Láser de baja potencia como alternativa terapéutica al eritema multiforme idiopático. Informe de caso

El eritema multiforme es una enfermedad aguda de la piel y/o de las mucosas de naturaleza inmunológica, siendo está de etiología desconocida. Solo el 20% de los casos se dan en niños. El diagnóstico se basa en la historia clínica y el examen físico y el tratamiento no está sistematizado. La terapia con láser de baja potencia está siendo cada vez más utilizada en el campo estomatológico. El objetivo fue evidenciar los beneficios del láser de baja potencia como alternativa terapéutica. Este caso corresponde a un paciente de 10 años de edad, que acudió a la cátedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción (UNA), derivado del Hospital General de Barrio Obrero con antecedentes de internación por presentar lesiones erosivas en labios, boca y máculas en toráx, abdomen, orejas y miembros. En el examen intraoral costras serohemáticas negruzcas en labios, lesiones ulceradas en lengua, piso de boca, paladar duro y mucosa yugal. Se procedió a hacer una lavado de la zona con agua oxigenada, en las áreas afectadas se colocó azul de metileno al 0,01% por 5 minutos, y para la aplicación de laserterapia se realizó una única sesión. El paciente mostró gran evolución a las 24 horas de la aplicación del tratamiento. A los 8 días estaba sin lesiones y asintomático. La fotobioestimulación a nivel celular que ofrece el láser de baja potencia es una herramienta verosímil que se suma a nuevas opciones terapéuticas.

Erythema multiforme is an acute disease of the skin and/or mucous membranes of an immunologic nature, the etiology of which is unknown. Only 20% of cases occur in children. Diagnosis is based on clinical history and physical examination and treatment is not systematized. Low power laser therapy is being increasingly used in the stomatological field. The objective was to demonstrate the benefits of low power laser as a therapeutic alternative. This case corresponds to a 10-year-old patient, who came to the Department of Oral Pathology of the Faculty of Dentistry of the National University of Asuncion (UNA), referred from the General Hospital of Barrio Obrero with a history of hospitalization for presenting erosive lesions on the lips, mouth and macules on the thorax, abdomen, ears and limbs. In the intraoral examination, blackish serohematic crusts on the lips, ulcerated lesions on the tongue, floor of the mouth, hard palate and jugal mucosa. The area was washed with hydrogen peroxide, methylene blue 0.01% was applied to the affected areas for 5 minutes, and only a single session was performed for the application of the laser therapy. The patient showed great evolution 24 hours after the application of the treatment. After 8 days he was completely free of lesions and asymptomatic. The photo-biostimulation at the cellular level offered by the low power laser is a credible tool that adds to new therapeutic options.

O eritema multiforme é uma doença aguda da pele e/ou mucosas de natureza imunológica, cuja etiologia é desconhecida. Apenas 20% dos casos ocorrem em crianças. O diagnóstico é baseado na história clínica e no exame físico. O tratamento não é sistematizado. A terapia laser de baixa potência é cada vez mais utilizada no campo estomatológico. O objectivo foi demonstrar os benefícios do laser de baixa potência como uma alternativa terapêutica. Este caso corresponde a um paciente de 10 anos de idade que veio ao Departamento de Patologia Oral da Faculdade de Odontologia da Universidade Nacional de Asunción (UNA) e foi encaminhado do Hospital Geral do Bairro Obrero com um historial de hospitalização por apresentar lesões erosivas nos lábios, boca e máculas no tórax, abdómen, orelhas e membros. No exame intraoral, crostas serohaemáticas negras nos lábios, lesões ulceradas na língua, chão da boca, palato duro e mucosa jugal. A área foi lavada com peróxido de hidrogénio, azul de metileno 0,01% foi aplicado nas áreas afectadas durante 5 minutos, e foi realizada uma única sessão de laserterapia. O paciente mostrou uma grande evolução 24 horas após a aplicação do tratamento. Após 8 dias, estava completamente livre de lesões e assintomático. A foto-biostimulação a nível celular oferecida pelo laser de baixa potência é uma ferramenta credível que se soma a novas opções terapêuticas.

