India

Background: Measles is an acute infectious exanthematous disease of childhood caused by paramyxovirus. With increase in immunization coverage levels, the intensity of measles outbreak has decreased in the country. In some parts of India, measles is still a major cause of morbidity and childhood mortality. Objective of the study was to determine the epidemiological and clinical characteristics of patients with macular/maculo-papular rash.Methods: A cross sectional record based retrospective study was carried out at Sir Ronald Ross institute of tropical and communicable diseases, Hyderabad. All the cases admitted in year 2016 with history of fever and macular/maculo-papular rash were included in the study. The study was carried out for 2 months.Results: A total of 639 cases were admitted to infectious disease hospital during the year 2016 with history of fever and rash. The mean age of study population was 6.08±4.9 years. Around 43.7% of cases were in the age group of 1–5 years. The disease was slightly higher among boys (52.3%) as compared to girls (47.7%). Amongst the clinical features, fever and rash were seen in 100%, coryza in 80%, and conjunctivitis in 63.3% of study population.Conclusions: Majority of the children suffering from measles was not vaccinated and the most common reason for failure to immunize children was lack of awareness. There is a need to increase awareness about importance of measles immunization to reduce under five mortality.

Cutaneous Adverse Drug Reactions in Sabah: A 3-year study between 2014 - 2016

Introduction:Cutaneous adverse drug reactions are one of the most common adverse drug reactions. Publicationson clinical correlation between cutaneous presentations and causative agents are limited among thelocal population. This study aims to determine the clinical presentations of cutaneous adverse drugreactions and the causative drugs in the local population.Methods:A retrospective, cross sectional study was conducted from the pharmacy cutaneous adverse drugreaction database from January 2014 to December 2016 in Tawau, Keningau & Queen Elizabeth (KotaKinabalu) Hospitals.Results:A total of 859 cases of cutaneous adverse drug reactions were identified. Out of these, 53.3% (n=458)were females and 46.7% (n=401) were males. The mean age was 36 years old. Majority of patients were20-29 years old (16.6%) followed by 50-59 years old (15.1%). Most of the cases were reported amongthe Chinese community (16.4%), followed by the Malay (15.9%), Dusun (14.7%) and Bajau (14.0%)populations. The most common cutaneous manifestations were urticaria and or angioedema (49%, n=421) and maculopapular rash (39.6%, n=340). Severe cutaneous adverse reactions (SCAR) constituted2.8% in total. The major causative agent was antibiotic which accounted for 55.1% (n=473), followedby nonsteroidal anti-inflammatory drugs (NSAIDs), 28.1% (n=241) and analgesics, 10.8% (n=93).Conclusion:The types of cutaneous manifestations and causative drugs in Sabah are similar to those reported inother states of the country and abroad. This study provides evidence of local cutaneous adverse drugreaction characteristics in different ethnic group.

Maculopapular rash presentation of febrile illness in an adult with Varicella zoster virus infection.

Varicella zoster usually manifests as maculopapular rash (MPR), which later progresses to vesicle. It can also manifest as MPR without progression to the vesicle stage. This atypical manifestation is more common in adults and immunocompromised patients. A 30‑year‑old female presented with high‑grade fever and rash over face and body for 5 days. She was diagnosed to have Varicella zoster virus (VZV) infection by positive VZV immunoglobulin M enzyme‑linked immunosorbent assay and polymerase chain reaction. We present this case to increase awareness among clinicians on the atypical manifestations of VZV and prevent complications by early diagnosis.

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.

Cutaneous Drug Eruption Caused by Amoxicillin: A Case Report.

Amoxicillin is a commonly used antimicrobial agent to combat various infections. Penicillin group of drugs are known to cause cutaneous drug eruptions especially in pediatric population. Most of the time, these eruptions are mild in nature, however, sometimes they represent the early manifestation of rare, severe drug-induced cutaneous reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Here, we report a case of maculopapular, erythematous rash induced by amoxicillin in an 18-year-old male patient. The case is being reported to emphasize the need for efficient pharmacovigilance in order to motivate adverse drug reaction reporting so as to gather more and more data regarding adverse drug reactions.

A Case of Cutaneous Hodgkin's Disease Presented with a Maculopapular Rash / 대한피부과학회지

Hodgkin's disease (HD) is a lymphoproliferative disorder that presents as a clinically asymptomatic mass or painless lymph node swelling. Cutaneous HD is a very rare manifestation in patients with HD. A 66-year-old man complained of a maculopapular rash waxing and waning for one year. A painful mass had developed on his left axilla 7 weeks prior to presenting. The biopsy specimens of both skin and lymph node revealed Hodgkin's lymphoma with atypical lymphoid cells and Reed-Sternberg cells. We report a case of cutaneous involvement of HD, which had been presented as a maculopapular rash for one year.

A Case of SIADH Related to Drug-indeced Generalized Maculopapular Rash / 대한내분비학회지

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.