RESUMO
INTRODUCTION: Erythema multiforme (EM) is a reactive mucocutaneous disorder typically initiated by viral infections. Although the management of EM differs according to the clinical course and trigger factor, it is not clear whether antiviral suppressive therapies may be useful in cases related to such infections. Moreover, the treatment is most often based on supportive care directed towards only the symptoms. AIM: To present a clinical case of a child in which antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) were used for orofacial manifestations of EM secondary to viral infections. CASE REPORT: A Brazilian 1-year-old boy was admitted to an ICU due to a severe Influenza A H3N2 infection, pneumonia with pleural effusion, and sepsis. About 10 days later, it was noted bleeding lip lesions covered by crusts and bleeding tongue lesions, diagnosed as EM secondary to both H3N2 and herpes simplex virus infections, confirmed by serology tests. A combination of an aPDT session and six PBMT sessions was proposed and resulted in almost complete resolution of the lesion on the 7th day. CONCLUSION: Given the complexity of the present case, the combination of phototherapies seems to be a promising tool for treating acute orofacial mucosal lesions of viruses-induced EM. More studies, however, are needed to reach a definite conclusion.
Assuntos
Eritema Multiforme , Herpes Simples , Fotoquimioterapia , Viroses , Masculino , Humanos , Criança , Lactente , Vírus da Influenza A Subtipo H3N2 , Fotoquimioterapia/métodos , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Viroses/complicaçõesRESUMO
RESUMEN: El eritema multiforme es una enfermedad autoinmune vesicular-ampollosa y autolimitada, se presenta de forma aguda afectando la piel y mucosa. En 2015, Lee E. y Freer J., incluyeron esta enfermedad dentro de los síndromes dermatológicos paraneoplásicos, pero actualmente no existen muchas publicaciones de esta entidad como manifestación a una neoplasia subyacente. El objetivo de esta investigación es presentar el eritema multiforme como una manifestación paraneoplásica inusual. En este caso una paciente de 64 años de edad que cursaba con adenocarcinoma de colon exhibió el eritema multiforme oral; cuyas manifestaciones bucales involucionaron gracias a la farmacoterapia local y sistémica en conjunto con la excéresis de la lesión cancerosa en el colon. Es importante reconocer la presencia de eritema multiforme como una manifestación paraneoplásica cuando no se exhiben los factores etiológicos frecuentes de esta patología y, por lo tanto, centrarse en la búsqueda subyacente de neoplasias malignas que no son muy evidentes.
ABSTRACT: Erythema multiforme is a self-limiting, blistering, autoimmune disease that presents acutely, affecting the skin and mucosa. In 2015, Lee E. and Freer J. included this disease in paraneoplastic dermatological syndromes, but there are currently not many publications about this entity as a manifestation of an underlying malignancy. The objective of this research is to present the erythema multiforme as an unusual paraneoplastic manifestation. In this case, a female 64-year-old patient with colon adenocarcinoma exhibited oral multiform erythema; whose oral manifestations regressed thanks to local and systemic pharmacotherapy in conjunction with the exeresis of the cancerous lesion in the colon. It is important to recognize the presence of erythema multiforme as a paraneoplastic manifestation when the frequent etiological factors of this pathology are not exhibited and, therefore, to focus on the underlying search for malignant neoplasms that are not very evident.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/etiologia , Adenocarcinoma/complicações , Eritema Multiforme/etiologia , Neoplasias do Colo/complicações , Síndromes Paraneoplásicas/tratamento farmacológico , Eritema Multiforme/tratamento farmacológicoRESUMO
Recurrent erythema multiforme is a chronic relapsing disease that represents a therapeutic challenge. Our objective was to retrospectively evaluate the clinical-epidemiological characteristics and therapeutic response of patients with recurrent erythema multiforme and suggest a therapeutic protocol. We included patients with recurrent erythema multiforme diagnosed between January 2000 and December 2019. Clinical symptoms and a positive serology for herpes simplex virus were the inclusion criteria to initiate acyclovir in monotherapy or a combined treatment with dapsone, thalidomide, or immunosuppressants in refractory cases. Thirty-five patients were included and 71.4% were female. The median disease onset age was 35.7 years and the mean follow-up was 7.58 years. The skin was the most affected site (91.4%). Herpes simplex virus immunoglobulin (Ig)G serology was positive in 91.1% of cases. Acyclovir treatment was used in 33 of 35 patients, and complete remission was achieved in 22 of 33 after the first therapeutic course; 16 of 22 relapsed and required a second acyclovir cycle. Combined treatment with dapsone was required in nine of 33 due to partial response to acyclovir; thalidomide was an adjuvant drug in four of 33 due to adverse effects to dapsone. After the first cycle of acyclovir with or without combined therapy, 19 of 33 patients relapsed and received 2-6 additional cycles. Our results suggest that recurrent erythema multiforme presents a good response to acyclovir in monotherapy or in combined therapy with dapsone or thalidomide in the majority of patients. We propose a long-term therapeutic protocol to enable disease remission.
