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Inmunosupresores/efectos adversos , Trastornos Linfoproliferativos/inducido químicamente , Trastornos Linfoproliferativos/virología , Metotrexato/efectos adversos , Úlcera Cutánea/inducido químicamente , Úlcera Cutánea/virología , Anciano , Artritis Reumatoide/tratamiento farmacológico , Diagnóstico Diferencial , Erupciones por Medicamentos/patología , Erupciones por Medicamentos/virología , Infecciones por Virus de Epstein-Barr/complicaciones , Femenino , HumanosAsunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Cefalosporinas/efectos adversos , Infecciones por Coronavirus/complicaciones , Erupciones por Medicamentos/virología , Fenilpropionatos/efectos adversos , Neumonía Viral/complicaciones , Betacoronavirus , COVID-19 , Femenino , Humanos , Persona de Mediana Edad , Pandemias , SARS-CoV-2RESUMEN
Severe drug eruption (SDE), a common skin disease, becomes dangerous when it occurs in patients with human immunodeficiency virus (HIV). However, the molecular mechanisms are poorly understood. Forty patients including HIV+ SDE+ (n = 15), HIV- SDE+ (n = 15) and HIV+ SDE- (n = 10) subjects were enrolled in our study. All HIV+ patients were at acquired immune deficiency syndrome (AIDS) stage. Serum levels of TNF-α, IFN-γ, IL-4, IL-13, IL-6, CXCL9, and CCL17 were quantified by ELISA. Epstein-Barr virus (EBV) and cytomegalovirus (CMV) loads were quantified by RT-qPCR. CD4, CD8, Th1, Th2, TNF-α-CD8, and IFN-γ-CD8 T cell populations were measured by flow cytometry. Levels of biochemical indexes in HIV+ SDE+ patients were significantly different from in HIV- SDE+ patients (P < .05). EBV and CMV viral loads were significantly higher in HIV+ SDE+ patients, but not in HIV- SDE+ patients (P < .05). Inflammatory cytokines TNF-α and IFN-γ were significantly elevated in HIV+ SDE+ patients (P < .05). Th2/Th1 populations and TNF-α secreting or IFN-γ secreting CD8+ T cells, were significantly up-regulated in HIV+ SDE+ patients compared to HIV- SDE+ patients (P < .05). Conversely, the CD4/CD8 ratio was significantly down-regulated in HIV+ SDE+ patients compared to HIV- SDE+ patients (P < .05). HIV infection confers distinct clinical phenotypes and immune inflammatory mechanisms in SDE. Sustained EBV and CMV activation, unbalanced Th2/Th1 and overactive CD8+ T cells mediating a pro-inflammatory response could act as distinct mechanisms in the aggravation of SDE in HIV+ SDE+ patients.
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Linfocitos T CD8-positivos/virología , Citomegalovirus/patogenicidad , Erupciones por Medicamentos/virología , Infecciones por VIH/virología , Herpesvirus Humano 4/patogenicidad , Células TH1/virología , Células Th2/virología , Activación Viral , Adulto , Linfocitos T CD8-positivos/inmunología , Linfocitos T CD8-positivos/metabolismo , Estudios de Casos y Controles , Citocinas/sangre , Citomegalovirus/inmunología , Erupciones por Medicamentos/sangre , Erupciones por Medicamentos/inmunología , Femenino , VIH/inmunología , VIH/patogenicidad , Infecciones por VIH/sangre , Infecciones por VIH/inmunología , Herpesvirus Humano 4/inmunología , Interacciones Huésped-Patógeno , Humanos , Huésped Inmunocomprometido , Mediadores de Inflamación/sangre , Masculino , Persona de Mediana Edad , Fenotipo , Índice de Severidad de la Enfermedad , Células TH1/inmunología , Células TH1/metabolismo , Células Th2/inmunología , Células Th2/metabolismoRESUMEN
We present a case of a patient with drug-induced hypersensitivity syndrome (DIHS) caused by salazosulfapyridine combined with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) caused by interstitial pneumonia (IP). A 67-year-old man with a past history of rheumatism (RA) presented with right hemiparalysis and aphasia as the chief complaints. A diagnosis of left embolic cerebral infarction following trial therapy for RA based on computed tomography findings was made, and external decompression was performed. Salazosulfapyridine was newly started on day 7. Dabigatran was started on day 37. On day 41, the patient developed fever. On day 42, edema and erythema appeared on his face, and erythema and rash appeared on his trunk and extremities, with gradual transition to erythroderma. The drug eruption was initially attributed to the dabigatran. Various symptoms of organ dysfunction (enteritis, myocarditis, interstitial pneumonia, hepatic disorder, stomatitis, and others) then appeared and persisted; hence, a diagnosis of DIHS associated with human herpes virus 6 and cytomegalovirus infection induced by salazosulfapyridine was suggested, and the oral administration of salazosulfapyridine was discontinued on day 53. Hyponatremia was observed in association with exacerbation of IP. Due to low serum osmotic pressure and prompt improvement of the serum sodium level by fluid restriction, the SIADH was attributed to IP. In this case, steroid pulse therapy followed by gradual decrease therapy prevented worsening of the condition.
