Síndrome de hipersensibilidad inducido por sulfasalazina asociado a reactivación de VHH-6 e inducción de síndrome antifosfolípido / Sulfasalazine-Induced Hypersensitivity Syndrome Associated With Human Herpesvirus 6 Reactivation and Induction of Antiphospholipid Syndrome

El síndrome de hipersensibilidad inducido por fármacos (DIHS) se engloba dentro de los cuadros toxicodérmicos con afectación sistémica, cuya sospecha obliga a la retirada lo más precoz posible del fármaco que consideremos pueda estar implicado, que puede haber sido introducido hasta tres meses antes. Es importante el despistaje de la reactivación del virus herpes humano (VHH) 6, tanto por su valor diagnóstico como por el pronóstico de gravedad que supone. Por otro lado, esta reactivación no contraindica que el tratamiento pueda llevarse a cabo con corticoides sistémicos, que además, deberán retirarse lentamente para evitar recaídas. Debería pensarse asimismo en la posibilidad de la presencia de anticuerpos antifofolipídicos en los casos en que apareciera trombopenia, alteración en la hemostasia o cuadros trombóticos asociados, como también tener en cuenta el desarrollo de procesos autoinmunes como secuela del cuadro, que requiere de monitorización y seguimiento a medio-largo plazo, a pesar de la resolución completa del cuadro. Describimos un nuevo caso donde se muestra la reactivación del VHH-6, la activación de anticuerpos anticardiolipina y la inducción de anticuerpos anti-tiroperoxidasa (anti-TPO) (AU)

Drug-induced hypersensitivity syndrome is a toxicoderma with systemic involvement. Suspicion of this disorder obliges rapid withdrawal of the suspected drug, which may have been introduced up to 3 months earlier. Screening for human herpesvirus (HHV) 6 reactivation is important both for its diagnostic value and for its association with a poor prognosis. Reactivation of this virus is not a contraindication for systemic corticosteroid treatment, which should be tapered slowly in order to avoid recurrence. The possible appearance of antiphospholipid antibodies must also be considered in those cases associated with thrombocytopenia, altered hemostasis, or thrombotic events. Autoimmune disorders may also develop as a sequela of the condition. Medium-to-long-term follow-up is required even after complete resolution of the condition. We describe a new case of sulfasalazine-induced hypersensitivity syndrome associated with HHV-6 reactivation and the induction of anticardiolipin and anti-thyroid peroxidase antibodie (AU)

[Sulfasalazine-induced hypersensitivity syndrome associated with human herpesvirus 6 reactivation and induction of antiphospholipid syndrome]. / Síndrome de hipersensibilidad inducido por sulfasalazina asociado a reactivación de VHH-6 e inducción de síndrome antifosfolípido.

Drug-induced hypersensitivity syndrome is a toxicoderma with systemic involvement. Suspicion of this disorder obliges rapid withdrawal of the suspected drug, which may have been introduced up to 3 months earlier. Screening for human herpesvirus (HHV) 6 reactivation is important both for its diagnostic value and for its association with a poor prognosis. Reactivation of this virus is not a contraindication for systemic corticosteroid treatment, which should be tapered slowly in order to avoid recurrence. The possible appearance of antiphospholipid antibodies must also be considered in those cases associated with thrombocytopenia, altered hemostasis, or thrombotic events. Autoimmune disorders may also develop as a sequela of the condition. Medium-to-long-term follow-up is required even after complete resolution of the condition. We describe a new case of sulfasalazine-induced hypersensitivity syndrome associated with HHV-6 reactivation and the induction of anticardiolipin and anti-thyroid peroxidase antibodies.

Detection of human papilloma virus in normal skin and in superficial and nodular basal cell carcinomas in immunocompetent subjects.

BACKGROUND: Human papilloma virus (HPV) is increasingly recognized as an important human carcinogen but its role in the aetiopathogenesis of basal cell carcinoma (BCC) in immunocompetent individuals is unclear. OBJECTIVE: A prospective case-control study was designed to compare the prevalence of HPV in BCC and normal skin samples from immunocompetent subjects and to assess the influence of different clinical features on the risk of cutaneous HPV. METHODS: A total of 142 samples from 70 BCC cases (superficial BCC 38 and nodular BCC 32) and 72 controls were analysed by a degenerated nested PCR technique. Clinical data were recorded and risk factors for HPV infection were assessed by multivariate analysis. RESULTS: There were 31 HPV DNA-positive samples. HPV was detected more frequently in cases (25.7%) than in controls (18.1%) and in nodular (31.3%) than in superficial (21.1%) BCC lesions but differences were not statistically significant. Older age (OR 1.5; 95% CI: 1.02-1.09) and actinic keratosis (OR 2.62; 95% CI 1.15-5.96) were the only significant factors associated to the presence of HPV. Risk of HPV positivity was also higher in blond-haired subjects, fair/pale skin colour, history of sunburn, solar lentigines and seborrheic keratosis but the differences were not significant. Both in cases and controls, ß -types were the most frequent. CONCLUSIONS: HPV does not seem to play a fundamental role in the aetiopathogenesis of either nodular or superficial BCC. The presence of HPV appears to be more related to actinic damage and possibly to an alteration of the barrier function associated with ageing.

[Ciprofloxacin-induced vasculitis with cutaneous and renal involvement]. / Vasculitis por ciprofloxacino con afectación cutánea y renal.

Quinolone antibiotics are frequently used in the practice of medicine. Nephrotoxic side effects related to the use of quinolones are uncommon. We report a patient in treatment with ciprofloxacin who presented with purpuric skin lesions and alteration of renal function. We review these antibacterial agents with special attention on associated adverse reactions, and present-day experience with the newer quinolone antibiotics.

Vasculitis por ciprofloxacino con afectación cutánea y renal / Ciprofloxacin-induced vasculitis with skin and renal involvement

Las quinolonas son antibióticos utilizados frecuentemente en la práctica médica diaria. Las alteraciones renales asociadas al uso de quinolonas son raras. Presentamos el caso de una paciente tratada con ciprofloxacino que desarrolló lesiones cutáneas de tipo purpúrico y alteración de la función renal. Revisamos también éste grupo antibiótico con especial atención en las reacciones adversas asociadas, así como la experiencia actual con los nuevos fármacos de éste grupo. (AU)

[Tinea capitis by Microsporum audouinii]. / Tinea capitis por Microsporum audouinii.

We report the case of a four year-old girl from Equatorial Guinea who had been living in Spain for the last month. She presented several alopecic patches on the scalp. The direct study of the hair with 40% KOH showed an ectothrix infection and the mycological study revealed the etiologic agent was Microsporum audouinii. We present this case because of its rarity in our country and we point out the increasing interest of the imported tineas due to immigration from African countries.