1/89. Pseudoporphyria induced by propionic acid derivatives.BACKGROUND: Pseudoporphyria is a photosensitive bullous skin disease that is distinguished from porphyria cutanea tarda (PCT) by its normal porphyrin profile. Drugs are a major cause of this disease, and the list of culprits is continually expanding. Nonsteroidal antiinflammatory agents (NSAIDs), especially naproxen and other propionic acid derivatives, appear to be the most common offenders. OBJECTIVE: The study was carried out to increase awareness about the etiology and characteristic features of pseudoporphyria. methods: We report two cases of pseudoporphyria caused by naproxen and oxaprozin. We review the current English language literature on this entity and discuss its clinical features, histology, ultrastructure, etiology, and pathophysiology. RESULTS: A 44-year-old man taking naproxen for chronic low back pain and a 20-year-old woman on oxaprozin for rheumatoid arthritis presented with tense bullae and cutaneous fragility on the face and the back of the hands. In both, skin biopsy showed a cell-poor subepidermal vesicle with festooning of the dermal papillae. Direct immunofluorescence revealed staining at the dermal-epidermal junction and around blood vessels with IgG in the first case and with IgG, IgA, and fibrin in the second case. urine collections and serum samples yielded normal levels of uro- and coproporphyrins. CONCLUSIONS: Most cases of pseudoporphyria are drug-induced. naproxen, the most common offender, has been associated with a dimorphic clinical pattern: a PCT-like presentation and one simulating erythropoietic protoporphyria in the pediatric population. Other NSAIDs of the propionic acid family can also cause pseudoporphyria.- - - - - - - - - - ranking = 1keywords = family (Clic here for more details about this article) |
2/89. tretinoin-induced sticky skin: a case report and review of the literature.Sticky skin has been reported relatively infrequently in the literature in association with etretinate and doxorubicin/ketoconazole administration. It has a poorly understood pathogenesis, and the associated histologic changes have not been described. We report a case of a patient who experienced sticky skin in areas treated with tretinoin. These reverted to normal after cessation of treatment. In comparison to a biopsy taken while the skin was not sticky, the histologic findings included a thickened, compact stratum corneum and granulosum. The basal epithelial cells showed proliferation with slight crowding and a tall, columnar shape. To our knowledge, this is the first report of sticky skin occurring in response to topical retinoid application. We suggest that the histologic changes observed could represent a modified keratin maturation profile.- - - - - - - - - - ranking = 0.029216148139773keywords = life (Clic here for more details about this article) |
3/89. Necrotizing vasculitis of the skin and uterine cervix associated with minocycline therapy for acne vulgaris.In recent years, minocycline has become a commonly used agent for the treatment of acne vulgaris and rosacea. With this increased use have come reports of severe and in some cases life-threatening toxicity, often occurring in otherwise healthy young women after prolonged courses of minocycline. These adverse reactions include hepatotoxicity, drug-induced lupus erythematosus, eosinophilic pneumonitis, and hypersensitivity syndrome. We describe a 35-year-old woman who had necrotizing vasculitis of the skin and uterine cervix after 2 years of minocycline therapy for acne vulgaris. skin and cervical biopsies revealed acute inflammation involving through-and-through necrosis of vessel walls with thrombosis, focal fibrinoid change, and a perivascular lymphohistiocytic infiltrate. The disease fully resolved within 3 months of discontinuance of the minocycline therapy. patients should be informed of these rare but potentially serious adverse effects before the initiation of minocycline therapy. Early recognition of these complications can result in complete resolution.- - - - - - - - - - ranking = 0.029216148139773keywords = life (Clic here for more details about this article) |
4/89. dermatomyositis-like eruption and leg ulceration caused by hydroxyurea in a patient with psoriasis.We report the case of an elderly woman who had been on hydroxyurea for long-standing widespread psoriasis. After approximately 5 years's treatment with hydroxyurea, she developed a symmetrical dermatomyositis-like eruption on her hands, together with bilateral leg ulceration. Although similar skin eruptions have been reported after long-term hydroxyurea treatment, all of the previous patients were being treated for myeloproliferative disorders. A dermatomyositis-like eruption has not previously been reported to occur as a consequence of hydroxyurea treatment for psoriasis. Its recognition is important to prevent unnecessary investigation or treatment withdrawal.- - - - - - - - - - ranking = 0.029216148139773keywords = life (Clic here for more details about this article) |
5/89. Cutaneous fibrosis induced by docetaxel: a case report.BACKGROUND: Docetaxel is a taxoid antineoplastic agent approved for use in the treatment of metastatic breast carcinoma. The current study reports an unusual case of generalized cutaneous fibrosis in a 39-year-old white female after treatment with 18 cycles of docetaxel for metastatic breast carcinoma. methods: Cutaneous fibrosis represents a rare and unique reaction associated with the cyclic use of docetaxel. The reaction is manifested by a distinct sequence of events involving pronounced edema followed by the rapid development of cutaneous fibrosis in dependent areas. RESULTS: Cessation of therapy results in dramatic reversal of the fibrotic process. CONCLUSIONS: This case report further substantiates the belief that docetaxel represents one of a very limited number of agents that appear capable of giving rise to scleroderma-like features.- - - - - - - - - - ranking = 0.87204703488043keywords = cycle (Clic here for more details about this article) |