Assuntos
Eritema Multiforme , Herpes Simples , Aciclovir/uso terapêutico , Adulto , Doença Crônica , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Feminino , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Humanos , Recidiva , Estudos RetrospectivosRESUMO
A 63-year-old female patient with recent diagnosis of hepatitis C and cirrhosis and no other comorbidities, on no medications, was found to have Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma and began systemic therapy with sorafenib 400mg twice daily. Five days after starting treatment, the patient went to an emergency department with pruritic, target-shaped, erythematous papules compatible with erythema multiforme, painful oral aphthous ulcers, and fever. Sorafenib was suspended and the patient underwent oral corticosteroid treatment for 5 days, showing significant improvement of the lesions. One month after discharge, the patient was reassessed at an outpatient clinic. As she was asymptomatic and had no skin lesions, sorafenib was resumed at a lower dose (200mg daily). Three hours after ingesting a single dose of sorafenib, the patient experienced chills, fever, rash, angioedema and stridor. She immediately sought the emergency department and was diagnosed with anaphylaxis. The patient received intravenous corticosteroid therapy, which improved her respiratory and cutaneous symptoms in 72h. Sorafenib was permanently suspended, and regorafenib could not be prescribed as second-line therapy. This is the first description of anaphylaxis to sorafenib.
Assuntos
Anafilaxia/induzido quimicamente , Eritema Multiforme/induzido quimicamente , Prednisona/uso terapêutico , Sorafenibe/efeitos adversos , Anafilaxia/tratamento farmacológico , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/tratamento farmacológico , Eritema Multiforme/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/tratamento farmacológico , Pessoa de Meia-Idade , Sorafenibe/uso terapêuticoRESUMO
We are currently facing a worldwide epidemic of syphilis. Clinical manifestations that are rarely seen have been encountered, leading the dermatologist to confront unusual clinical conditions in daily practice. Erythema multiforme triggered by syphilis is very rare and is also seldom reported in the literature. We report a case of secondary syphilis in an HIV-positive patient, whose clinical, pathologic and serologic features were consistent with the diagnosis of erythema multiforme triggered by syphilis.
Assuntos
Eritema Multiforme/etiologia , Infecções por HIV/complicações , Sífilis/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Biópsia , Eritema Multiforme/complicações , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Humanos , Penicilina G/uso terapêuticoRESUMO
El Eritema Multiforme (EM) es una reacción poco común, aguda, de piel y mucosa. Es una reacción de hipersensibilidad, caracterizada por erupciones en piel en forma de diana, constituidas por zonas concéntricas de diferente coloración, y lesiones ulcerosas o vesículo-ampollares en mucosa. La enfermedad puede ser desencadenada por infecciones, principalmente por virus del herpes simple (HSV) y Mycoplasma pneumoniae y por ingestión de drogas, siendo las más frecuentes las sulfonamidas y las penicilinas. Se presentan tres casos relacionados a la infección por el virus del herpes simple.
