Recurrent Toxic Epidermal Necrolysis Syndrome: A Report of Two Cases.

An 81-year-old male and a 47-year-old female experienced recurrent severe bullous dermatosis secondary to an intake of drugs and alternative medicines indicated for arthralgias. The first patient had previously presented with Stevens-Johnson/toxic epidermal necrolysis (TEN) overlap syndrome in 2007 secondary to ingestion of trimethoprim/sulfamethoxazole indicated for a urinary tract infection; 6 years later, he presented with the same syndrome 2 days after ingestion of oral naproxen tablets 250 mg twice daily. The second patient had presented 5 years previously with TEN after receiving trimethoprim/sulfamethoxazole. In 2014, she presented with arthralgias and received a xenobiotic oral called 'miracle pills' (dosage is unknown); 3 weeks later, she again experienced TEN. Both patients were treated with intravenous immunoglobulin 400 mg/kg/day; duration of treatment was 5 days for the first patient and 3 days for the second. However, the male patient died from severe sepsis; the female patient experienced a favorable outcome. There are many risk factors for the development of cutaneous adverse drug reactions; a history of allergic reactions is one important risk factor, and both patients had it. This article reviews the scientific literature on this topic and analyzes the possible causes, including infectious processes, immunological defects, and immunogenetic factors.

Effect of avocado soybean unsaponifiables on insulin secretion and insulin sensitivity in patients with obesity.

AIM: To evaluate the effect of avocado soybean unsaponifiables (ASU) on insulin secretion and insulin sensitivity in patients with obesity. METHODS: A randomized, double-blind, placebo-controlled, clinical trial was carried out in 14 obese adult volunteers. After random allocation of the intervention, 7 patients received 300 mg of ASU or placebo during a fasting state for 3 months. A metabolic profile including IL-6 and high-sensitivity C-reactive protein (hs-CRP) levels was carried out prior to the intervention. A hyperglycemic-hyperinsulinemic clamp technique was used to assess insulin secretion and insulin sensitivity phases. Mann-Whitney U test and Wilcoxon test were performed for statistical analyses. The study was approved by the local ethics committee of our institution. RESULTS: At baseline, both groups were similar according to clinical and laboratory characteristics. There was no significant difference in insulin secretion and insulin sensitivity with ASU. CONCLUSIONS: ASU administration for 3 months did not modify insulin secretion and insulin sensitivity in patients with obesity.

[Necrotizing scleritis and recurrent erythema nodosum: a diagnostic challenge]. / Escleritis necrotizante y eritema nodoso recurrente: un reto diagnóstico. Informe de un caso.

The necrotizing scleritis and recurrent erythema nodosum, two clinical entities difficult to diagnose and which represent a challenge to the physician. Tuberculosis produces both processes by an immune reaction of delayed hypersensitivity type IV to various antigenic components of mycobacteria. Most tuberculosis patients have no ocular history of pulmonary or systemic disease in up to 50 % and no evidence of pathology in the chest radiograph. An adequate treatment leads to a favorable prognosis. It occurs when the diagnosis of infection is made on time. We describe the case of a woman with necrotizing scleritis associated with recurrent erythema nodosum secondary to infection with Mycobacterium tuberculosis complex.

[Bullous pemphigoid with figurate erythema. A case report]. / Penfigoide buloso con eritema figurado. Informe de un caso.

Bullous pemphigoid is an autoimmune dermatosis characterized by deposition of immunoglobulin G (IgG) and/or complement along basement membrane zone. The lesions of bullous pemphigoid are tense blisters on trunk and extremities, oral lesions are unusual. Figurate erythema includes some dermatologic pictures characterized by annular and polycyclic lesions. Figurate erythema can be confused with erythema gyratum repens, dermatosis associated statistically to malignant neoplasias. The objective for reporting this case is to inform the simultaneous association between bullous pemphigoid and figurate erythema in 83 year old man without underlying malignancy.

Effect of etanercept on insulin secretion and insulin sensitivity in a randomized trial with psoriatic patients at risk for developing type 2 diabetes mellitus.

Tumor necrosis factor-alpha (TNF-alpha) inhibitors have been used in the treatment of psoriasis, which is associated with the insulin resistance syndrome. The purpose of this study was to determine the effect of etanercept, a TNF-alpha inhibitor, on insulin secretion and insulin sensitivity in psoriatic patients with high risk factors to develop type 2 diabetes mellitus. Randomized double blind clinical trial with 2 weeks of follow-up. The allocation was done by simple randomization. The investigation was performed in 12 psoriatic patients with indication of systemic treatment and 2 or more risk factors for type 2 diabetes mellitus. Patients with infections, topical corticosteroids or salicylic acid ointments for 6 weeks before the study, diabetes, acromegaly, cancer and other systemic diseases were excluded. All subjects gave written informed consent to participate in the study and the protocol was approved by the hospital-based Ethical Committee. Etanercept was injected in a subcutaneous dose of 25 mg in 1 ml twice by week for 2 weeks or 1 ml of saline solution as placebo. Insulin secretion was estimated with the formula for the homeostasis model analysis beta-cell function index and insulin sensitivity was assessed using the euglycemic-hyperinsulinemic clamp technique. There was no significant difference in insulin secretion and insulin sensitivity with etanercept. Fasting serum insulin levels were decreased in the etanercept group (146 +/- 117-111 +/- 87 pmol/l, P = 0.04). Etanercept did not modify insulin secretion and insulin sensitivity in psoriatic patients with risk factors for type 2 diabetes mellitus.

Lipid profile, insulin secretion, and insulin sensitivity in psoriasis.

BACKGROUND: Psoriasis has been associated with an abnormal plasma lipid metabolism and diabetes mellitus possibly related to alterations in insulin secretion and sensitivity. OBJECTIVE: We sought to identify lipid profile, insulin secretion, and insulin sensitivity in patients with psoriasis and healthy control patients. METHODS: A cross-sectional study was performed in 44 nonobese adults, 22 with psoriasis and 22 without. The psoriasis activity was evaluated by the psoriasis area and severity index. Insulin secretion was estimated using the homeostasis model analysis beta-cell function index. Insulin sensitivity was assessed with the insulin tolerance test. RESULTS: High-density lipoprotein cholesterol was significantly decreased in patients with psoriasis (P =.02). There were no significant differences in insulin secretion or sensitivity in patients with psoriasis compared with control patients. CONCLUSION: Patients with psoriasis had significantly decreased high-density lipoprotein cholesterol concentrations. There were no differences in insulin secretion or sensitivity compared with control patients.

Sarcoma de Kaposi en un paciente con lepra lepromatosa VIH negativo / Kaposi's sarcoma in a VIH negative patient with lepromatous lepra

El sarcoma de Kaposi se considera una neoplasia oportunista y ha sido descrita con frecuencia en pacientes con el síndrome de inmunodeficiencia adquirida. El propósito de la presentación de este caso es recordar que existen otros factores de inmunosupresión como la lepra y el uso crónico de corticoides que favorecen el desarrollo del sarcoma. Se presenta la evolución de un paciente masculino de 53 años de edad, con estudio negativo para la infección por VIH tipos I y II, que padecía lepra lepromatosa nodular on reacción leprosa recidivante, se automedicó por 18 meses prednisona hasta que desarrolló la neoplasia mencinada, con diseminación cutánea y visceral que se complicó con amiloidosis renal