Láser de baja potencia como alternativa terapéutica al eritema multiforme idiopático. Informe de caso

El eritema multiforme es una enfermedad aguda de la piel y/o de las mucosas de naturaleza inmunológica, siendo está de etiología desconocida. Solo el 20% de los casos se dan en niños. El diagnóstico se basa en la historia clínica y el examen físico y el tratamiento no está sistematizado. La terapia con láser de baja potencia está siendo cada vez más utilizada en el campo estomatológico. El objetivo fue evidenciar los beneficios del láser de baja potencia como alternativa terapéutica. Este caso corresponde a un paciente de 10 años de edad, que acudió a la cátedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción (UNA), derivado del Hospital General de Barrio Obrero con antecedentes de internación por presentar lesiones erosivas en labios, boca y máculas en toráx, abdomen, orejas y miembros. En el examen intraoral costras serohemáticas negruzcas en labios, lesiones ulceradas en lengua, piso de boca, paladar duro y mucosa yugal. Se procedió a hacer una lavado de la zona con agua oxigenada, en las áreas afectadas se colocó azul de metileno al 0,01% por 5 minutos, y para la aplicación de laserterapia se realizó una única sesión. El paciente mostró gran evolución a las 24 horas de la aplicación del tratamiento. A los 8 días estaba sin lesiones y asintomático. La fotobioestimulación a nivel celular que ofrece el láser de baja potencia es una herramienta verosímil que se suma a nuevas opciones terapéuticas.

Erythema multiforme is an acute disease of the skin and/or mucous membranes of an immunologic nature, the etiology of which is unknown. Only 20% of cases occur in children. Diagnosis is based on clinical history and physical examination and treatment is not systematized. Low power laser therapy is being increasingly used in the stomatological field. The objective was to demonstrate the benefits of low power laser as a therapeutic alternative. This case corresponds to a 10-year-old patient, who came to the Department of Oral Pathology of the Faculty of Dentistry of the National University of Asuncion (UNA), referred from the General Hospital of Barrio Obrero with a history of hospitalization for presenting erosive lesions on the lips, mouth and macules on the thorax, abdomen, ears and limbs. In the intraoral examination, blackish serohematic crusts on the lips, ulcerated lesions on the tongue, floor of the mouth, hard palate and jugal mucosa. The area was washed with hydrogen peroxide, methylene blue 0.01% was applied to the affected areas for 5 minutes, and only a single session was performed for the application of the laser therapy. The patient showed great evolution 24 hours after the application of the treatment. After 8 days he was completely free of lesions and asymptomatic. The photo-biostimulation at the cellular level offered by the low power laser is a credible tool that adds to new therapeutic options.

O eritema multiforme é uma doença aguda da pele e/ou mucosas de natureza imunológica, cuja etiologia é desconhecida. Apenas 20% dos casos ocorrem em crianças. O diagnóstico é baseado na história clínica e no exame físico. O tratamento não é sistematizado. A terapia laser de baixa potência é cada vez mais utilizada no campo estomatológico. O objectivo foi demonstrar os benefícios do laser de baixa potência como uma alternativa terapêutica. Este caso corresponde a um paciente de 10 anos de idade que veio ao Departamento de Patologia Oral da Faculdade de Odontologia da Universidade Nacional de Asunción (UNA) e foi encaminhado do Hospital Geral do Bairro Obrero com um historial de hospitalização por apresentar lesões erosivas nos lábios, boca e máculas no tórax, abdómen, orelhas e membros. No exame intraoral, crostas serohaemáticas negras nos lábios, lesões ulceradas na língua, chão da boca, palato duro e mucosa jugal. A área foi lavada com peróxido de hidrogénio, azul de metileno 0,01% foi aplicado nas áreas afectadas durante 5 minutos, e foi realizada uma única sessão de laserterapia. O paciente mostrou uma grande evolução 24 horas após a aplicação do tratamento. Após 8 dias, estava completamente livre de lesões e assintomático. A foto-biostimulação a nível celular oferecida pelo laser de baixa potência é uma ferramenta credível que se soma a novas opções terapêuticas.

