RESUMO
Drug-induced hypersensitivity syndrome (DiHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a rare but potentially life-threatening condition induced by drug hypersensitivity that leads to significant morbidity and mortality and often occurs in patients undergoing combination antibiotic therapy. Due to a recent increase in the incidence of methicillin-resistant Staphylococcus aureus infections, the occurrence of vancomycin-induced DiHS/DRESS has increased rapidly. However, because of insufficient pharmacogenetic data on vancomycin-induced drug eruptions in Asians coupled with the risk of re-eliciting the symptoms by provocation tests, confirmation of the culprit drug in vancomycin-induced DiHS/DRESS is often challenging. Here, we report a case of vancomycin-induced DiHS/DRESS, where the causal relationship was confirmed using a lymphocyte transformation test (LTT). A 51-year-old woman was treated with combination antibiotics, including vancomycin, for infective pericarditis. The patient subsequently developed fever, facial edema, generalized rash followed by multiple internal organ involvement, including the kidney, lung, liver, and heart. Thus, based on the International Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) criteria, the case was diagnosed as ‘definite’ DiHS/ DRESS, although the culprit drug was obscured by combination antibiotic therapy. The LTT confirmed that vancomycin, but not other glycopeptide antibiotics, specifically induced Tcell proliferation in this case. Collectively, our case suggests that clinicians can utilize LTT to identify the causative medication of DiHS/DRESS when the clinical information is limited to defining the culprit drug.
RESUMO
Background@#Recurrent aphthous stomatitis (RAS) is a common disorder characterized by episodic ulcerations in the oral mucosa. Although colchicine has been a common systemic treatment for RAS, there is still considerable uncertainty regarding its efficacy and drug survival in this setting. @*Objective@#We aimed to study drug survival, efficacy, and safety of colchicine for the treatment of RAS, especially in the real clinical setting. @*Methods@#Between 2012 and 2016, 150 patients given colchicine for RAS were selected for a single-centre retrospective study of real-world efficacy and drug survival. @*Results@#Among the 114 patients who qualified, 81.6% showed moderate or substantial responses (>25% improvement). Gastrointestinal complications (16.7%), neutropenia (3.5%), and liver enzyme elevation (4.4%) were reported within 2 weeks after initiating treatment.Delayed adverse manifestations were rare. One year after onset, colchicine use was sustained in roughly one-half (49.5%) of patients, whereas many (30.3%) had discontinued the drug, primarily due to lack of efficacy or adverse events. In Cox proportional hazard analysis, minor ulcers were identified as potential determinants of longer drug survival owing to less probability of non-efficacy. However, major ulcers had emerged as predictors of early discontinuation due to lack of efficacy. @*Conclusion@#In patients with RAS, colchicine may be an effective and safe treatment amenable to long-term maintenance. Monitoring of adverse events within 2 weeks after initiating treatment is advisable to ensure safe administration.
RESUMO
Background@#Chronic actinic dermatitis is a rare, acquired, persistent eczematous eruption of photo-distributed areas.There are limited data available on the clinical characteristics of Korean patients diagnosed with chronic actinic dermatitis. @*Objective@#To evaluate the clinical features and prognosis of chronic actinic dermatitis patients in Korea. @*Methods@#Sixty-two Korean patients diagnosed with chronic actinic dermatitis through clinical findings, phototesting, and skin biopsy from six hospitals were included in this study, and their clinical characteristics were evaluated. @*Results@#Among the 62 patients, 51 were men, and the mean age at diagnosis was 60.3±12.8 years. Phototesting was performed for 27 patients, with results available for 18 patients. Patch tests were performed for only 4.8% of the patients. Skin pathology tests were performed for 47 patients and showed the following: spongiosis, acanthosis, actinic elastosis, and pseudo-lymphomatous change. Twelve patients were clinically diagnosed without using diagnostic tools such as phototesting, patch testing, and skin biopsy. The most commonly used systemic treatments were antihistamine, cyclosporine, steroid, and azathioprine. Although avoiding ultraviolet irradiation and outdoor activities are critical, only 22.6% of patients used sunscreen. @*Conclusion@#Although phototesting is highly recommended for diagnosing chronic actinic dermatitis, phototesting was performed for less than half of the patients to diagnose chronic actinic dermatitis. Patch tests and photopatch tests are also recommended to disclose a causative agent.
RESUMO
Background@#Chronic actinic dermatitis is a rare, acquired, persistent eczematous eruption of photo-distributed areas.There are limited data available on the clinical characteristics of Korean patients diagnosed with chronic actinic dermatitis. @*Objective@#To evaluate the clinical features and prognosis of chronic actinic dermatitis patients in Korea. @*Methods@#Sixty-two Korean patients diagnosed with chronic actinic dermatitis through clinical findings, phototesting, and skin biopsy from six hospitals were included in this study, and their clinical characteristics were evaluated. @*Results@#Among the 62 patients, 51 were men, and the mean age at diagnosis was 60.3±12.8 years. Phototesting was performed for 27 patients, with results available for 18 patients. Patch tests were performed for only 4.8% of the patients. Skin pathology tests were performed for 47 patients and showed the following: spongiosis, acanthosis, actinic elastosis, and pseudo-lymphomatous change. Twelve patients were clinically diagnosed without using diagnostic tools such as phototesting, patch testing, and skin biopsy. The most commonly used systemic treatments were antihistamine, cyclosporine, steroid, and azathioprine. Although avoiding ultraviolet irradiation and outdoor activities are critical, only 22.6% of patients used sunscreen. @*Conclusion@#Although phototesting is highly recommended for diagnosing chronic actinic dermatitis, phototesting was performed for less than half of the patients to diagnose chronic actinic dermatitis. Patch tests and photopatch tests are also recommended to disclose a causative agent.