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Infecciones por Citomegalovirus/inducido químicamente , Erupciones por Medicamentos/virología , Exantema Súbito/inducido químicamente , Sulfasalazina/efectos adversos , Anciano , Infecciones por Citomegalovirus/tratamiento farmacológico , Erupciones por Medicamentos/tratamiento farmacológico , Exantema Súbito/tratamiento farmacológico , Humanos , Síndrome de Secreción Inadecuada de ADH , Enfermedades Pulmonares Intersticiales , Masculino , Esteroides/uso terapéutico , Resultado del TratamientoRESUMEN
From April to September 2017, Bangladesh experienced a huge outbreak of acute Chikungunya virus infection in Dhaka. This series describes the clinical and laboratory features of a large number of cases (690; 399 confirmed and 291 probable) suffered during that period. This observational study was carried out at Dhaka Medical College Hospital, Bangladesh. The median age of the patients at presentation was 38 years (IQR 30-50) with a male (57.3%) predominance. Hypertension and diabetes were the most common comorbidities. The mean (±SD) duration of fever was 3.7 (±1.4) days. Other common manifestations were arthralgia (99.2%), maculopapular rash (50.2%), morning stiffness (49.7%), joint swelling (48.5%), and headache (37.6%). Cases were confirmed by anti-chikungunya IgG (173; 43.3%), IgM (165; 42.3%), and reverse transcription polymerase chain reaction (44; 11.0%). Important laboratory findings include high erythrocyte sedimentation rate (156; 22.6%), raised serum glutamic pyruvic transaminase (73; 10.5%), random blood sugar (54; 7.8%), leukopenia (72; 10.4%), thrombocytopenia (41; 5.9%), and others. The oligo-articular (453; 66.1%) variety of joint involvement was significantly more common compared with the poly-articular (237; 34.5%) variety. Commonly involved joints were the wrist (371; 54.1%), small joints of the hand (321; 46.8%), ankle (251; 36.6%), knee (240; 35.0%), and elbow (228; 33.2%). Eleven cases were found to be complicated with neurological involvement and two of them died. Another patient died due to myocarditis. Public health experts, clinicians, and policymakers could use the results of this study to construct the future strategy tackling chikungunya in Bangladesh and other epidemic countries.
