RESUMEN
Biologics have significantly advanced the treatment of inflammatory disorders, including psoriasis. However, their use in immunosuppressed patients, such as those with solid-organ transplants, is less understood. These patients often face dermatological issues, but inflammatory skin diseases are rare due to their immunosuppressive treatments. Our study aims to assess biologics' effectiveness in such immunocompromised patients. We report a case from our institution of a 29-year-old man with a history of psoriasis, who underwent a kidney transplant and later developed erythroderma. He did not respond to traditional treatments and was successfully treated with adalimumab, leading to the discontinuation of MMF. We also reviewed literature in solid organ transplant patients with psoriasis. Our findings, based on 10 articles, indicate a cautious approach to using biologics in this group, with further research needed for efficacy and safety.
Asunto(s)
Adalimumab , Productos Biológicos , Trasplante de Riñón , Psoriasis , Humanos , Psoriasis/tratamiento farmacológico , Masculino , Adulto , Productos Biológicos/uso terapéutico , Productos Biológicos/efectos adversos , Adalimumab/uso terapéutico , Adalimumab/efectos adversos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Inmunosupresores/efectos adversos , Receptores de TrasplantesAsunto(s)
Acné Vulgar , Fármacos Dermatológicos , Adhesión a Directriz , Isotretinoína , Pautas de la Práctica en Medicina , Humanos , Isotretinoína/uso terapéutico , Irlanda , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Fármacos Dermatológicos/uso terapéutico , Adhesión a Directriz/estadística & datos numéricos , Acné Vulgar/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Prescripciones de Medicamentos/normas , Prescripciones de Medicamentos/estadística & datos numéricosRESUMEN
A bimodal pattern of mortality in systemic lupus erythematosus (SLE) exists. Early-stage deaths are predominantly caused by infection, whereas later-stage deaths are mainly caused by atherosclerotic disease. Further, although SLE-related mortality has reduced considerably in recent years, cardiovascular (CV) events remain one of the leading causes of death in people with SLE. Accelerated atherosclerosis in SLE is attributed to both an increase in traditional CV risk factors and the inflammatory effects of SLE itself. Many of these changes occur within the microenvironment of the vascular-immune interface, the site of atherosclerotic plaque development. Here, an intimate interaction between endothelial cells, vascular smooth muscle cells, and immune cells dictates physiological vs pathological responses to a chronic type 1 interferon environment. Low-density neutrophils (LDNs) have also been implicated in eliciting vasculature-damaging effects at such lesion sites. These changes are thought to be governed by dysfunctional metabolism of immune cells in this niche due at least in part to the chronic induction of type 1 interferons. Understanding these novel pathophysiological mechanisms and metabolic pathways may unveil potential innovative pharmacological targets and therapeutic opportunities for atherosclerosis, as well as shed light on the development of premature atherosclerosis in patients with SLE who develop CV events.
Asunto(s)
Aterosclerosis , Lupus Eritematoso Sistémico , Enfermedades Reumáticas , Humanos , Células Endoteliales , Factores de Riesgo , Aterosclerosis/etiología , Lupus Eritematoso Sistémico/tratamiento farmacológico , Enfermedades Reumáticas/complicacionesAsunto(s)
Anestésicos Locales , Bloqueo Nervioso , Humanos , Anestesia Local , Lidocaína , Método Doble CiegoRESUMEN
A man in his 80s had a 4-week history of progressive weakness and fatigue, with associated development of purple bruiselike lesions on his head. What is your diagnosis?