6/89. acute generalized exanthematous pustulosis associated with oral terbinafine.A case history of acute generalized exanthematous pustulosis (AGEP) following oral terbinafine is reported. A 64-year-old woman presented with a rapidly spreading micropustular eruption 3 days after completing a 28-day course of oral terbinafine. There was a positive family history of psoriasis but no personal history. The clinical presentation and histopathology were consistent with AGEP. There was nearly complete resolution of the pustular eruption within 3.5 weeks following cessation of oral terbinafine and treatment with topical and systemic corticosteroids. The patient has remained free of any recurrence 18 months later. A summary of drugs known to be associated with AGEP is presented. Prompt recognition of AGEP is stressed in order to avoid confusion with acute generalized pustular psoriasis or a systemic infection. The most important aspect of management is the immediate withdrawal of the suspect drug.- - - - - - - - - - ranking = 1keywords = family (Clic here for more details about this article) |
7/89. azithromycin eruption in infectious mononucleosis: a proposed mechanism of interaction.The penicillin family of antibiotics may induce drug eruptions when prescribed to patients with infectious mononucleosis. Very similar phenomena have also been cited with other antibiotic families. We report the first case of a cutaneous reaction in a patient with infectious mononucleosis treated with azithromycin. We propose an immune-based hypothesis to explain the transient sensitivity resulting in this secondary cutaneous eruption.- - - - - - - - - - ranking = 1keywords = family (Clic here for more details about this article) |
8/89. Acute generalized exanthematic pustulosis (AGEP) in a patient treated with furosemide.BACKGROUND: Although they appear more rarely than electrolyte disturbances, cutaneous reactions are important adverse effects of furosemide. This is particularly true for bullous skin eruptions, because they may be life-threatening. CASE REPORT: We describe a patient who developed acute generalized exanthematic pustulosis (AGEP) during treatment with furosemide. Because the patient had developed similar skin eruptions during treatment with furosemide years before, furosemide was considered the most likely cause of this reaction. The short period of time between exposure to furosemide and the appearance of the skin reaction, as well as a positive lymphocyte transformation test, suggest an immunological mechanism of the skin disease. CONCLUSION: AGEP is a possible cutaneous side effect of furosemide.- - - - - - - - - - ranking = 0.029216148139773keywords = life (Clic here for more details about this article) |
9/89. Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after hiv exposures--worldwide, 1997-2000.In September 2000, two instances of life-threatening hepatotoxicity were reported in health-care workers taking nevirapine (NVP) for postexposure prophylaxis (PEP) after occupational human immunodeficiency virus (hiv) exposure. In one case, a 43-year-old female health-care worker required liver transplantation after developing fulminant hepatitis and end-stage hepatic failure while taking NVP, zidovudine, and lamivudine as PEP following a needlestick injury (1). In the second case, a 38-year-old male physician was hospitalized with life-threatening fulminant hepatitis while taking NVP, zidovudine, and lamivudine as PEP following a mucous membrane exposure. To characterize NVP-associated PEP toxicity, CDC and the food and Drug Administration (FDA) reviewed MedWatch reports of serious adverse events in persons taking NVP for PEP received by FDA (Figure 1). This report summarizes the results of that analysis and indicates that healthy persons taking abbreviated 4-week NVP regimens for PEP are at risk for serious adverse events. Clinicians should use recommended PEP guidelines and dosing instructions to reduce the risk for serious adverse events.- - - - - - - - - - ranking = 0.058432296279546keywords = life (Clic here for more details about this article) |
10/89. in vitro drug allergy detection system incorporating human liver microsomes in chlorazepate-induced skin rash: drug-specific proliferation associated with interleukin-5 secretion.BACKGROUND: Chlorazepate is a benzodiazepine often used for pre-operative anxiolysis. The central metabolite responsible for the pharmacological and probably for the adverse effects of most benzodiazepines, including chlorazepate, is N-desmethyldiazepam. We report a woman who developed a generalized exanthem 1 day after receiving chlorazepate and four other drugs related to anaesthesia for surgery of the larynx. patch tests pointed to chlorazepate as the culprit drug for the skin rash. OBJECTIVES: The purpose of this study was to detect drug allergy to chlorazepate or a metabolite in vitro by means of the lymphocyte transformation test (LTT), and to determine the concentrations of the T-helper (Th) 2-type cytokine interleukin (IL)-5 and the Th1-type cytokine interferon (IFN) -gamma in the culture supernatants. methods: We performed an LTT with peripheral blood mononuclear cells from the patient and a control, employing human liver microsomes containing cytochrome P450 enzymes as a metabolizing system, in parallel cultures. IL-5 and IFN-gamma concentrations in the culture supernatants were assessed by enzyme-linked immunosorbent assay. RESULTS: In the LTT, no T-cell reactivity was observed to the parent compound chlorazepate, whereas coincubation of the drug with human liver microsomes yielded proliferative T-cell reactivity, which was associated with secretion of IL-5 but not of IFN-gamma. CONCLUSIONS: We conclude that addition of a metabolizing system may be advantageous for in vitro detection of T-cell reactivity to drug metabolites in the LTT.- - - - - - - - - - ranking = 0.14608074069886keywords = life (Clic here for more details about this article) |
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