A importância das provas epicutâneas de contacto no diagnóstico diferencial de reações a medicamentos / The importance of patch tests in the differential diagnosis of adverse drug reactions

O eritema exsudativo multiforme é uma erupção aguda, autolimitada, frequentemente associada a infecções (geralmente virais), doenças sistêmicas e fármacos. Apresenta-se o caso de uma mulher de 39 anos, com o diagnóstico de lúpus eritematoso sistêmico, que recorreu à Urgência com quadro de eritema exsudativo multiforme, com início 10 dias após tomar amoxicilina e ácido clavulânico por amigdalite e, quase simultaneamente, receber a vacina antipneumocócica. Colocou-se também a hipótese de síndrome de Rowell. Efetuaram-se testes epicutâneos de contacto com bateria básica (portuguesa) e princípios ativos dos fármacos suspeitos (Chemotechnique®). Encontrou-se hipersensibilidade à amoxicilina 10 por cento vas (++), à ampicilina 10 por cento vas (++) e à penicilina G potássica 10 por cento vas (+), atribuindo-se à amoxicilina a causa mais provável do eritema exsudativo multiforme.

Exudative erythema multiforme is an acute self-limited skin disease often associated with infections (usually viral), and also with systemic diseases and drugs. We report the case of a 39-year-old woman diagnosed with systemic lupus erythematosus, who presented at the emergency clinic with exudative erythema multiforme which started 10 days after taking amoxicillin and clavulanic acid for tonsillitis together (almost simultaneously) with the pneumococcal vaccine. Rowell's syndrome was also considered to be a possibility. Skin patch tests were carried with the standard battery of patches (GPEDC) and the active ingredients of the suspected drugs (Chemotechnique ®), with readings at D2 and D3. The tests were positive for amoxicillin 10 percent pet (++), ampicillin 10 percent pet (+ +) and penicillin G potassium 10 percent pet (+). We accepted the diagnosis of erythema multiforme due to amoxicillin, confirmed by patch testing.

Cutaneous drug reactions in patients admitted to the dermatology unit at the University Hospital of the West Indies, Kingston, Jamaica / Reacciones cutáneas medicamentosas en pacientes ingresados en la Unidad de Dermatología del Hospital Universitario de West Indies, Kingston, Jamaica

OBJECTIVE: Cutaneous reactions are among the most common adverse reactions to drugs. The purpose of this study is to examine the aetiology and outcome of cutaneous drug reactions among patients admitted to the Dermatology Ward at the University Hospital of the West Indies. SUBJECTS AND METHODS: This was a retrospective study looking at all patients who were admitted with a diagnosis of a cutaneous drug eruption from January 1, 1997 to December 31, 2005. Data included patient demographics, date of admission to hospital, duration of hospitalization and a detailed drug history including any previous episodes of drug sensitivity. All drugs reportedly ingested by the patients up to three months prior to their cutaneous reaction were documented and the period of time between drug ingestion and the appearance of skin lesions was also noted. Clinical diagnosis, co-morbidities, histopathological diagnosis, final outcome and all ensuing disabilities were noted. The data retrieved were collated and analyzed using SPSS 12.0. RESULTS: The results showed a female to male ratio of 2.2:1. The categories of drugs most commonly implicated were antimicrobials followed by anti-epileptic drugs and nonsteroidal anti-inflammatory drugs. The most common form of drug eruption requiring admission was the exanthematous drug eruption followed by erythema multiforme, toxic epidermal necrolysis and Stevens-Johnson syndrome. CONCLUSION: In general, the causative agents identified and the types of drug eruptions were similar to those found in previous studies. However, the anti-epileptic drugs, phenytoin and carbamazepine, ranked among the most commonly implicated drugs which differ significantly from other studies.

Las reacciones cutáneas se hallan entre las reacciones adversas más comunes frente a los medicamentos. El propósito de este estudio fue examinar la etiología y la evolución clínica de las reacciones cutáneas medicamentosas entre pacientes ingresados a la sala de dermatología en el Hospital Universitario de West Indies. MÉTODOS: Este es un estudio retrospectivo que pasa revista a todos los pacientes que fueron ingresados con diagnóstico de erupción cutánea desde el 1ero. de enero de 1997 al 31 de diciembre de 2005. RESULTADOS: Los resultados mostraron una proporción hembra-varón de 2.2:1. Las categorías de los medicamentos más frecuentemente implicados fueron los antimicrobianos, seguidos por los medicamentos antiepilépticos y los antiinflamatorios no esteroideos. La forma más común de erupción que requirió ingreso a causa de medicamentos, fue la erupción exantemática medicamentosa seguida por el eritema multiforme, la necrólisis epidérmica tóxica, y el síndrome de Stevens-Johnson. CONCLUSIÓN: En general, los agentes causativos identificados y los tipos de erupciones medicamentosas, fueron similares a los hallados en estudios previos. Sin embargo, los antiepilépticos conocidos como fenitoína y carbamazepina, estuvieron entre los medicamentos más comúnmente implicados, presentándose en tal sentido una diferencia significativa con los otros estudios.