Erythema multiforme (EM) is a condition acute, mucocutaneous, caused by hypersensitivity reaction, characterized by skin eruption (target lesions with concentric zones) and mucous membrane lesions (ulcerous, bullous-vesicular lesions). The disorder can be induced by infections, particularly herpes simplex(VSH) and Mycoplasma pneumoniae, or by drug intake (AINE, sulfonamides, penicillins) Three cases related to VHS infection, are presented.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/etiologia , Eritema Multiforme/patologia , Antivirais/uso terapêutico , Herpes Simples/complicações , Herpes Simples/tratamento farmacológico , Boca/lesõesRESUMO
Introducción la lepra, llamada también enfermedad de Hansen, es una afección de la piel y de los nervios periféricos, infectocontagiosa, causada por Mycobacterium leprae. Las reacciones lepromatosas se presentan aún con tratamiento y son expresiones de respuesta inmunitaria. Conocerlas es importante a fin de facilitar el abordaje. Objetivo determinar la frecuencia y tipo de reacciones lepromatosas en pacientes con diagnóstico de lepra que acuden al centro de referencia de Enfermedad de Hansen en el Hospital Distrital de San Lorenzo, de enero 2013 a diciembre 2015. Metodología observacional, descriptivo, retrospectivo de corte transverso. Resultados se incluyeron 217 pacientes, 72% presentaban lepra MB y 63% era de sexo masculino. La prevalencia de reacción lepromatosa fue 44%, siendo más frecuentes las de tipo 2 (65%). Se presentó reacción lepromatosa como debut de la enfermedad en 27 %. Treinta y tres pacientes presentaron de tres a doce episodios de reacción lepromatosa. El tratamiento fue talidomida y corticoides. Conclusiones la prevalencia de leprorreacciones fue cercana al 50%, predominando las de tipo 2. El tratamiento utilizado fue talidomida y/o corticoides dependiendo del tipo de reacción lepromatosa.
Introduction leprosy, wich is cause by Mycobacterium leprae, also known as Hansen's Disease, affects skin and peripheral nerves. Lepromatous reactions (LRs) are expressions of an immune reaction and remain as a major persistent problem. LRs are present even with appropriated treatment. Emphasis must be made in early diagnosis and prevention of the catastrophic consequences of LRs. Objective to determine the frequency and type of lepromatous reactions in leprosy patients with leprosy attending to reference center of Hansen´s Disease in the District Center Hospital in San Lorenzo, from January 2013 to December 2015. Methodology observational, retrospective cross sectional study. Results 217 patients were included, 72% with multibacillary leprosy. 63% were male. Lepromatous reactions were found in 44%, been more frequent Type II reaction, in 65% of cases. LRs as oset disease occurred in 27%. 33 patients presented from 3 to 12 episodes of lepromatous reaction. The number of LRs episodes per patient were 3 to 12. Thalidomide was used as treatment in Erithema Nodosum Leprosum (ENL) and corticosteroids for the other types de LRs. Conclusions prevalence of PRs were 50%, been more frecuent the type II. Reaction the treatment used was Thalidomide and/or corticosteroids depending on the type of lepromatosus reaction.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Hanseníase Multibacilar/fisiopatologia , Hanseníase Multibacilar/epidemiologia , Hanseníase Paucibacilar/fisiopatologia , Hanseníase Paucibacilar/epidemiologia , Paraguai/epidemiologia , Talidomida/uso terapêutico , Prevalência , Estudos Transversais , Estudos Retrospectivos , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/epidemiologia , Corticosteroides/uso terapêutico , Eritema Nodoso/tratamento farmacológico , Eritema Nodoso/epidemiologia , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Paucibacilar/tratamento farmacológicoAssuntos
Eritema Multiforme/etiologia , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/complicações , Biópsia por Agulha , Brasil , Quimioterapia Combinada , Doenças Endêmicas , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/patologia , Feminino , Mãos , Humanos , Imuno-Histoquímica , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Meglumina/uso terapêutico , Prednisona/uso terapêutico , Medição de Risco , Índice de Gravidade de Doença , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/etiologia , Resultado do Tratamento , Cicatrização/fisiologia , Adulto JovemAssuntos
DNA Bacteriano/análise , Eritema Multiforme/etiologia , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/complicações , Criança , Diagnóstico Diferencial , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase , Radiografia TorácicaRESUMO
