Vasculite urticariforme e exantema: uma reação de hipersensibilidade tardia mista a dimenidrinato ­ relato de caso / Urticarial vasculitis and rash: a mixed delayed hypersensitivity reaction to dimenhydrinate ­ case report

Dimenidrinato é um anti-histamínico H1 do grupo das etanolaminas, com importantes propriedades anticolinérgicas, antisserotoninérgicas e sedativas. Relatamos um caso de uma mulher que após 14 dias de ter usado dimenidrinato, iniciou quadro de exantema e vasculite urticariforme, além de sintomas constitucionais. Avaliação laboratorial sem alterações. Biopsia de pele evidenciou dermatite de interface do tipo vacuolar e púrpura com leucocitoclasia e derrame pigmentar. Imunofluorescência positiva para IgG, com presença de fluorescência dos núcleos dos queratinócitos da epiderme. Tratada com corticoide oral por 2 meses até remissão completa do quadro, e posterior realização de teste intradérmico, que foi positivo na leitura de 48h. A reação de hipersensibilidade tardia observada foi relacionada a mecanismo misto de Gell e Coombs (III e IV), com positividade no teste cutâneo intradérmico de leitura tardia em 48h (reação tipo IV) e biópsia compatível com vasculite cutânea (reação tipo III); lesões exantemáticas (reação tipo IV) e urticária vasculítica (reação tipo III). O teste cutâneo com dimenidrinato positivo reforça o diagnóstico de reação de hipersensibilidade.

Dimenhydrinate is an H1 antihistamine from the ethanolamine group, with important anticholinergic, antiserotoninergic and sedative properties. We report the case of a woman who, after 14 days of using dimenhydrinate, developed rash and urticarial vasculitis, in addition to constitutional symptoms. Laboratory tests were normal. Skin biopsy revealed interface purpuric dermatitis with leukocytoclasia and pigment effusion. Immunofluorescence was positive for IgG, showing nuclear fluorescence of epidermal keratinocytes. She was treated with oral corticosteroid for 2 months until complete remission of symptoms. Subsequent intradermal test resulted positive on the 48-h reading. The delayed hypersensitivity reaction was related to a mixed Gell and Coombs mechanism (III and IV), with positive results in the intradermal cutaneous test on the 48-h reading (type IV reaction) and a biopsy compatible with cutaneous vasculitis (type III reaction), exanthematous lesions (type IV reaction,) and urticarial vasculitis (type III reaction). The positive skin test for dimenhydrinate reinforces the diagnosis of hypersensitivity reaction.

Phenytoin/albendazole induced exanthematous eruptions: a case report.

Exanthematous drug eruptions, often called “drug rashes” or “maculopapular eruptions” by non-dermatologists are the most common form of cutaneous drug eruption. Cutaneous reactions are among the most common adverse effects of drugs, including penicillins, cephalosporins, sulfonamides, and allopurinol (with an incidence of up to 50 cases per 1000 new users), and particularly the aromatic amine anti-seizure medications, including carbamazepine, phenytoin, and lamotrigine (with an incidence of up to 100 cases per 1000 new users). Phenytoin is a hydantoin derivative anticonvulsant drug used primarily in the management of complex partial seizures and generalized tonic-clonic seizures. Albendazole is a benzimidazole medication used for the treatment of a variety of parasitic worm infestations. Carbamazepine and phenytoin are among the most common causes of antiepileptic drug-related cutaneous adverse reactions. Manifestations range from a mild erythematous maculopapular rash to life-threatening Stevens-Johnson syndrome and toxic epidermal necrolysis. Albendazole induced rashes and urticaria have been reported in less than 1% of the patients. Here we present the case of a 12-year-old male patient who came to the dermatology outpatient department with complaints of itching and maculopapular eruptions all over the body. The patient gave a history of taking tablet phenytoin and tablet albendazole for neurocysticercosis since 1-week. There was no fever or any other systemic manifestations. There was no history of any other drug intake. A diagnosis of phenytoin/albendazole induced exanthematous eruptions was made. Both the medications were discontinued, and the patient was advised to take syrup sodium valproate 200 mg BD. For the rashes and itching, the patient was advised to take tablet hydroxyzine HCl 10 mg OD, tablet prednisolone and tablet levocetirizine for 5 days. Improvement was seen and the itching reduced. Rechallenge was not done. In this event, casualty assessment using Naranjo adverse drug reaction probability scale revealed that phenytoin/albendazole were probable causes for the adverse drug reaction.

Effects of Polysaccharide from B.Jiangsiensis to the immune deficit mouse's specific immunological function / 中国基层医药

Objective To investigate the enhanced effect of polysaccharide from B.jiangsiensis(PBJ) on the immune hypofunction mouse models and its dose-effect relationship.Methods The immune hypofunction mouse models were made by hypodermic injection with cyclophosphamide(Cy) in mice.PBJ's effect on hemolysin content in mouse body induced by chicken erythrocytes and the delayed-type hypersensitivity(DTH) induced by dinitrochlorobenzene in mice were observed and contrasted in the different mouse groups treated with Cy in vivo by hypodermic injection together with PBJ at doses of 400mg/kg,200mg/kg and 50mg/kg,respectively.Results The test showed that the index of hemolysin,hemolytic plaque formation and delayed hypersensitivity reaction in model group markedly decreased while the indexes of hemolysin test in the control group,high and middle dose groups increased(P

A Case of Vancomycin Induced Delayed Hypersensitivity Reaction: A Patient of Bacterial Endocarditis with Systemic Emboli / 대한내과학회지

Vancomycin, one of glycopeptide antibiotics, has been used in recent years with the emergence of methicillin- resistant staphylococcus aureus (MRSA), coagulase negative staphylococci (CNS) as important hospital pathogens. A 75 years male patient receiving vancomycin 1g intravenously as twice daily dose for treatment of bacterial endocarditis, suffered from high fever, generalized diffuse erythematous maculopapular eruption, itching and eosinophilia, during course of 16th day of vancomycin therapy for treatment of bacterial endocarditis. This delayed hypersensitivity reaction was resolved with discontinuation of the drug and treatment with antihistamine. Awareness of vancomycin associated delayed hypersensitivity reactions is necessary during the treatment in patients with long-term infusion of vancomyin despite of delayed cutaneous reaction and fever associated with vancomycin therapy is not common.

Post-zoster Granuloma

We present a patient who developed granuloma in a previous herpes zoster scar (post-zoster granuloma). The development of granuloma in healed herpes zoster lesions may represent an atypical delayed hypersensitivity reaction to viral antigens or tissue antigens altered by the virus. To our knowledge, this is the first case reported in Korean literature.