Sever erythema multiforme post-COVID-19 moderna vaccine: Case report and literature review.

Introduction: Although the COVID-19 Vaccine usually causes a few non-serious side effects, serious ones such as Erythema multiforme recently has been linked to it. Case presentation: Our patient presented with severe skin reaction one day post-Covid-19 Moderna vaccine diagnosed as erythema multiforme proven by skin biopsy that responded well to steroids. Discussion: Erythema multiform major, an immune-mediated cutaneous reaction to infections or drugs involving the oral cavity, should be considered a possible adverse effect of numerous vaccinations, including SARSCoV2. Correct patient history gathering enables early detection and successful medical therapy with oral corticosteroids.Furthermore, the disease's rarity makes establishing a causative link difficult. However, because we are still learning about the innovative antiSARSCoV2 vaccines, it is crucial to be cautious of the potential cutaneous adverse responses. Conclusion: Despite being rare, life-threatening adverse reactions can occur post-COVID-19 Vaccination.

Detection of granzyme B in CD3-positive cells infiltrated in lesional skin of a dog with erythema multiforme associated with zonisamide.

In human erythema multiforme (EM), cytotoxic T lymphocytes (CTLs) play an essential role in the pathogenesis. In canine EM, immunohistochemical staining with anti-CD8 antibody using frozen sections has shown the involvement of CTLs; however, CTL infiltration has never been quantitatively analyzed. We herein quantitatively analyzed CTL infiltration by immunohistochemical staining with granzyme B and CD3 antibodies using paraffin sections of a dog with EM associated with zonisamide. The present results indicated approximately 70% of cells at the border between the epidermis and dermis consisted of CTLs. Detection of granzyme B and CD3 using paraffin sections employed in this study can be a clinically applicable method for detecting CTLs.

Case Report: Enfortumab Vedotin for Metastatic Urothelial Carcinoma: A Case Series on the Clinical and Histopathologic Spectrum of Adverse Cutaneous Reactions From Fatal Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis to Dermal Hypersensitivity Reaction.

Enfortumab vedotin is a Nectin-4 directed antibody-drug conjugate approved in metastatic urothelial carcinoma following progression on a platinum-containing chemotherapy and immune checkpoint blockade. On-target dermatologic toxicity may occur from Nectin-4 expression in the skin. We highlight a case of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis following enfortumab infusions that was ultimately fatal. The second case describes an erythema multiforme-like rash with interface dermatitis related to enfortumab. Dermatologic findings, immunohistochemistry studies, and immune profiling are detailed. These cases demonstrate the potentially catastrophic outcomes in some patients treated with enfortumab. Patients must be monitored for cutaneous toxicities with early involvement of dermatology and dermatopathology.

A Case of Rhupus with Rowell Syndrome.

We report a case of 30-year-old female who presented initially with hair loss, photosensitive malar rash, morning stiffness and synovitis. She was diagnosed with Rhupus syndrome based on clinical and laboratory findings. Few months after starting hydroxychloroquine, esomeprazole and azathioprine, and failing methotrexate (because of erosive pill-induced esophagitis), she presented with generalized maculopapular dusky reddish rash in her body, back and extremities. Her anti-double stranded-DNA, anti-nuclear antibody, anti-Ro/SSA and anti-La/SSB were positive. Anti-cyclic citrullinated peptide antibody was moderately positive. She had low complements: C3 and C4. Herpes simplex IgM and mycoplasma tested negative. Skin biopsy from right arm showed evidence of erythema multiform. She met the criteria for the diagnosis of Rowell syndrome. We managed her with hydroxychloroquine, prednisolone, mycophenolate mofetil and topical agents and discontinued esomeprazole. We also review the management of Rowell syndrome in the literature.

Variants of Erythema Multiforme: A Case Report and Literature Review.

Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. There are two variants of this condition, one with mucosal involvement, termed erythema multiforme major, and one without mucosal involvement, known as erythema multiforme minor. Due to the similarities in clinical and histological findings, it was previously believed that erythema multiforme major was indistinguishable from Steven-Johnson syndrome (SJS). However, evidence suggests these are two distinct diseases with a different etiology. It is important for clinicians to readily identify the difference between erythema multiforme from SJS, as the prognosis and mortality rate vary significantly between the two disorders.

Complications of post-operative seizure prophylaxis in patients submitted to cranial irradiation

The clinical status of patients with malignant intracranial tumors, such as high-grade gliomas, is often aggravated by seizure activity. Phenytoin is typically employed as prophylactic anticonvulsant in this setting. In such patients, severe systemic drug reactions such as erythema multiforme (EM) may occur. However, in a subgroup of patients with brain radiation therapy, EM-like lesions appear to develop in an increased ratio. The acronym ‘EMPACT’ (E: erythema; M: multiform; associated with P: phenytoin; A: and; C: cranial, radiation; T: therapy) has been suggested to best describes this syndrome. In this article, the authors present a case report of a patient treated with phenytoin for seizure prophylaxis, during the post-operative period following resection of a malignant glioma, and who presented a severe cutaneous rash, evolving with serious consequences due to abrupt change of seizure medications. Because of these predictable complications we abandoned our routine institutional protocol which employed phenytoin for seizure prophylaxis for patients in the post-operative period following malignant tumor resection and which expect to be irradiated in the near future. Once both carbamazepine and barbiturates show cross-sensitivity with phenytoin and may interfere with serum levels of chemotherapy drugs, we now advocate, as other worldwide renown neuro-oncological centers, the use of valproate gabapentin, or alternatively, as recent literature guidelines suggests levetiracetam (keppra), for seizure prophylaxis in this select subset of patients.

El estado clínico de los pacientes con tumores malignos intracraneales, como los gliomas de alto grado, es a menudo agravado por la actividad convulsiva. La fenitoína es normalmente empleadaa como anticonvulsivante profiláctico en esto contexto. En estos pacientes, graves reacciones sistémicas, como eritema multiforme (EM) puedem ocurrir. Sin embargo, en un subgrupo de pacientes con terapia de radiación en el cerebro, lesiones de EM, parece que se desarrollan en una proporción mayor. ‘EMPACT’ La sigla (E: eritema, M: multiforme; asociados con P: fenitoína; A: y C: la radiación craneal, T: La terapia) Se ha sugerido que mejor describe este síndrome. En esto artículo, los autores presentan un caso clínico de un paciente tratado con fenitoína para la profilaxia de convulsiones, durante el período post-operatorio después de la resección de un glioma maligno, y que presenta una erupción cutánea grave, que evoluciona con consecuencias graves debido al cambio brusco de medicamentos anticonvulsivos. Debido a estas complicaciones predecibles, que abandonamos nuestro protocolo institucional de rutina que la fenitoína empleadas para la profilaxia de convulsiones en los pacientes en el período post-operatorio después de la resección del tumor maligno y que esperan ser irradiado en un futuro próximo. Una vez que ambos carbamazepina y los barbitúricos mostran sensibilidad cruzada con fenitoína y puede interferir con los niveles séricos de drogas de la quimioterapia, ahora defendemos, como otros centros de renombre mundial neuro-oncológico, el uso de gabapentina valproato, o bien, como orientación la literatura reciente sugiere levetiracetam (keppra), para la profilaxia de las convulsiones en este subgrupo seleccionado de pacientes.

Drug-hypersensitivity syndrome: diagnosis and treatment.

Drug-induced hypersensitivity syndrome is a systemic autoimmune disorder that results in mucocutaneous symptoms ranging in severity from mild pruritus to life-threatening skin and mucosal loss, with different nomenclature depending on the severity of the symptoms. The purpose of this article is to review the recent advances in understanding the pathology of drug-induced hypersensitivity syndrome, as well as current recommendations for both medical and wound management.