Assuntos
Antibacterianos/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Síndrome de Hipersensibilidade a Medicamentos/prevenção & controle , Levofloxacino/efeitos adversos , Doenças Raras/etiologia , Doenças Raras/prevenção & controle , Idoso , Antibacterianos/administração & dosagem , Artrite Reumatoide/complicações , Dermatite Esfoliativa/terapia , Síndrome de Hipersensibilidade a Medicamentos/sangue , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico por imagem , Feminino , Seguimentos , Herpesvirus Humano 6 , Humanos , Levofloxacino/administração & dosagem , Linfadenopatia/terapia , Testes do Emplastro , Doenças Raras/sangue , Doenças Raras/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Síndrome de Sjogren/complicações , Tomógrafos Computadorizados , Resultado do TratamentoRESUMO
OBJECTIVE: To report on 2 women with multiple sclerosis (MS) who developed severe neurologic deterioration and a drug reaction with eosinophilia and systemic symptoms (DRESS) after treatment with 2 and 4 subcutaneous injections of daclizumab, respectively. METHODS: This report includes clinical, MRI, and histopathologic data. RESULTS: Daclizumab is a humanized monoclonal antibody that binds the interleukin-2 receptor. It was approved for the treatment of relapsing MS. DRESS is an immunologic reaction to various medications that is characterized by eosinophilia as well as cutaneous and visceral manifestations. Following daclizumab treatment, both patients showed fulminant neurologic deterioration along with blood eosinophilia and skin changes, and both fulfilled the clinical criteria for the diagnosis of DRESS. They presented with multiple gadolinium-enhancing supra- and infratentorial lesions, with lesions in the basal ganglia, mesencephalon, and cerebellum. Brain biopsies revealed a pronounced inflammatory infiltrate including numerous eosinophils infiltrating demyelinating lesions, a feature that is atypical for MS but compatible with DRESS. In addition, numerous plasma cells and changes reminiscent of vasculitis were evident. CONCLUSIONS: Neurologic deterioration and DRESS occurred as severe adverse drug effects of daclizumab treatment. Early diagnosis and treatment of DRESS are essential because it is associated with complications such as new autoimmune diseases and liver failure, and may even be lethal. Because of its potential serious side effects, daclizumab was recently suspended for use in the European Union.
Assuntos
Daclizumabe/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico por imagem , Imunossupressores/efeitos adversos , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/tratamento farmacológico , Adulto , Daclizumabe/administração & dosagem , Síndrome de Hipersensibilidade a Medicamentos/complicações , Eosinofilia/induzido quimicamente , Eosinofilia/complicações , Eosinofilia/diagnóstico por imagem , Feminino , Humanos , Imunossupressores/administração & dosagem , Injeções Subcutâneas , Esclerose Múltipla/complicaçõesRESUMO
Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare and severe side-effect, mainly described after intake of anticonvulsants, allopurinol, or antibiotics. It usually begins within 2 months after drug introduction. Symptoms include cutaneous rash, hematologic abnormalities, and internal organ involvement and the diagnosis might be challenging. This case report illustrates for the first time this life-threatening complication in a patient with cystic fibrosis (CF). In this case, withdrawal of the offending drug was sufficient for full recovery. Clinicians involved in CF care should be aware of DRESS syndrome, as they commonly prescribe several potentially culprit drugs. Pediatr Pulmonol. 2017;52:E18-E21. © 2016 Wiley Periodicals, Inc.
Assuntos
Antibacterianos/efeitos adversos , Fibrose Cística/complicações , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Eosinofilia/diagnóstico , Rifampina/efeitos adversos , Fibrose Cística/diagnóstico por imagem , Diagnóstico Diferencial , Síndrome de Hipersensibilidade a Medicamentos/complicações , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico por imagem , Eosinofilia/complicações , Eosinofilia/diagnóstico por imagem , Humanos , Masculino , Adulto JovemAssuntos
Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/imunologia , Fibrinolíticos/efeitos adversos , Rivaroxabana/efeitos adversos , Idoso , Artroplastia de Quadril , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico por imagem , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Humanos , Masculino , RadiografiaRESUMO
Acute eosinophilic myocarditis is a rare cause of acute heart failure. We present the case of a 32-year-old woman who had presumptive eosinophilic myocarditis as part of a generalized hypersensitivity reaction (Drug Rash with Eosinophilia and Systemic Symptoms [DRESS] syndrome) that exhibited a dramatic response to steroid therapy. We highlight the central role of 2-dimensional and tissue-Doppler echocardiography in the diagnosis of myocarditis and the serial evaluation of left ventricular systolic and diastolic function in this setting.