Drug hypersensitivity syndrome induced by propylthiouracil: One case report and literature review / 中华内分泌代谢杂志

This article reports a case of a 38-year-old female who developed drug hypersensitivity syndrome one month after receiving propylthiouracil. The patient showed improvement with adalimumab, corticosteroids, intravenous immunoglobulin, and plasma exchange. Propylthiouracil is a rare medication associated with drug hypersensitivity syndrome. Additionally, during the follow-up after discharge, rapid changes in thyroid autoantibodies and thyroid function were observed in this patient. By analyzing the progression of this case and reviewing literature, it aims to enhance clinical understanding and management.

Clinical characteristics and progress in diagnosis and treatment of drug reactions with eosinophilia and syste-mic symptoms in children / 中华实用儿科临床杂志

Drug reactions with eosinophilia and systemic symptom (DRESS) are a severe drug eruption, which is characterized by fever, rash, lymphadenopathy, hematological system abnormalities and involvement of internal organs.It also has such clinical characteristics as delayed onset, relapsing symptoms and reactivation of human herpesvi-ruses.The clinical characteristics of DRESS make it different from other drug reactions, with high clinical heterogeneity, variability and unpredictability.DRESS in children has some unique characteristics that are different from adults, such as culprit drugs, rash characteristics, and involved systems and organs.Moreover, the course of disease is shorter, the severity is milder, the morbidity and mortality are lower, and the prognosis is better compared with adults.In this paper, the clinical characteristics and progress in diagnosis and treatment of DRESS in children are reviewed.

Receptor MrgprX2 nas anafilaxias não alérgicas / MRGPRX2 receptor in non-allergic anaphylaxis

A identificação e descrição das propriedades do receptor MrgprX2 possibilitou maior compreensão das funções dos mastócitos nas reações de hipersensibilidade não alérgicas, assim como em processos inflamatórios e infecciosos. Neste artigo revisamos brevemente as principais funções deste receptor, enfatizando seu papel nas reações de hipersensibilidade a medicamentos, promovendo a desgranulação direta de mastócitos.

The Identification identification of the receptor MRGPRX2 receptor and the description of its properties has improved the knowledge about mast cell actions in non-allergic hypersensitivity reactions, as well as in inflammatory and infectious processes. In this paper we briefly review the main functions of this receptor, highlighting its role in the drug-induced hypersensitivity reactions, with direct degranulation of mast cells.

Síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos en pediatría: Caso clínico / DRESS syndrome in paediatrics: Clinical case

El síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos es una enfermedad potencialmente mortal, caracterizada por exantema, fiebre, adenopatías, alteraciones hematológicas y compromiso de órganos internos. Objetivo: Presentar una afección poco frecuente en pediatría para facilitar la sospecha diagnóstica y el rápido reconocimiento por parte de los médicos. Caso clínico: Lactante de 9 meses hospitalizada por un cuadro de neumonía viral grave con ventilación mecánica no invasiva, tratada con ceftriaxona entre otros medicamentos. Al quinto día de suspendido el antibiótico presentó un exantema maculopapular violáceo, confluente de predominio en el tronco, la cara y las extremidades superiores, asociado a fiebre, eosinofilia y elevación de transaminasas. Se manejó con prednisona oral más corticoides tópicos por 6 semanas, con buena evolución a los 3 meses de seguimiento. Conclusiones: El diagnóstico de síndrome de sensibilidad a fármacos con eosinofilia y síntomas sistémicos se realiza por clínica y exámenes de laboratorio, además de biopsia cutánea en caso de duda diagnóstica. Si bien su causa más frecuente son los anticonvulsivantes se han descrito casos con un sinnúmero de fármacos. El manejo consiste en la suspensión del fármaco sospechoso asociado a medidas de soporte y tratamiento corticosteroide por tiempos prolongados.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes skin eruption, haematological abnormalities, lymphadenopathy, and internal organ involvement. Objective: Presenting a rare condition in children, to facilitate a rapid diagnostic suspicion and recognition by doctors. Case report: An 9 months old infant admitted due to a severe viral pneumonia, managed with non-invasive ventilation and ceftriaxone. Five days after stopping antibiotics, a confluent maculopapular rash appeared, which was predominantly in the trunk, face and upper extremities, combined with a fever, eosinophilia, and elevated serum levels of transaminase. She received treatment with oral prednisone and topical corticosteroids for 6 weeks, with a good outcome after 3 months. Conclusions: The diagnosis of DRESS syndrome is made using clinical criteria, laboratory values, and histopathology, if there is any query. Although it is classically caused by anticonvulsants and sulphonamides, many other drugs have been implicated. The offending drug should be immediately discontinued and the patient given supportive treatment, and systemic corticosteroids for long periods of treatment.

Drug-induced hypersensitivity syndrome in children：a case report / 临床儿科杂志

Objective To analyze the diagnose and treatment of drug-induced hypersensitivity syndrome (DIHS) in children.MethodsThe clinical data from one case of highly suspected DIHS were retrospectively analyzed. The related literatures were reviewed.ResultsA 22-month-old male child with severe pneumonia, after treated with vancomycin, suffered with high fever and skin rash combined with hepatic lesion and hematological system disorder. After withdrawal of vancomycin and then treatment with the combination of high-dose methylprednisolone and intravenous immunoglobulin, the clinical symptoms were gradually relieved in 24 hours. The child was improved and discharged on 17th day.ConclusionThe child has the characteristics of DIHS which is highly suspected to be caused by vancomycin.

