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1.
J Dermatol ; 47(5): 476-482, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32162382

RESUMO

Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characteristically associated with sequential reactivation of herpesviruses, such as human herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Since systemic corticosteroids are thought to result in viral reactivation due to their immunosuppressive effects, we clarified the influence of systemic corticosteroid therapy on viral reactivation in DIHS/DRESS. Viral DNA in peripheral whole blood and serum sIL-2R level were measured during the disease course in twenty DIHS/DRESS patients. Six of seven patients treated without corticosteroids experienced HHV-6 viremia associated with elevated serum sIL-2R levels. In contrast, high-dose corticosteroids started within 1 week after onset tended to inhibit the occurrence of HHV-6 reactivation with remarkable suppression of serum sIL-2R level. Low-dose corticosteroids or late-start high-dose corticosteroids did not suppress occurrence of HHV-6 viremia and the increase of sIL-2R levels. HHV-6 load in the blood was clearly correlated with the serum sIL-2R level. On the other hand, increased CMV load were found in patients treated with corticosteroids regardless of the start time. The frequency of detection of EBV DNA in peripheral blood was similarly observed in all groups. In conclusion, high-dose corticosteroids started within 1 week tended to suppress HHV-6 reactivation through suppression of T cell activation. However, CMV proliferation was promoted by corticosteroids regardless of the start time. These observations suggested that careful consideration should be given to the dose and timing of administration of systemic corticosteroids in the treatment of DIHS/DRESS.


Assuntos
Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Glucocorticoides/efeitos adversos , Infecções por Herpesviridae/diagnóstico , Imunossupressores/efeitos adversos , Ativação Viral/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Citomegalovirus/genética , Citomegalovirus/imunologia , Citomegalovirus/isolamento & purificação , DNA Viral/isolamento & purificação , Relação Dose-Resposta a Droga , Esquema de Medicação , Síndrome de Hipersensibilidade a Medicamentos/complicações , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/imunologia , Feminino , Glucocorticoides/administração & dosagem , Infecções por Herpesviridae/sangue , Infecções por Herpesviridae/imunologia , Infecções por Herpesviridae/virologia , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 4/isolamento & purificação , Herpesvirus Humano 6/genética , Herpesvirus Humano 6/imunologia , Herpesvirus Humano 6/isolamento & purificação , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Ativação Viral/imunologia , Adulto Jovem
2.
Intern Med ; 57(21): 3141-3147, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29877284

RESUMO

A 64-year-old man was admitted to our hospital for purpuric rash, joint pain, and a fever. He had earlier undergone a follow-up examination for interstitial lung disease. At the current visit, the diagnosis was immunoglobulin A (IgA) vasculitis, based on skin and renal biopsy findings. He developed sudden breathlessness and hemoptysis. Chest computed tomography revealed ground glass opacity in the right lower lung fields, suggesting pulmonary hemorrhaging associated with IgA vasculitis. Despite steroid and cyclophosphamide therapy, and plasma exchange, he died 52 days after admission. Early aggressive therapies may be recommended for old patients with IgA vasculitis who have an additional comorbidities.


Assuntos
Hemoptise/etiologia , Imunoglobulina A/imunologia , Vasculite/complicações , Vasculite/imunologia , Artralgia/etiologia , Dispneia/patologia , Exantema/etiologia , Evolução Fatal , Febre/etiologia , Humanos , Rim/patologia , Masculino , Pessoa de Meia-Idade , Vasculite/patologia , Vasculite/terapia
3.
J Dermatol ; 43(4): 419-22, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26506947