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Anticuerpos Antivirales/sangre , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/fisiopatología , Virus Chikungunya/inmunología , Brotes de Enfermedades , Enfermedad Aguda , Adulto , Artralgia/epidemiología , Artralgia/mortalidad , Artralgia/fisiopatología , Artralgia/virología , Bangladesh/epidemiología , Fiebre Chikungunya/mortalidad , Fiebre Chikungunya/virología , Virus Chikungunya/genética , Virus Chikungunya/aislamiento & purificación , Comorbilidad , Diabetes Mellitus/epidemiología , Diabetes Mellitus/mortalidad , Diabetes Mellitus/fisiopatología , Diabetes Mellitus/virología , Erupciones por Medicamentos/epidemiología , Erupciones por Medicamentos/mortalidad , Erupciones por Medicamentos/fisiopatología , Erupciones por Medicamentos/virología , Femenino , Cefalea/epidemiología , Cefalea/mortalidad , Cefalea/fisiopatología , Cefalea/virología , Humanos , Hipertensión/epidemiología , Hipertensión/mortalidad , Hipertensión/fisiopatología , Hipertensión/virología , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Leucopenia/epidemiología , Leucopenia/mortalidad , Leucopenia/fisiopatología , Leucopenia/virología , Masculino , Persona de Mediana Edad , Análisis de Supervivencia , Trombocitopenia/epidemiología , Trombocitopenia/mortalidad , Trombocitopenia/fisiopatología , Trombocitopenia/virologíaRESUMEN
Fixed drug eruption (FDE) is a type of drug reaction characterized by localized erythema, hyperpigmentation, and bullous at the same site(s), generally observed following every intake of a causative drug. Delayed-type cellular hypersensitivity (Type IVC) is considered to play a role in FDE etiology. Several antibiotics, barbiturates, oral contraceptives, nonsteroidal anti-inflammatory drugs, laxative-containing phenolphthalein, metronidazole, and quinine are known to be the primary drugs responsible for FDE. Bullous FDE, on the other hand, is a relatively rare form of FDE. Hepatitis B is a significant worldwide health problem, and entecavir is a common nucleoside (deoxyguanosine) analog used for treating hepatitis B; however, it has various side effects, such as lactic acidosis, myalgia, azotemia, hypophosphatemia, headache, diarrhea, pancreatitis, and neuropathy, and, in rare cases, cutaneous drug eruption. Our aim is to present a case of entecavir-associated bullous drug reaction, which has not been reported in the literature. Furthermore, we performed a review of literature to compile previously reported entecavir-associated drug reactions.
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Antivirales/efectos adversos , Erupciones por Medicamentos/patología , Guanina/análogos & derivados , Hepatitis B/tratamiento farmacológico , Erupciones por Medicamentos/virología , Femenino , Guanina/efectos adversos , Virus de la Hepatitis B , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Viral infections and drug reactions are the commonest causes of exanthems in clinical practice. Clinically, their overlapping features may pose a diagnostic challenge. Hematologic, in vitro, and drug provocation tests are either unreliable or impractical. METHODS: This was a descriptive, prospective study to assess and compare histopathological features of maculopapular viral and drug exanthem. Subjects fulfilling case definition of exanthems were included. Serum C-reactive protein (CRP) and absolute eosinophil count (AEC) were also studied. RESULTS: Skin biopsy slides of 48 cases were evaluated and AEC and CRP were performed. Both median AEC and CRP were lower in viral exanthem compared with drug exanthem. On histopathological evaluation, features such as lymphocytic exocytosis, and dermal infiltrate of eosinophils, lymphocytes and histiocytes were seen in a significantly greater number of drug exanthems. Other findings such as focal spongiosis, acanthosis, keratinocyte necrosis, basal cell damage, papillary dermal edema and atypical lymphocytes in the dermis were also observed in higher though not statistically significant number of drug exanthem biopsies. CONCLUSIONS: Certain histopathological features can help to differentiate between the two exanthems and this modality may be used in situations when there is clinical overlap and when drug rechallenge cannot be undertaken.
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Erupciones por Medicamentos/patología , Eosinófilos/patología , Exantema/patología , Histiocitos/patología , Queratinocitos/patología , Linfocitos/patología , Piel/patología , Adolescente , Adulto , Anciano , Biopsia , Proteína C-Reactiva/análisis , Niño , Preescolar , Diagnóstico Diferencial , Erupciones por Medicamentos/virología , Eosinófilos/citología , Exantema/inducido químicamente , Exocitosis , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Necrosis/patología , Estudios Prospectivos , Adulto JovenRESUMEN
Treatment with interferon (IFN) could be associated with variable cutaneous adverse reactions. The aim of this study was to describe the clinicopathological spectrum of cutaneous granulomas associated with IFN therapy and identify the causal relation between IFN therapy and granulomatous reactions. The study included 18 patients (16 males and 2 females) with an average age of 48 years. Clinically, most of the lesions were solitary (83.3%) and located on the face (44.4%) and/or trunk (38.9%). The lesions were commonly presented as nodules (33.3%) or plaques (27.8%) with a common size of 5-10 cm. Granulomatous reactions were localized to the injection site in 4 cases, distributed on other body areas (remote granuloma) in 11 cases, and associated with lung involvement (systemic granuloma) in 3 cases. Histologically, injection site granuloma showed suppurative reaction in 75% and sarcoidal reaction in 25%. Remote granuloma showed tuberculoid reaction in 27.3%, interstitial in 27.3%, and sarcoidal in 45.4%. Systemic granuloma showed sarcoidal reaction in all cases. After withdrawal of IFN, only 3 lesions showed spontaneous complete clearance, whereas most of the lesions (83.3%) showed only partial improvement. Our results suggested that IFN is not a causal agent of all associated cutaneous granulomas but it mostly provokes the appearance of granulomatous reactions in susceptible individuals. Findings that prove this concept include the formation of granuloma in body sites away from the injection site, the heterogeneous pattern of granuloma both clinically and histologically, and incomplete clearance of most of the lesions after withdrawal of IFN.
