RESUMEN
BACKGROUND: Erythema nodosum leprosum (ENL) is an acute and systemic inflammatory reaction of leprosy characterised by painful nodules and involvement of various organs. Thalidomide is an immunomodulatory and anti-inflammatory drug currently used to treat this condition. Cereblon (CRBN) protein is the primary target of thalidomide, and it has been pointed out as necessary for the efficacy of this drug in others therapeutics settings. OBJECTIVES: In this study, we aimed to evaluate the influence of CRBN gene variants on the dose of thalidomide as well as its adverse effects during treatment of ENL. METHODS: A total of 103 ENL patients in treatment with thalidomide were included in this study. DNA samples were obtained from saliva and molecular analysis of CRBN gene were performed to investigate the variants rs1620675, rs1672770 and rs4183. Different genotypes of CRBN variants were evaluated in relation to their influence on the dose of thalidomide and on the occurrence of adverse effects. FINDINGS: No association was found between CRBN variants and thalidomide dose variation. However, the genotypes of rs1672770 showed association with gastrointestinal effects (p = 0.040). Moreover, the haplotype DEL/C/T (rs4183/rs1672770/rs1620675) was also associated with gastrointestinal adverse effects (p = 0.015). MAIN CONCLUSIONS: Our results show that CRBN variants affect the treatment of ENH with thalidomide, especially on the adverse effects related to the drug.
Asunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra Multibacilar , Humanos , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/genética , Eritema Nudoso/inducido químicamente , Talidomida/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/genética , Lepra Lepromatosa/inducido químicamente , Leprostáticos/uso terapéuticoRESUMEN
Erythema nodosum (EN) is the most common clinical presentation of panniculitis, an inflammatory process that affects subcutaneous cellular tissue, characterized by the acute appearance of painful erythematous nodules predominantly in the lower extremities. An unusual case of EN is presented below, secondary to the administration of zoledronic acid (ZA) and denosumab, in which incidental histopathological findings of calciphylaxis were also found.
Asunto(s)
Calcifilaxia , Eritema Nudoso , Paniculitis , Humanos , Eritema Nudoso/inducido químicamente , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Ácido Zoledrónico/efectos adversos , Denosumab/efectos adversos , Calcifilaxia/inducido químicamente , Calcifilaxia/diagnóstico , Calcifilaxia/tratamiento farmacológicoRESUMEN
El eritema nodoso (EN) es la forma de paniculitis más común. Este trastorno representa una reacción de hipersensibilidad frente a diferentes antígenos, así como múltiples enfermedades sistémicas y fármacos, aunque en la mayoría de casos se desconoce la causa. Nuevos fármacos se añaden a la lista de involucrados en la etiopatogenia del eritema nodoso conforme van pasando los años, siendo uno de ellos los anticonceptivos hormonales orales combinados. El objetivo de este trabajo es proponer una relación entre los estrógenos de cualquier método anticonceptivo como puede ser el anillo vaginal combinado y la aparición del eritema nodoso.
Erythema nodosum (EN) is the most common form of panniculitis. This disorder represents a hypersensitivity reaction in front of different antigens, as well as multiple systemic diseases and drugs, although in most cases the cause is unknown. New drugs are added to the list of those involved in the etiopathogenesis of erythema nodosum as the years go by, one of them being combined oral hormonal contraceptives. The objective of this study is to propose a relationship between estrogens from any contraceptive method such as the combined vaginal ring and the appearance of erythema nodosum.
Asunto(s)
Humanos , Femenino , Adulto Joven , Dispositivos Anticonceptivos Femeninos/efectos adversos , Eritema Nudoso/inducido químicamente , Agentes Anticonceptivos Hormonales/efectos adversos , Paniculitis/inducido químicamente , Quimioterapia CombinadaRESUMEN
La lepra es una infección crónica, granulomatosa, producida por Mycobacterium leprae, que afecta piel y nervios periféricos. Se describen dos tipos de reacciones leprosas: tipo I y tipo II, las que corresponden a cuadros agudos que exacerban la enfermedad. Estas leproreacciones pueden ocurrir antes, durante o después del tratamiento. Se presenta el caso de un paciente masculino que acude a consultar con lesiones cutáneas y resultado de biopsia de piel con diagnóstico de lepra. Se inicia tratamiento multidroga OMS-MB1. Posteriormente presenta una leproreacción tipo I, por lo que se le realiza tratamiento con prednisona.