RESUMO

Paraneoplastic pemphigus (PNP) is an autoimmune blistering disease that presents as severe mucosal erosions and variable cutaneous lesions and is primarily associated with hematologically malignant or benign diseases. A 59-year-old Japanese woman presented with oral, ocular and vaginal mucosal erosions and erythema as well as blistering on her trunk and limbs. She developed bronchiolitis obliterans; lymphadenopathy in the cervical, subclavian, para-aortic and intraperitoneal regions; and splenomegaly. PNP with B-cell lymphoma was diagnosed. She was treated with two courses of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) for B-cell lymphoma, rituximab once every 3 weeks for five cycles, steroid pulse therapy, oral prednisolone, cyclosporin and high-dose i.v. immunoglobulin. The B-cell lymphoma was in remission after two courses of R-CHOP treatment. Although her skin erythema and blistering were also improved, the mucosal erosions and bronchiolitis obliterans gradually worsened. The patient died of bronchiolitis obliterans after 6 months of hospitalization. Because a cellular immune response is thought to be involved in the pathogenesis of PNP, cyclosporin therapy is expected to aid in suppressing the cellular response. In this case, however, the patient's mucosal lesions and bronchiolitis obliterans were not improved by regular administration of cyclosporin therapy.


Assuntos
Antineoplásicos/uso terapêutico , Bronquiolite Obliterante/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Linfoma de Células B/diagnóstico , Síndromes Paraneoplásicas/diagnóstico , Pênfigo/diagnóstico , Antineoplásicos/administração & dosagem , Bronquiolite Obliterante/diagnóstico , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Evolução Fatal , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Imunidade Celular/efeitos dos fármacos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/administração & dosagem , Japão , Linfoma de Células B/tratamento farmacológico , Pessoa de Meia-Idade , Mucosa/patologia , Síndromes Paraneoplásicas/tratamento farmacológico , Síndromes Paraneoplásicas/imunologia , Pênfigo/tratamento farmacológico , Pênfigo/imunologia , Rituximab/administração & dosagem , Rituximab/uso terapêutico
4.
Dermatology ; 231(4): 304-11, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26440444

RESUMO

Pustulosis palmaris et plantaris or palmoplantar pustulosis (PPP) is a refractory pustular eruption of the palms and soles with unknown etiology. In addition to skin lesions, PPP patients may present with severe joint pain and pustulotic arthro-osteitis (PAO), especially of the sternoclavicular joint. PAO is sometimes regarded as a variant of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. Hence, macrolide and tetracycline antibiotics are used for the treatment of PPP with PAO. We report 3 cases of PPP with PAO that did not improve upon administration of macrolide antibiotics with NSAIDs. After administration of cefcapene pivoxil hydrochloride (CFPN-PI), a third-generation cephalosporin, the swelling and sternoclavicular joint pain were promptly reduced and dramatically improved in all 3 cases. We review the conventional antibiotic treatments used currently and propose CFPN-PI as a potentially new therapy for PPP or PPP + PAO.


Assuntos
Síndrome de Hiperostose Adquirida/tratamento farmacológico , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
J Dermatol ; 41(5): 403-6, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24801915

RESUMO

Infantile generalized pustular psoriasis is a rare form of psoriasis and the best treatment is controversial. We experienced a 2-year-old female with erythema on her neck and axilla starting at 3 months of age. She presented with recurrent annular and geographic scaly erythema with a few pustules on the neck, precordium and axilla, but no fever. The histopathology revealed subcorneal neutrophilic infiltration and microabscesses without Kogoj's spongiform pustules. The initial diagnosis was subcorneal pustular dermatosis. However, she developed widespread geographic erythema and numerous pustules over her entire body with a fever when she got a cold. A second skin biopsy revealed monolocular pustules and Kogoj's spongiform pustules in the subcorneal layer. Etretinate was administrated after a diagnosis of pustular psoriasis was made and her condition improved gradually. The choice of treatment depends on patient age, general condition and the disease severity.


Assuntos
Etretinato/administração & dosagem , Ceratolíticos/administração & dosagem , Psoríase/tratamento farmacológico , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Psoríase/diagnóstico , Psoríase/patologia , Dermatopatias Vesiculobolhosas/diagnóstico
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