Cancer immunotherapy and toxic epidermal necrolysis

2020 ◽  
Vol 10 (3) ◽  
pp. 314-315 ◽  
Author(s):  
Liyan Zhang ◽  
Lin Shen ◽  
Yuhan Lu ◽  
Jing Xue
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Secondary Infection ◽  
Young Female ◽  
Multiple Organ ◽  
Adverse Outcomes ◽  
Nutrition Support ◽  
Systemic Glucocorticoid ◽  
Ensure Patient Safety ◽  
Mucous Membranes ◽  
Comprehensive Treatments

ObjectivesImmunotherapy has come to play an increasingly important role in cancer treatment. Accordingly, immune-related adverse events (irAEs) have drawn considerable attention. In this case, a young female patient developed immune-related toxic epidermal necrolysis (TEN). The same irAEs have been rarely reported in previous studies. In this study, we describe the treatment and care methods used in this case in detail in order to provide a reference for clinical practice.MethodsAfter being diagnosed with TEN, the patient accepted systemic glucocorticoid therapy, timely care of skin and mucous membranes, nutrition support, antiacid therapy, anti-inflammatory, analgesics and other supportive measures.ResultsThe patient’s skin recovered completely, and no serious adverse outcomes, such as secondary infection or multiple organ failure, occurred during treatment.ConclusionMedical staff should be able to identify the performance of rare irAEs such as TENs and actively explore comprehensive treatments to ensure patient safety and avoid adverse outcomes.

Toxic epidermal necrolysis in the practice of a family doctor

2020 ◽  
pp. 61-67
Author(s):  
Esed Esedov ◽  
Fariza Akhmedova ◽  
Dina Akbiyeva
Keyword(s):  
Allergic Reaction ◽  
Toxic Epidermal Necrolysis ◽  
Family Doctor ◽  
Favorable Outcome ◽  
Rational Treatment ◽  
Systemic Allergic Reaction ◽  
Timely Diagnosis ◽  
First Case ◽  
Mucous Membranes

Toxic epidermal necrolysis is a severe delayed-type systemic allergic reaction, in which there is a combined lesion of the skin and mucous membranes. 2 cases of toxic epidermal necrolysis from the practice of a family doctor are described in the article. Timely diagnosis and rational treatment of the disease in the first case led to a favorable outcome, in the second case, the outcome of the disease was unfavorable.

Developing an adolescent and adult Fontan Management Programme

2021 ◽  
pp. 1-6
Author(s):  
Adam M. Lubert ◽  
Tarek Alsaied ◽  
Andrew T. Trout ◽  
Jonathan R. Dillman ◽  
Joseph J. Palermo ◽  
...  
Keyword(s):  
Single Ventricle ◽  
Fontan Procedure ◽  
Multiple Organ ◽  
Fontan Circulation ◽  
Management Programme ◽  
Adverse Outcomes ◽  
Cardiac Complications ◽  
Organ Systems ◽  
Adolescents And Adults ◽  
Care Models

Abstract Patients with single-ventricle CHD undergo a series of palliative surgeries that culminate in the Fontan procedure. While the Fontan procedure allows most patients to survive to adulthood, the Fontan circulation can eventually lead to multiple cardiac complications and multi-organ dysfunction. Care for adolescents and adults with a Fontan circulation has begun to transition from a primarily cardiac-focused model to care models, which are designed to monitor multiple organ systems, and using clues from this screening, identify patients who are at risk for adverse outcomes. The complexity of care required for these patients led our centre to develop a multidisciplinary Fontan Management Programme with the primary goals of earlier detection and treatment of complications through the development of a cohesive network of diverse medical subspecialists with Fontan expertise.

INFLUENCE OF BACTRIO-CARRY IN THE FAMILY ON THE COURSE OF ATOPIC DERMATITIS IN A CHILD

2021 ◽  
pp. 114-119
Author(s):  
Vasileva E.A. ◽  
Kuyarov A.A. ◽  
Kuyarov A.V.
Keyword(s):  
Atopic Dermatitis ◽  
Secondary Infection ◽  
Family Members ◽  
Upper Respiratory Tract ◽  
Epidermal Barrier ◽  
The Family ◽  
Mucous Membranes ◽  
High Degree ◽  
Nose And Throat