Leprosy is a chronic granulomatous infection of the skin and peripheral nervous system produced by Mycobacterium leprae. Two types of acute leprosy reactions have been described: type I and type II. These reactions can occur before, during or after treatment. We present the case of an adult male patient presenting with skin lesions and skin biopsy diagnostic for leprosy. A multidrug WHO-MB 1 treatment was initiated, after which he presents with type I lepra reaction requiring corticosteroids.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Clofazimina/efectos adversos , Quimioterapia Combinada/efectos adversos , Eritema Nudoso/inducido químicamente , Rifampin/efectos adversos , Biopsia , Dapsona/efectos adversos , Lepra Multibacilar/patología , Leprostáticos/efectos adversosRESUMEN
OBJECTIVE: To report a case of simultaneous erythema nodosum and erythema multiforme after local lidocaine injection. CASE SUMMARY: A 33-year-old female experienced coexisting erythema nodosum and erythema multiforme after lidocaine spray was used for upper gastrointestinal endoscopy. The reaction was exacerbated after localized injection of 2% lidocaine for a skin biopsy. An objective causality assessment revealed that an adverse drug reaction was highly probable. DISCUSSION: Lidocaine is the most frequently used local anesthetic agent. The coexistence of erythema nodosum and erythema multiforme has been reported in lepromatous leprosy, Yersinia enterocolítica and Yersinia pseudotuberculosis gastrointestinal infection (both with diarrhea), histoplasmosis, hepatitis C, and milkers nodule, but not with lidocaine. CONCLUSIONS: If clinicians observe similar lesions after lidocaine exposure, they should suspect an adverse drug reaction and exercise caution in the administration of amide anesthetics to patients with a documented history of adverse reaction to lidocaine.
Asunto(s)
Anestésicos Locales/efectos adversos , Eritema Multiforme/inducido químicamente , Eritema Nudoso/inducido químicamente , Lidocaína/efectos adversos , Administración Tópica , Adulto , Biopsia , Endoscopía Gastrointestinal , Femenino , HumanosRESUMEN
Changes in peripheral blood platelet counts associated with the onset of symptomatic erythema nodosum leprosum (ENL) were studied by comparing, in each patient, the value obtained on the day thalidomide therapy commenced with the average of the three preceding values. In the 11 patients studied, the mean platelet count rose from 235 to 322 x 10(3)/mm3, p < 0.001. In 3, the platelet count was above the normal limit, qualifying as thrombocytosis, in 7 the rise was appreciable, and in 2 it was negligible. In the 3 patients studied 1-2 weeks after beginning thalidomide, the mean count was 414 x 10(3)/mm3. Counts obtained after 3 or more weeks of thalidomide therapy were within normal limits. This study provided no direct evidence as to the mechanism responsible for the elevated platelet count, but mediation by interleukin-6 (IL-6) was concluded to be an attractive hypothesis, consistent with prior studies of IL-6 in reactive thrombocytosis and of IL-6 in ENL.
Asunto(s)
Eritema Nudoso/sangre , Lepra Lepromatosa/sangre , Trombocitosis/sangre , Adulto , Eritema Nudoso/inducido químicamente , Femenino , Humanos , Leprostáticos/efectos adversos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Masculino , México/etnología , Persona de Mediana Edad , Filipinas/etnología , Recuento de Plaquetas , Estudios Retrospectivos , Talidomida/efectos adversos , Talidomida/uso terapéutico , Trombocitosis/inducido químicamente , Estados UnidosRESUMEN
A group of 9 Mexican lepromatous leprosy patients was studied at the beginning of a type II reaction (erythema nodosum leprosum, ENL) and after 1 or 2 months of thalidomide treatment. ENL patients at the onset of the reaction had slightly higher amounts of anti-Mycobacterium leprae IgG1 and IgG2 antibodies, compared to similar lepromatous patients that did not develop ENL. Neither these antibody levels nor IgM and the other IgG subclasses were importantly modified after thalidomide treatment. Serum TNF was significantly higher in the patients that developed ENL compared to those that did not develop the reaction. TNF levels were slightly decreased after 1 month of thalidomide treatment and significantly decreased after 2 months of treatment. Serum IFN-gamma was significantly lower in patients at the onset of ENL and was increased after 1 and 2 months of thalidomide treatment.