Phenobarbital induced erythroderma: a case report.

Phenobarbital (PHB) (International Non-proprietary Name) or Phenobarbitone (British Approved Name) is a long acting barbiturate and the most widely used antiseizure medication globally. Fever, skin reactions, limb edema, and drug-induced hypersensitivity have been reported in children because of various drugs, mainly aromatic antiepileptic drugs such as phenytoin, PHB, carbamazepine, and primidone. The skin reactions differ in severity and range from a mild maculopapular erythema to exfoliative dermatitis. A 2-month-old male baby was brought to the dermatology out-patient department with complaints of redness and scaling all over the body (erythroderma) after 2-3 weeks of PHB treatment for convulsions. PHB was stopped, and corticosteroids (topical and systemic) were started. The baby improved over a period of 2 weeks. According to Naranjo’s adverse drug reaction probability scale, the causality relation between erythroderma and PHB was found to be a probable one.

Analysis of 28 cases with drug-induced hypersensitivity syndrome / 中国基层医药

Objective To investigate the pharmacoepidemiologic features of drug-induced hypersensitivity syndrome (DHS) and improve the recognition of its particularity.Methods The clinical data of 28 patients with DHS were retrospectively analyzed and summarized.Results Of 28 DHS patients,the suspected drugs were allopurinol in 17 cases,anti-epileptic drugs in 4 cases,antiuberculotic drugs in 3 cases and non-steroidal anti-inflammatory drugs in 4 cases.The earliest symptoms of DHS were skin rash (89.3 ％) and fever(85.7 ％),secondly liver function damaged(75.0％),which may be accompanied by mucosa,eye,genital damage (53.6％),eosinophilia (32.1％),renal impairment (17.9％),even multiple organ failure and death.Conclusion DHS should be on the alert when rash,repeated fever and visceral lesion occurred in a patient,without good therapeutic efficacy through ordinary anti-anaphylaxis and anti-infective therapy,as well as with the above medication history.

Dapsone Hypersensitivity Syndrome with EBV Reactivation / 대한피부과학회지

No abstract available.

Drug-induced hypersensitivity syndrome with human herpesvirus-6 reactivation.

A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR) on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6). Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS) was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.

Clinical Comparison of In-patients with Drug-induced Hypersensitivity Syndrome between the Departments of Dermatology and Internal Medicine / 대한피부과학회지

BACKGROUND: Because more severe patients tend to be admitted to the Department of Internal Medicine, drug-induced hypersensitivity syndrome may be underestimated by the dermatological evaluation of only in-patients. OBJECTIVE: The purpose of this study was designed to compare the clinical features of in-patients with drug-induced hypersensitivity syndrome in the Departments of Dermatology and Internal Medicine. METHODS: Between January 2000 and September 2010, we retrospectively reviewed the medical records of 10 in-patients in the Department of Dermatology and 11 in-patients in the Department of Internal Medicine in drug-induced hypersensitivity syndrome. RESULTS: The average age of onset was older in the internal medicine group than the dermatology group. The most common causative agent in the dermatology group was carbamazepine. The most common causative agents in the internal medicine group were carbamazepine, anti-tuberculosis, and allopruinol. The average latent period was longer in the internal medicine group than the dermatology group. The most common morphological feature in the dermatology group was maculopapular eruption, but in the internal medicine group was exfoliative dermatitis. Abnormal laboratory findings in drug-induced hypersensitivity syndrome were more severe in the internal medicine group than the dermatology group. The average treatment period was longer in the internal medicine group than the dermatology group. CONCLUSION: Our study suggests that in-patients of the internal medicine in drug-induced hypersensitivity syndrome are more severe than in-patients ofthe dermatology. Therefore, it is important that dermatologists recognize the concept of this syndrome much more widely.

A Case of Vogt-Koyanagi-Harada Disease in a Patient With Graves Disease

A case of Vogt-Koyanagi-Harada disease (VKH) that developed in a 36-year-old woman with Graves' disease was described. The patient was treated with Lugol's solution and presented with bilateral serous retinal detachment. She had also suffered from methimazole-induced hypersensitivity and steroid-induced myopathy. Fluorescein angiography showed multiple leakage points and a lumbar puncture revealed pleocytosis, which was compatible with VKH. High dose steroid pulse therapy was successful. Altered immune regulation associated with drug-induced hypersensitivity may contribute to the development of VKH in patients with Graves' disease.

Two Cases of Antituberculosis Drug-induced Hypersensitivity Syndrome / 대한피부과학회지

Drug-induced hypersensitivity syndrome is a rare, but severe, life-threatening disease with multiorgan failure. Aromatic antiepileptic drugs are frequent causes of this syndrome. The association of the human herpes virus-6 has been recently reported in patients with drug-induced hypersensitivity syndrome. We report two patients who were diagnosed as having antituberculosis drug-induced hypersensitivity syndrome based on clinical course and laboratory data. In addition, human herpes virus-6 DNA was detected by polymerase chain reaction in peripheral blood mononuclear cells and the serum. There was a favorable outcome after discontinuation of the causative drug, plus corticosteroid therapy. After the treatment, human herpes virus-6 DNA was not detected by polymerase chain reaction. This is the first report of antituberculosis drug-induced hypersensitivity syndrome associated with reactivation of human herpes virus-6.