RESUMEN
With the expansion of the COVID-19 vaccination drive, an increasing number of adverse effects are surfacing. A 74-year-old woman presented with multiple erythematous and itchy patches on several sites. She had no relevant medical history, apart from the first AZD1222 vaccination 1 month previously. Microscopically, epidermal changes, including mild spongiosis and parakeratosis, were observed. Tight perivascular lymphocytic infiltration (coat-sleeve pattern) was also observed in the dermis. The final diagnosis was erythema annulare centrifugum (EAC) induced by SARS-CoV-2 vaccination. Based on this report, dermatologists should be aware of the possibility of EAC from the AZD1222 vaccination.
Asunto(s)
Vacunas contra la COVID-19/efectos adversos , Eritema/inducido químicamente , Enfermedades Cutáneas Genéticas/inducido químicamente , Anciano , Femenino , HumanosAsunto(s)
Carcinoma Hepatocelular/tratamiento farmacológico , Eritema/inducido químicamente , Neoplasias Hepáticas/tratamiento farmacológico , Enfermedades Cutáneas Genéticas/inducido químicamente , Sorafenib/efectos adversos , Anciano , Biopsia con Aguja , Carcinoma Hepatocelular/patología , Eritema/patología , Humanos , Inmunohistoquímica , Dermatosis de la Pierna/inducido químicamente , Dermatosis de la Pierna/patología , Neoplasias Hepáticas/patología , Masculino , Remisión Espontánea , Enfermedades Cutáneas Genéticas/patología , Sorafenib/uso terapéuticoAsunto(s)
Celulitis (Flemón)/inducido químicamente , Dermatosis del Cuero Cabelludo/inducido químicamente , Enfermedades Cutáneas Genéticas/inducido químicamente , Congéneres de la Testosterona/efectos adversos , Adulto , Celulitis (Flemón)/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Erupciones por Medicamentos/tratamiento farmacológico , Erupciones por Medicamentos/etiología , Sustitución de Medicamentos , Humanos , Isotretinoína/administración & dosificación , Isotretinoína/uso terapéutico , Masculino , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Enfermedades Cutáneas Genéticas/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Capecitabina/efectos adversos , Carcinoma Hepatocelular/tratamiento farmacológico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Enfermedades Cutáneas Genéticas/patología , Capecitabina/uso terapéutico , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/patología , Neoplasias Colorrectales/patología , Dermatoglifia , Femenino , Fluorouracilo/efectos adversos , Síndrome Mano-Pie/etiología , Síndrome Mano-Pie/patología , Humanos , Neoplasias Hepáticas/patología , Masculino , Enfermedades Cutáneas Genéticas/inducido químicamenteRESUMEN
Ligneous conjunctivitis is a rare severe conjunctivitis characterised by fibrin-rich, 'woody', pseudomembranes on the tarsal conjunctiva complicated by congenital hypoplasminogenaemia. A previous report suggested that ligneous conjunctivitis may result from tranexamic acid (TA)-induced 'secondary' hypoplasminogenaemia. However, the serum plasminogen level has not been confirmed in that scenario. We report for the first time a case of TA-induced ligneous conjunctivitis with reversible hypoplasminogenaemia. A 70-year-old woman developed a gastric ulcer that was treated with oral TA. After 5â weeks of treatment, the patient presented with bilateral pale yellow pseudomembranes on the palpebral conjunctivae. Haematological analysis showed hypoplasminogenaemia. We diagnosed ligneous conjunctivitis. TA was discontinued after 14â weeks after the gastric ulcer symptoms resolved. Six weeks after discontinuation of therapy, the pseudomembranes regressed and the serum plasminogen level returned to the normal range. TA should be considered a possible aetiology in the setting of unresolving ligneous conjunctivitis.