Asunto(s)
Anticuerpos Antibacterianos/clasificación , Eritema Nudoso/inducido químicamente , Inmunoglobulina G/sangre , Inmunoglobulina G/clasificación , Interferón gamma/metabolismo , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Talidomida/uso terapéutico , Factor de Necrosis Tumoral alfa/metabolismo , Adolescente , Adulto , Anciano , Anticuerpos Antibacterianos/sangre , Interpretación Estadística de Datos , Femenino , Humanos , Inmunoglobulina M/sangre , Inmunoglobulina M/clasificación , Interferón gamma/sangre , Leprostáticos/administración & dosificación , Leprostáticos/efectos adversos , Lepra Dimorfa/sangre , Lepra Dimorfa/tratamiento farmacológico , Lepra Lepromatosa/metabolismo , Lepra Tuberculoide/sangre , Lepra Tuberculoide/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Mycobacterium leprae/inmunología , Talidomida/administración & dosificación , Talidomida/efectos adversosAsunto(s)
Adolescente , Anticuerpos Antibacterianos/clasificación , Anticuerpos Antibacterianos/sangre , Eritema Nudoso/inducido químicamente , Factor de Necrosis Tumoral alfa , Leprostáticos/administración & dosificación , Leprostáticos/efectos adversos , Leprostáticos/uso terapéutico , Lepra Dimorfa/sangre , Lepra Dimorfa/tratamiento farmacológico , Lepra Tuberculoide/sangre , Lepra Tuberculoide/tratamiento farmacológico , Inmunoglobulina M , Interferón gamma/metabolismo , Interferón gamma/sangre , Interpretación Estadística de Datos , Mycobacterium leprae/inmunología , Talidomida/administración & dosificación , Talidomida/efectos adversos , Talidomida/uso terapéuticoRESUMEN
La isotretinoína es una droga efectiva para el tratamiento del acné. Su uso puede acompañarse de diversas reacciones adversas, tales como queilitis, xerodermia, epistaxis, prurito, trastornos oculares y cefalea. Presentamos un paciente de 17 años que desarrolló acné fulminans, eritema nodoso y complejos inmunes circulantes, diez días después de haber comenzado el tratamiento con isotretinoína. Se discuten los aspectos etiopatogénicos del acné fulminans (AU)
Asunto(s)
Masculino , Humanos , Adolescente , Isotretinoína/efectos adversos , Acné Vulgar/complicaciones , Eritema Nudoso/inducido químicamente , Acné Vulgar/diagnóstico , Acné Vulgar/tratamiento farmacológico , Eritema Nudoso/etiología , Isotretinoína/farmacología , Isotretinoína/inmunología , Hipersensibilidad a las Drogas/terapiaRESUMEN
La isotretinoína es una droga efectiva para el tratamiento del acné. Su uso puede acompañarse de diversas reacciones adversas, tales como queilitis, xerodermia, epistaxis, prurito, trastornos oculares y cefalea. Presentamos un paciente de 17 años que desarrolló acné fulminans, eritema nodoso y complejos inmunes circulantes, diez días después de haber comenzado el tratamiento con isotretinoína. Se discuten los aspectos etiopatogénicos del acné fulminans
Asunto(s)
Masculino , Humanos , Adolescente , Acné Vulgar/complicaciones , Eritema Nudoso/inducido químicamente , Isotretinoína/efectos adversos , Acné Vulgar/diagnóstico , Acné Vulgar/tratamiento farmacológico , Hipersensibilidad a las Drogas/terapia , Eritema Nudoso/etiología , Isotretinoína/farmacología , Isotretinoína/inmunologíaRESUMEN
Foram estudadas quatro crianças com diagnóstico clínico e histopatológico de eritema nodoso. Como fatores citológicos: tuberculose pulmonar (um caso), infecçåo estreptocócica (um caso), Dipirona (um caso); em um caso nåo se detectou a etiologia. Destacam-se a ausência de publicaçöes em nosso meioe o interesse do eritema nodoso no diagnóstico de doenças gerais associadas