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Erupciones por Medicamentos/etiología , Granuloma/inducido químicamente , Factores Inmunológicos/efectos adversos , Interferones/efectos adversos , Piel/efectos de los fármacos , Tuberculosis Cutánea/inducido químicamente , Adulto , Anciano , Biopsia , ADN Bacteriano/genética , ADN Viral/genética , Erupciones por Medicamentos/microbiología , Erupciones por Medicamentos/patología , Erupciones por Medicamentos/virología , Femenino , Granuloma/microbiología , Granuloma/patología , Granuloma/virología , Virus de Hepatitis/genética , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa , Ribotipificación , Piel/microbiología , Piel/patología , Piel/virología , Prueba de Tuberculina , Tuberculosis Cutánea/microbiología , Tuberculosis Cutánea/patologíaRESUMEN
BACKGROUND: Sequential human herpes virus (HHV) reactivation is well known in drug reaction with eosinophilia and systemic symptom (DRESS), but such a phenomenon has seldom studied in other types of cutaneous adverse drug reactions (cADRs). Moreover, the association between viral reactivations and cytokine or chemokine changes is largely unknown. We aimed to evaluate the viral reactivation rates of HHV-6, HHV-7, Epstein-Barr virus (EBV), and cytomegalovirus (CMV) in different cADRs and their impacts on clinical prognosis. Cytokine and chemokine changes with viral reactivations were also examined. METHODS: A prospective study was conducted to monitor the viral statuses of patients with different cADRs by polymerase chain reaction and serum-specific antibody titers. Changes in plasma cytokine and chemokine levels were also evaluated by sequential blood samples. RESULTS: Among the various cADRs, HHV-6 reactivation was only observed in DRESS, but EBV and CMV could be detected in other cADRs. Many proinflammatory cytokines and chemokines, including interleukin (IL)-1ß, IL-2, IL-6, interferon-γ, tumor necrosis factor-α, were significantly lower in DRESS patients with HHV-6 reactivation when compared to those without HHV-6 reactivation. In addition, these mediators were significantly lower before and during HHV-6 reactivation, compared to cytokine levels after HHV-6 reactivation in the same patient. CONCLUSION: HHV-6 reactivation was only observed in DRESS patients, not in any other cADR. In DRESS patients, some proinflammatory cytokines were significantly lower before or during HHV-6 reactivation.
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Citocinas/sangre , Erupciones por Medicamentos/virología , Infecciones por Herpesviridae/virología , Activación Viral/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , ADN Viral/análisis , Erupciones por Medicamentos/inmunología , Síndrome de Hipersensibilidad a Medicamentos/inmunología , Síndrome de Hipersensibilidad a Medicamentos/virología , Femenino , Herpesviridae/fisiología , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Adulto JovenRESUMEN
A growing number of cells, mediators, and pathways have been implicated in severe drug eruptions. Fifteen years ago, we published landmark studies that sparked the current advances in our understanding of the role of viral reactivations in severe drug eruptions. Viral reactivations then became critically important as diagnostic tools, but how precisely they participated in the pathogenesis remained less well-defined. The question of whether viral reactivations are pathogenic or are instead as epiphenomenon of severe tissue damage has plagued the field of drug allergy for some decades. Recent evidence points to a crucial role for tissue-resident memory T (TRM) cells in immune protection against viral infections. Yet immune protection against viral infections is but one side of a coin, the other side of which comprises effector cells capable of mediating severe immunopathology: Once drug antigen is cross-recognized by these T cells, they could be activated to kill surrounding epidermal cells, resulting in drug-induced tissue damage. Such TRM cells could persistently reside in the skin lesions of fixed drug eruptions (FDE) and are most likely a major cell type responsible for the development of FDE. We also discuss the role of regulatory T (Treg) cells in the setting of drug allergy, in which herpesviruses are reactivated in sequence. Although many details of the complicated interactions among viruses, anti-viral immune responses, TRM cells, and Treg cells remain to be elucidated, we review the current status of this rapidly advancing field.