The pathogenesis of atopic dermatitis (AD) is complex, and at present a unified concept of the development of the disease has not been formed. At the heart of pathogenesis, there is a complex interaction of numerous factors, such as genetic predisposition, dysfunction of the autonomic nervous system and the epidermal barrier. Previously, it has been proven that a high microbial contamination of the affected areas helps to maintain inflammation and aggravates skin dysfunction as a result of chronic inflammation, and favorable factors appear for the attachment of a secondary infection. However, little attention has been paid to dysfunctions of the epidermal barrier, the role of violations of the quantitative and qualitative composition of the microbiota in the development of AD, and this issue remains relevant at the present time. The aim of this study was to assess the effect of the carrier of bacteria on the mucous membranes of the upper respiratory tract in family members on the course of atopic dermatitis in a child. A bacteriological examination of the mucous membranes of the nose and throat was carried out in 34 children with AD and members of their families (74 people). When examining the mucous membranes of the nose and throat in family members of children with AD, it was found that the microflora isolated from family members in more than half of the cases has an increased potential for pathogenicity with a high degree of contamination (CFU lg 3), which forms an increased bacteriological load on the child. The tendency of bacterial carriage was revealed, contributing to the formation in the family of a permanent persistence of microflora with a high potential for pathogenicity. Asymptomatic carriage of bacteria forms an additional epidemiological load on the child, affects the severity of AD and is a risk factor in the development of secondary infection of the skin.

scholarly journals Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis; Extensive Review of Reports of Drug-Induced Etiologies, and Possible Therapeutic Modalities

2018 ◽  
Vol 6 (4) ◽  
pp. 730-738 ◽  
Author(s):  
Adegbenro Omotuyi John Fakoya ◽  
Princess Omenyi ◽  
Precious Anthony ◽  
Favour Anthony ◽  
Precious Etti ◽  
...  
Keyword(s):  
Adverse Drug Reaction ◽  
Toxic Epidermal Necrolysis ◽  
Stevens Johnson Syndrome ◽  
Hypersensitivity Reactions ◽  
Extensive Review ◽  
Drug Induced ◽  
Therapeutic Modalities ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Degrees Of Severity

Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis are adverse hypersensitivity reactions that affect the skin and mucous membranes. They are characterised by erythematous macules and hemorrhagic erosions of the mucous membranes. Epidermal detachments of varying degrees of severity also occur in these conditions. Various aetiologies are associated with these conditions, with adverse drug reaction being the most common. Though the worldwide incidence of these conditions is recorded as low, diverse types of medication are being observed to lead to these conditions. This review compiles information on the details of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis, the pathophysiology, therapeutic management, and largely considers the drug-induced etiologies associated with these conditions.

Head and Neck Manifestations of Erythema Multiforme in Children

1994 ◽  
Vol 111 (3P1) ◽  
pp. 236-242 ◽  
Author(s):  
Michael G. Stewart ◽  
Newton O. Duncan ◽  
Daniel J. Franklin ◽  
Ellen M. Friedman ◽  
Marcelle Sulek
Keyword(s):  
Oral Cavity ◽  
Toxic Epidermal Necrolysis ◽  
Head And Neck ◽  
Erythema Multiforme ◽  
Medication Use ◽  
Stevens Johnson Syndrome ◽  
Striking Increase ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Mucous Membranes

Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are related disorders of skin and mucous membranes, which are typically associated with antecedent medication use or infection. We review 108 cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis from Texas Children's Hospital, Houston, Texas, from 1981 to 1991, and illustrate the characteristic skin and mucosal lesions. In addition, we describe in detail two unusual cases requiring intensive airway management. Head and neck manifestations were present in 4 of 79 patients (5%) with erythema multiforme and 26 of 28 patients (93%) with Stevens-Johnson syndrome. In Stevens-Johnson syndrome, mucosal involvement of the lip (93%), conjunctiva (82%), oral cavity (79%), and nose (36%) were most common. Antecedent medication use was identified in 59% of erythema multiforme patients and 68% of Stevens-Johnson syndrome patients. We note a striking increase in the number of cases in our series caused by cephalosporins. Fifty percent of Stevens-Johnson syndrome patients required supplemental hydration or alimentation because of the severity of the oral cavity involvement. The head and neck mucosal manifestations largely respond to local care, and the routine use of prophylactic antibiotics or systemic steroids is not recommended.

