RESUMO
BACKGROUND: Adverse cutaneous drug reactions are frequent in hospital settings and are responsible for increased morbidity, mortality, and socioeconomic costs. The objective of this study was to identify high risk factors in hospitalized patients with adverse cutaneous drug reactions. METHODS: This descriptive and retrospective study was performed with data from 117 patients admitted to a quaternary hospital over 44 months. We reviewed their epidemiological data, suspected drugs, clinical presentation, histopathological diagnosis, and outcome. Statistical analysis was performed using the chi-squared test with a significance level of 5%. RESULTS: Anticonvulsants were responsible for 23.9% of cases followed by antibiotics (22.2%). In 29% of cases, patients were taking multiple medications that could have triggered their reactions. The most common clinical forms were exanthema (37.6%), drug reaction with eosinophilia and systemic symptoms (DRESS) (14.5%), and Stevens-Johnson syndrome/toxic epidermal necrolysis (12.8%). Anticonvulsants were associated with severe forms of adverse drug reactions. Most patients (89.7%) presented clinical improvement after treatment. There was a relationship between the use of anticonvulsants and atypical lymphocytes in the dermal infiltrate, as well as the clinical form DRESS and atypical lymphocytes in the dermal infiltrate. CONCLUSIONS: The use of anticonvulsants was a high risk factor for severe clinical forms of drug reactions. The presence of atypical lymphocyte infiltrates in the dermis could indicate the use of anticonvulsants.
Assuntos
Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Toxidermias/etiologia , Exantema/induzido quimicamente , Pustulose Exantematosa Aguda Generalizada/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dermatite Esfoliativa/induzido quimicamente , Toxidermias/patologia , Toxidermias/terapia , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Síndrome de Hipersensibilidade a Medicamentos/patologia , Eritema Multiforme/induzido quimicamente , Feminino , Síndrome Mão-Pé/etiologia , Hospitais , Humanos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Síndrome de Stevens-Johnson/etiologia , Urticária/induzido quimicamente , Vasculite/induzido quimicamente , Adulto JovemRESUMO
The Euphorbiaceae family are plants that have in common latex production. There are over 8000 species. They have worldwide distribution. We can find trees, shrubs or herbs. Many important species belong to this family and they are used in our country for industrial and medical purposes. There are also ornamental plants with attractive appearance that stimulate children curiosity, intake or manipulation. In the National Poison Center consultations for plants represent a small number (0.2%) of the total accidents in children, however they can be serious. We report the case of a 4 years old girl who manipulated and swallowed part of an Euphorbiaceae family plant (Synadenium grantii).
Assuntos
Dermatite Esfoliativa/induzido quimicamente , Hevea/efeitos adversos , Pré-Escolar , Feminino , HumanosRESUMO
A woman diagnosed of a renal cell carcinoma in 1989 had a metastatic kidney cancer localised in subcutaneous nodules, gut and lung in 2007. Sorafenib treatment was initiated a 400 mg orally twice a day. The patient developed generalised erythematous skin eruptions and two weeks later a widespread erythematous maculopapular eruption located exclusively on the legs and arms, along with an objective response. The most likely cause of the generalised erythematous skin eruptions was considered to be sorafenib because of the close temporal relationship between exposure to the drug and onset of symptoms. Furthermore, a relationship between sorafenib skin toxicity and treatment efficacy was observed. This therapeutic efficacy of EGFR inhibitors and cutaneous side effects should be better assessed in large cohorts or trials to determine whether the skin toxicity of patients can be linked to an objective antitumour response.
Assuntos
Benzenossulfonatos/efeitos adversos , Benzenossulfonatos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Dermatite Esfoliativa/induzido quimicamente , Neoplasias Renais/tratamento farmacológico , Piridinas/efeitos adversos , Piridinas/uso terapêutico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Dermatite Esfoliativa/diagnóstico , Toxidermias/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Niacinamida/análogos & derivados , Compostos de Fenilureia , Pele/efeitos dos fármacos , Sorafenibe , Resultado do TratamentoRESUMO
Acute intoxication with methotrexate, used as an abortive, has not been described in Chile. We report two female patients, aged 15 and 24 years old, who presented with mucositis, erythrodermia, pancytopenia, and elevation of hepatic enzymes. Plasma methotrexate levels confirmed the clinical diagnosis and both patients were treated with high leucovorin doses and management of associated complications. In one patient, pregnancy continued, giving birth to a newborn with cranial, face and limb malformations. The second patient had a late rescue with leucovorin and was discharged with a persistent sensory motor neuropathy. Considering the severity of complications and that patients may deny its use, when there is reasonable clinical suspicion of methotrexate intoxication, leucovorin treatment should be started
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Intoxicação/tratamento farmacológico , Metotrexato/intoxicação , Leucovorina/administração & dosagem , Pancitopenia/induzido quimicamente , Dermatite Esfoliativa/induzido quimicamente , Aborto Induzido/efeitos adversos , Transaminases/sangue , Doenças do Recém-Nascido/induzido quimicamenteRESUMO
Pyrimethamine-sulfadoxine has been associated with severe and fatal cutaneous reactions as well as transient liver damage. We report the case of a patient who died of progressive hepatic failure caused by pyrimethamine-sulfadoxine administration. In addition, we summarize reports made to the Food and Drug Administration since 1982 that focus on hepatotoxic reactions to pyrimethamine-sulfadoxine. We suggest that fatal hepatic injury can occur after treatment with pyrimethamine-sulfadoxine and that physicians who prescribe the drug should be aware of this possibility.