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Erupciones por Medicamentos/virología , Herpesviridae/inmunología , Piel/inmunología , Subgrupos de Linfocitos T/inmunología , Linfocitos T Reguladores/inmunología , Virosis/inmunología , Animales , Reacciones Cruzadas , Citotoxicidad Inmunológica/efectos de los fármacos , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/inmunología , Humanos , Memoria Inmunológica , Piel/efectos de los fármacos , Piel/virología , Subgrupos de Linfocitos T/efectos de los fármacos , Subgrupos de Linfocitos T/virología , Linfocitos T Reguladores/efectos de los fármacos , Linfocitos T Reguladores/virología , Activación ViralAsunto(s)
Citomegalovirus/fisiología , Erupciones por Medicamentos/virología , Herpesvirus Humano 6/fisiología , Herpesvirus Humano 7/fisiología , Infecciones por Roseolovirus/virología , Adulto , Infecciones por Citomegalovirus/virología , Infecciones por Virus de Epstein-Barr/virología , Herpesvirus Humano 4/fisiología , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
Reactivation of certain latent viruses has been linked with a more severe course of drug-induced hypersensitivity reaction (HSR). For example, reactivation of human herpes virus (HHV)-6 is associated with severe organ involvement and a prolonged course of disease. The present study discusses an HSR developed in a previously healthy male exposed to ceftriaxone, doxycycline, vancomycin, and trimethoprim/sulfamethoxazole (co-trimoxazole; TMP/SMX). Initially, the patient presented clinical manifestations of HSR, as well as clinical and laboratory measurements compatible with liver and renal failure. Moreover, the patient presented skin desquamation compatible with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis. During the reaction, it was observed HHV-6 reactivation. The severity of clinical symptoms is correlated with HHV-6 titer, as well as with results of the in vitro lymphocyte toxicity assay (LTA). Serum levels of a large panel of cytokines are compared between the patient, a large population of SJS patients, and a cohort of healthy controls, using data collected by our laboratory over the years. HHV-6 was measured in the cell culture media from lymphocytes incubated with each of the 4 drugs. Moreover, we describe a new assay using cytokines released by patient lymphocytes following in vitro exposure to the incriminated drugs as biomarkers of HSR. Based on LTA results, HHV-6 reactivation and cytokine measurements, we establish that only doxycycline and TMP/SMX were involved in the HSR. As result of this analysis, the patient could continue to use the other 2 antibiotics safely.
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Antibacterianos/efectos adversos , Herpesvirus Humano 6/efectos de los fármacos , Herpesvirus Humano 6/patogenicidad , Activación Viral/efectos de los fármacos , Enfermedad Hepática Inducida por Sustancias y Drogas/inmunología , Enfermedad Hepática Inducida por Sustancias y Drogas/virología , Citocinas/sangre , Citocinas/metabolismo , Doxiciclina/efectos adversos , Erupciones por Medicamentos/inmunología , Erupciones por Medicamentos/virología , Hipersensibilidad a las Drogas/inmunología , Hipersensibilidad a las Drogas/virología , Humanos , Linfocitos/efectos de los fármacos , Linfocitos/inmunología , Masculino , Infecciones por Roseolovirus/etiología , Infecciones por Roseolovirus/inmunología , Síndrome de Stevens-Johnson/inducido químicamente , Síndrome de Stevens-Johnson/inmunología , Síndrome de Stevens-Johnson/virología , Investigación Biomédica Traslacional , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Adulto JovenAsunto(s)
Antimaníacos/efectos adversos , Carbamazepina/efectos adversos , Erupciones por Medicamentos/complicaciones , Erupciones por Medicamentos/virología , Tiroiditis/etiología , Tiroiditis/virología , Activación Viral , Trastorno Bipolar/tratamiento farmacológico , Citomegalovirus/fisiología , Erupciones por Medicamentos/etiología , Herpesvirus Humano 6/fisiología , Herpesvirus Humano 7/fisiología , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Erupciones por Medicamentos/tratamiento farmacológico , Eosinofilia/tratamiento farmacológico , Inmunoglobulinas Intravenosas/efectos adversos , Activación Viral , Corticoesteroides/uso terapéutico , Adulto , Anciano , Citomegalovirus/fisiología , Progresión de la Enfermedad , Erupciones por Medicamentos/inmunología , Erupciones por Medicamentos/virología , Eosinofilia/inmunología , Eosinofilia/virología , Femenino , Fiebre/etiología , Herpesvirus Humano 4/fisiología , Herpesvirus Humano 6/fisiología , Herpesvirus Humano 7/fisiología , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Interferón gamma/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Inducción de Remisión , Medición de Riesgo , Factores de Necrosis Tumoral/sangreRESUMEN
A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR) on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6). Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS) was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.