Experience in using Topicream soothing cream CICA for rehabilitation of skin and mucous membranes after destructive dermatocosmetological procedures in combination therapy of dermatoses

2021 ◽  
pp. 33-38
Author(s):  
L.V. Hrechanska ◽  
O.V. Podluzhna ◽  
S.Р. Ostapenko ◽  
А.Е. Alatorskyh
Keyword(s):  
Clinical Practice ◽  
High Efficiency ◽  
Skin Diseases ◽  
Secondary Infection ◽  
Skin Neoplasms ◽  
Skin Surface ◽  
Punch Biopsy ◽  
Duration Of Treatment ◽  
Inflammatory Reactions ◽  
Mucous Membranes

The widespread introduction of the destructive methods of treatment into the clinical practice of dermatovenerologists is caused by the significant spread of benign skin and mucous neoplasms. At the same time, any effect on the skin — chemical, physical or mechanical — causes damage. Thus, patients using these procedures need proper care for damaged skin and mucous membranes to prevent secondary infection and scaring. Disruption of the epidermal barrier after removal of benign skin neoplasms, carrying out biopsy and chemical peels always requires application of topical agents promoting full recovery of the epidermis. In addition, many skin diseases are accompanied by inflammatory reactions, which are complicated by secondary infection. The use of drugs with anti­inflammatory and reparative properties reduces the duration of treatment and promotes skin recovery.Objective — to evaluate the clinical efficacy and tolerability of using Topicream soothing cream CICA after derma­tocosmetological procedures on the skin and mucous membranes and to investigate the efficacy of its use at various skin and mucous membranes diseases including children.Materials and methods. The study included 57 patients aged 1 to 75 years with various skin diseases, benign skin and mucosal neoplasms, after punch biopsy and cosmetology procedures. Topical application of the Topicream soothing cream CICA on the damaged skin and mucosal areas was recommended to all participants of the study twice a day. Results and discussion. The use of the regenerating cream after dermatological treatment of benign skin neoplasms with apparatus methods, chemical peelings and punch biopsy, as well as the auxiliary treatment of skin diseases such as cheilitis, herpes, perianal fissure, allergic contact dermatitis (including in children) localized in folds and on the face, contributes to a significant reduction in signs of inflammation and subjective sensations, as well as rapid healing of the affected skin surface. At the same time, there is a good tolerance and the absence of side effects of Topicream soothing cream CICA, which allows it to be widely used in clinical dermatovenerology, gynecology and pediatrics.Conclusions. High efficiency and safety of Topicream soothing cream CICA allow its widespread use in clinical practice of dermatovenerologists, gynecologists and pediatricians.

Warfarin-induced toxic epidermal necrolysis after mitral valve replacement

2020 ◽  
Vol 28 (9) ◽  
pp. 601-603
Author(s):  
Taiyo Kuroda ◽  
Yukifusa Yokoyama ◽  
Masao Yamada ◽  
Satoshi Yuhara ◽  
Hiroki Hasegawa ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Toxic Epidermal Necrolysis ◽  
Drug Hypersensitivity ◽  
Lymphocyte Transformation ◽  
Lymphocyte Transformation Test ◽  
Stevens Johnson Syndrome ◽  
Valve Prosthesis ◽  
Mitral Valve Prosthesis ◽  
Johnson Syndrome ◽  
Mucous Membranes

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare diseases that cause acute destruction of the epithelium of the skin and mucous membranes, almost always attributable to drugs. However, warfarin-induced Stevens-Johnson syndrome and toxic epidermal necrolysis is extremely rare. We report the case of 71-year-old woman who died due to destructive erosion all over her skin and mucous membranes. She had received a mitral valve prosthesis, and warfarin was prescribed for antithrombotic therapy. A lymphocyte transformation test for drug hypersensitivity and the clinical history confirmed this phenomenon as warfarin-induced toxic epidermal necrolysis.