Síndrome de Stevens-Johnson associada ao uso de antimicrobiano / Stevens-Johnson syndrome associated with antimicrobial agent

Dentre as reações medicamentosas graves, figuram como grandes representantes as doenças mucocutâneas imunologicamente mediadas. A síndrome de Stevens-Johnson, ou eritema multiforme maior, aparece como um distúrbio sistêmico com envolvimento de pele e membranas mucosas relacionado a diversos fatores, tais como infecções virais ou bacterianas e, principalmente, a administração de medicamentos, em geral analgésicos e antibióticos. O objetivo deste artigo é relatar o aparecimento de lesões vesículo-bolhosas ulcerativas em regiões de lábios, gengiva, língua e mucosa genital em um paciente de 26 anos, leucoderma, gênero masculino, em tratamento de infecção respiratória com sulfametoxazol-trimetropima, diagnosticado como síndrome de Stevens-Johnson

Among the severe reactions to medications, immune-mediated Mucocutaneous Disorders are widely represented. Steven-Johnson's syndrome, or great multiform erythema, appears as a systemic disturbance, involving the skin and mucous membranes, and is related to several factors, such as, viral or bacterial infections and particularly the administration of medicines, in general painkillers and antibiotics. The objective of this article is report the onset of ulcerative vesicle ûblister lesions in the regions of the lips, gums, tongue and genital mucosa membrane in a 26 year-old patient, a leukoderm man, being treated with sulfamethoxazole trimethoprim for a respiratory infection, after being diagnosed as having the Steven-Johnson syndrome.

Erythema multiforme following vaccination in an infant.

Erythema multiforme is a cutaneous reaction pattern precipitated by varied agents, notably herpes simplex and drugs. It predominantly occurs in adolescents and young adults but may be seen at other ages also. While vaccination is rarely a precipitating factor for erythema multiforme, it may occasionally be seen in infants and children. We report here a case of a two month-old infant with lesions of erythema multiforme minor appearing after two weeks following vaccination for DPT, Hepatitis B and influenza.

Octreotide-LAR-associated erythema multiforme in an acromegalic subject: case report

Long-acting somatostatin analogs are often used for treating acromegaly, either as adjuvant to surgery or radiotherapy or, more recently, as a primary therapeutic option. These drugs seem to be reasonably safe, but new adverse effects not yet described may occur during the use of the relatively new long-acting formulations. In this case report, we describe a severe cutaneous reaction (erythema multiforme) in a patient treated with long-acting release (LAR) octreotide, and also discuss the need of previous "testing" with short subcutaneous preparation of octreotide.

Análogos da somatostatina de longa duração são freqüentemente usados no tratamento da acromegalia, como adjuvante à cirurgia ou à radioterapia ou, mais recentemente, como opção terapêutica primária. Essas drogas parecem ser razoavelmente seguras, mas podem ocorrer feitos colaterais ainda não descritos com o uso das relativamente novas formulações de ação prolongada. Neste relato de caso, descrevemos uma reação cutânea grave (eritema multiforme) em uma paciente tratada com octreotide de liberação prolongada (LAR) e discutimos a necessidade de submeter os pacientes previamente a um "teste" com a formulação subcutânea do octreotide de ação rápida.

Reações adversas a drogas / Adverse reactions to drugs

Os autores apresentam quadros clínicos de lesões estomatológicas que podem ser provocadas pelo uso de medicamentos, fazendo referências aos prováveis agentes etiológicos, às características das lesões e à conduta do profissional frente às mesmas

Carbamazepine-induced erythema multiforme in two patients with bipolar disorder

Stevens-Johnson's syndrome [SJS], a severe form of erythema multiforme [EM],is an uncommon hypersensitive inflammatory reaction which could involve symmetrically multiple mucocutaneous areas of the body. It has been characterized by distinctive diagnostic criteria and carries a mortality of 1% to 15%. Two young male adult patients with bipolar disorder who during the course of manic-depressive illness developed SJS temporally caused by carbamazepine [CBZ] therapy are described and the most pertinent clinical issues are discussed. In light of this case report and a brief review of literature, twomain recommendations mechanisms not only underlying the mood disorders but also a spectrum of erythema multiforme. secondly for the purpose of prevention it is mandatory that clinicians must take a detailed history of carbamazepine [tegretol] sensitivity both from the mental patients and the most reliable key relatives before prescribing this drug to patients with mood disorder

Eritema fijo medicamentoso / Fixed drug erythema

Se presenta un caso que ingresa por lesiones eritematoampollosas y pigmentadas, diseminadas por todo el cuerpo, incluyendo genitales, con el antecedente de tomar analgésicos con frecuencia por presentar cefalea. Se plantea un eritema fijo medicamentoso, diagnóstico que se corrobora por estudio histopatológico. Se informa que en sus 2 ingresos, su evolución fue favorable, los análisis estuvieron dentro de los límites normales. Se expresa que su tratamiento consistió en corticosteroides, antihistamínicos y tratamiento local. Se indica que al salir de alta su cuadro estaba mejorando. Se hace un breve comentario del paciente y de las características de su enfermedad