El eritema multiforme, aparece como una enfermedad sistémica con la participación de la piel y las membranas mucosas en relación con varios factores como las infecciones bacterianas o virales, y en particular la administración de drogas, analgésicos y antibióticos en general. Se presenta un paciente masculino de 29 años de edad con eritema multiforme mayor desencadenado por antimicrobianos con la aparición de lesiones vesiculares-bulloso-ulcerosas en las regiones de los labios, encías, la lengua y la mucosa genital en tratamiento de una infección del tracto urinario con norfloxacino 400 mg por una semana. Fue realizado un tratamiento de soporte con el uso de colutorios para la higienización bucal y pomada a base de corticoide para protección de las úlceras, antihistamínicos y orientación nutricional de dieta líquida hipercalórica e hiperproteica. Este síndrome está caracterizado como un proceso eruptivo buloso agudo que compromete la calidad de vida del paciente y no hay pruebas de laboratorio específicas por lo que su diagnóstico debe estar basado en la revisión minuciosa de la anamnesis y en los hallazgos clínicos(AU)
The multiform erythema appears as a systemic disease where skin and the mucous membranes have participation in relation to some factors such as bacterial or viral infections and in particular the drugs administration, analgesics and antibiotics in general. The aim of present paper was the presentation of case of big multiform erythema triggering by antimicrobials. Authors present the case of a male patient aged 29 with appearance of ulcerous bullous-vesicular lesions in lips, gums, tongue and genital mucosa under treatment with 400 mg norfloxacin due to urinary tract infection for a week. We made support treatment using mouthwashes for oral hygiene and corticoids ointment for ulcer protection, antihistaminics and nutritional guiding of a hypercaloric and hyperprotein liquid diet. This syndrome is characterized as an acute bullous eruptive process involving the patient's quality of life and there are not specific laboratory tests thus its diagnosis must to be based on a highly detailed review of anamnesis and the clinical findings(AU)
Assuntos
Humanos , Masculino , Adulto , Eritema Multiforme/tratamento farmacológico , Infecções do Sistema Genital/tratamento farmacológico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Mucosa Bucal/patologia , Higiene Bucal/efeitos adversos , Coleta de Dados/métodos , Corticosteroides/uso terapêutico , Antissépticos Bucais/uso terapêuticoAssuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Fenobarbital , Leishmaniose/diagnóstico , Leishmaniose/tratamento farmacológico , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/tratamento farmacológico , Medicina InternaAssuntos
Eritema Multiforme/diagnóstico , Esporotricose/diagnóstico , Animais , Antifúngicos/uso terapêutico , Brasil , Gatos , Diagnóstico Diferencial , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/patologia , Feminino , Mãos , Humanos , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Esporotricose/tratamento farmacológico , Esporotricose/patologia , Coxa da PernaRESUMO
From a clinician's point of view, diseases of the immune system are broadly grouped into the following categories: I. Immunodeficiency disorders II.Autoimmune diseases III. Hypersensitivity reactions (AU)
Assuntos
Humanos , Estomatite Aftosa/etiologia , Estomatite Aftosa/diagnóstico , Síndrome de Behçet/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/etiologia , Líquen Plano Bucal/diagnóstico , Líquen Plano Bucal/tratamento farmacológico , Síndrome de Sjogren/diagnóstico , Epidermólise Bolhosa/diagnóstico , Dermatite Herpetiforme , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológicoAssuntos
Humanos , Dermatopatias/complicações , Dermatite Esfoliativa/diagnóstico , Dermatite Esfoliativa/tratamento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/tratamento farmacológico , Pênfigo/diagnóstico , Pênfigo/tratamento farmacológico , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/tratamento farmacológico , Queimadura Solar/diagnóstico , Vesícula/diagnóstico , Vesícula/terapiaAssuntos
Anti-Inflamatórios/uso terapêutico , Antituberculosos/efeitos adversos , Dapsona/efeitos adversos , Dermatopatias/tratamento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Hanseníase Dimorfa/tratamento farmacológico , Prednisolona/uso terapêutico , Pênfigo/tratamento farmacológico , Serviços Médicos de EmergênciaRESUMO
Para estudiar la efectividad de la Talidomida en patologías dermatológicas diferentes de la reacción leprosa, se seleccionaron 4 pacientes que acudían a la consulta externa del Instituto de Biomedicina (Caracas). Un paciente con Líquen plano hipertrófico; un paciente con Eritoma Multiforme, uno con aftas orales recurrentes y un paciente con Lupus Subagudo y manifestacines cutáneas de Lupus Eritematoso Discoideo Crónico (LEDC). Los cuatro pacientes tenían en común la ausencia parcial o total de respuesta a los tratamientos convencionales para estas afecciones. En todos los casos se observó una buena a excelente respuesta al uso de la Talidomida. La Talidomida debe quedar a la disposición del Dermatólogo para el tratamiento de la reacción leprosa, aftosis recurrente, líquen plano, LEDC y tal vez para algunos otros casos muy seleccionados tomando en cada caso las precauciones necesarias con el fin de evitar los riesgos de teratogénesis y posible neuropatía