Asunto(s)
Carbamazepina/efectos adversos , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/virología , Herpesvirus Humano 6 , Infecciones por Roseolovirus/virología , Activación Viral/efectos de los fármacos , Anticonvulsivantes/efectos adversos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Genetic and non-genetic factors can alter the action of a medicinal drug, resulting in a wide range of responses in different individuals. Among the many potential side effects of therapies, a drug eruption is an adverse drug reaction in the skin. Genetic associations between HLA haplotype and drug eruption have been reported, and immune responses against latent herpesvirus have also been implicated in some forms of this syndrome. We believe that it is essential to understand the immune mechanisms by which some drugs induce hypersensitivity so that we can better target these pathways to limit drug side effects. The identification of patient risk factors for drug eruptions will allow the rational design of novel immunotherapies for these life-threatening reactions, and the development of alternative interventions for high-risk patients.
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Erupciones por Medicamentos/inmunología , Erupciones por Medicamentos/virología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Infecciones por Herpesviridae/inmunología , Herpesviridae/inmunología , Piel/inmunología , Activación Viral/efectos de los fármacos , Erupciones por Medicamentos/genética , Predisposición Genética a la Enfermedad , Antígenos HLA/genética , Infecciones por Herpesviridae/complicaciones , Humanos , Preparaciones Farmacéuticas/química , Polimorfismo Genético , Factores de Riesgo , Piel/virología , Activación Viral/inmunologíaAsunto(s)
Erupciones por Medicamentos/etiología , Eosinofilia/etiología , Herpesvirus Humano 7/patogenicidad , Analgésicos no Narcóticos/efectos adversos , Carbamazepina/efectos adversos , Erupciones por Medicamentos/patología , Erupciones por Medicamentos/virología , Eosinofilia/virología , Herpesvirus Humano 6 , Herpesvirus Humano 7/fisiología , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Roseolovirus/complicaciones , Activación ViralRESUMEN
BACKGROUND: Sulfonamides are divided into two main groups which are sulfonamide antibiotics and sulfonamide non-antibiotics. The wide use of sulfonamide antibiotics leads to increasing incidence of sulfonamide cutaneous reactions. OBJECTIVE: The purpose of this study is to explore the cutaneous manifestations induced by sulfonamide antibiotics in a large number of Thai patients, including human immunodeficiency virus (HIV) and non-HIV infected individuals. The second purpose is to determine the risk factors for development of sulfonamide cutaneous reactions. METHODS: We retrospectively studied 191 patients with sulfonamide antibiotics cutaneous reactions attending the adverse drug reaction center, Siriraj Hospital, Bangkok between 2006 and 2010. RESULTS: Majority of the patients was female (59.7%).Maculopapular rash was the most common cutaneous manifestation (37.7%) followed by fixed drug eruption (22%), angioedema with or without urticaria (12.6%) and urticaria alone (12%). Among those with known HIV serology, maculopapular eruption occurred more frequently in the HIV positive group while fixed drug eruption occurred more frequently in HIV-negative group. CONCLUSION: From our study, there were no significant determination factors to develop serious drug reactions. However, the HIV-positive status and lower level of CD4 count had a tendency to increase risk of developing serious cutaneous reactions.