Asunto(s)
Conjuntivitis/inducido químicamente , Plasminógeno/deficiencia , Plasminógeno/metabolismo , Enfermedades Cutáneas Genéticas/inducido químicamente , Úlcera Gástrica/tratamiento farmacológico , Ácido Tranexámico/efectos adversos , Administración Oral , Anciano , Conjuntivitis/fisiopatología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/terapia , Remisión Espontánea , Diálisis Renal/métodos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Enfermedades Cutáneas Genéticas/fisiopatología , Úlcera Gástrica/diagnóstico , Ácido Tranexámico/uso terapéuticoRESUMEN
BACKGROUND: Pegylated interferon-α combined with ribavirin is the current standard treatment for chronic hepatitis C virus infection. During interferon and ribavirin therapy, both local and generalized mucocutaneous adverse reactions have been reported. Erythema annulare centrifugum induced by this therapy regimen has not been reported previously. CASE REPORT: A 29-year-old woman was referred to our clinic for a 1-week history of slightly pruritic annular erythematous eruptions on the lower extremities and hands. The eruptions had first occurred on the hands 3 to 4 days after pegylated interferon-α-2a plus ribavirin combination therapy for hepatitis C virus infection. Histopathologic examination supported the diagnosis of erythema annulare centrifugum. The lesions completely regressed within 2 weeks after the cessation of treatment but recurred on similar localizations within 24 hours with the same therapy. It was thought that erythema annulare centrifugum was induced by pegylated interferon-α-2a plus ribavirin combination therapy. CONCLUSION: Erythema annulare centrifugum is considered an inflammatory skin disease with unknown etiology. It is thought to represent a hypersensitivity reaction to some triggering factors, including infections, immunologic disorders, malign neoplasms, foods, pregnancy, and drugs. We report the first case of erythema annulare centrifigum induced by pegylated interferon-α-2a plus ribavirin combination therapy.
Asunto(s)
Eritema/inducido químicamente , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/efectos adversos , Polietilenglicoles/efectos adversos , Ribavirina/efectos adversos , Enfermedades Cutáneas Genéticas/inducido químicamente , Adulto , Eritema/diagnóstico , Eritema/patología , Eritema/virología , Femenino , Humanos , Interferón-alfa/uso terapéutico , Polietilenglicoles/uso terapéutico , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Ribavirina/uso terapéutico , Enfermedades Cutáneas Genéticas/diagnóstico , Enfermedades Cutáneas Genéticas/patología , Enfermedades Cutáneas Genéticas/virologíaRESUMEN
OBJECTIVES: In HIV-infected persons, a rash is the most common manifestation of drug hypersensitivity reactions. Non-nucleotide reverse transcriptase inhibitors are a major cause of cutaneous reactions. While the characteristics of nevirapine-associated cutaneous adverse drug reactions (CADRs) have been well described, there are limited data on efavirenz-associated CADRs. The objective of this study was to characterize the clinical features of consecutive cases of efavirenz-associated CADRs in a single referral centre diagnosed over a 3 year period. METHODS: We retrospectively reviewed the clinical records of 231 patients admitted with CADRs to a tertiary dermatology ward in Cape Town, South Africa. RESULTS: In 42/231(18%) cases, there had been exposure to efavirenz in the preceding 8 weeks. Of these, 5/42 (12%) patients were diagnosed with probable efavirenz-associated CADRs based on the Naranjo score. The median exposure to efavirenz before the onset of the rash was 12 days (range 2-48). All the patients were female, with a median age of 31 years and a median CD4 cell count of 300 cells/mm(3) (range 81-887). Four had a photo-distributed eruption and one had a confluent indurated erythema affecting the face, trunk and limbs. In three out of five cases, there were annular plaques with raised erythematous edges and dusky centres, which were photo-distributed. Two patients had a mild transaminitis and another a mild eosinophilia. Histological features were non-specific, with perivascular lymphocytes the only consistent feature. In all five cases, efavirenz was withdrawn and potent topical steroid was the only CADR-specific intervention. The eruptions resolved on discharge from hospital, with no sequelae except for residual post-inflammatory hyperpigmentation. CONCLUSIONS: Photo-distribution and annular erythema should alert clinicians to the possibility of efavirenz-associated CADRs.