Nutrition support and the human immunodeficiency virus (HIV)

Parasitology ◽  
1993 ◽  
Vol 107 (S1) ◽  
pp. S53-S67 ◽  
Author(s):  
S. J. Bell ◽  
E. A. Mascioli ◽  
R. A. Forse ◽  
B. R. Bistrian
Keyword(s):  
Dietary Supplements ◽  
Nutritional Support ◽  
Secondary Infection ◽  
Rapid Development ◽  
Latency Period ◽  
Nutrient Utilization ◽  
Nutrition Support ◽  
Trauma Patients ◽  
Hiv Patients ◽  
Secondary Infections

SUMMARYNutritional support of patients with HIV or acquired immune deficiency syndrome (AIDS) has many similarities to other disease states in that the same nutritional products and techniques are used. Some patients with HIV, and many with AIDS without secondary infection, experience a metabolic milieu similar to patients with cancer cachexia. In providing dietary counselling to the HIV patient, we encounter many of the obstacles that must be overcome to improve nutrition in cancer: anorexia, gastrointestinal discomfort, lethargy, and poor nutrient utilization, which limit the ability for nutritional repletion. When a secondary infection is superimposed on HIV, patients resemble more highly catabolic trauma patients or patients in the intensive care unit (ICU), where, despite aggressive efforts to feed, there is usually a net nitrogen wasting leading to the more rapid development of cachexia. However, even in this setting, feeding will limit substantially net catabolism when compared to total starvation. Because the nutritional needs of HIV patients vary greatly, individual strategies have to be designed as the patient moves through the stages of disease. Patients are generally able to consume adequate nutrition either as regular food or dietary supplements during the latency period of viral replication. Once secondary infections become prevalent, artificial diets administered by tube or by vein may be required during the period of active secondary infections, with dietary supplements often helpful during more quiescent periods. Patients with HIV are among the most challenging for clinicians providing nutritional support. Knowledge from treatment of patients with other diseases may be useful, but more data must be gathered on the unique aspects of aetiology and treatment of the anorexia, malabsorption, and ultimate wasting associated with AIDS.

Critical Illness–Induced Immune Suppression: Current State of the Science

2016 ◽  
Vol 25 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Kristin C. Greathouse ◽  
Mark W. Hall
Keyword(s):  
Critical Illness ◽  
Immune Suppression ◽  
Secondary Infection ◽  
Production Capacity ◽  
Interferon Γ ◽  
Adverse Outcomes ◽  
Patient Specific ◽  
Cell Surface Molecule ◽  
Interleukin 7 ◽  
Macrophage Colony

Critical illness comprises a heterogeneous group of serious medical conditions that typically involve an initial proinflammatory process. A compensatory anti-inflammatory response may occur that, if severe and persistent, places the patient at high risk for adverse outcomes including secondary infection and death. Monitoring strategies can identify these patients through measurement of innate and adaptive immune function. Reductions in monocyte HLA-DR expression, reduced cytokine production capacity, increased inhibitory cell surface molecule expression, and lymphopenia have all been associated with this immune-suppressed state. Intriguing data suggest that critical illness–induced immune suppression may be reversible with agents such as interferon-γ, granulocyte macrophage colony-stimulating factor, interleukin 7, or anti–programmed death-1 therapy. Future approaches for characterization of patient-specific immune derangements and individualized treatment could revolutionize how we recognize and prevent complications in critically ill patients.

Serum metabolomics identifies citrulline as a predictor of adverse outcomes in an equine model of gut-derived sepsis

2014 ◽  
Vol 46 (10) ◽  
pp. 339-347 ◽  
Author(s):  
Samantha M. Steelman ◽  
Philip Johnson ◽  
Amy Jackson ◽  
James Schulze ◽  
Bhanu P. Chowdhary
Keyword(s):  
Critically Ill ◽  
Acid Metabolism ◽  
Gastrointestinal Disease ◽  
Weight Bearing ◽  
Multiple Organ ◽  
Adverse Outcomes ◽  
Serum Samples ◽  
Plasma Citrulline ◽  
Normal Ranges ◽  
Serum Metabolomics

Acute laminitis is an inflammatory disease of the equine foot that often occurs secondarily to sepsis or systemic inflammation associated with gastrointestinal disease. It has been suggested that laminitis is similar to multiple organ dysfunction syndrome in humans, although in horses the weight-bearing laminar epithelium of the foot appears to be the tissue most sensitive to insult and the first “organ” to fail. Metabolomics performed on serum samples collected before (Con) and after (Lmn) experimental induction of gastrointestinal-associated sepsis in six horses detected 1,177 metabolites of both mammalian and bacterial origin in equine serum. Network and correlation analyses suggested a dysregulation of fatty acid metabolism in the Lmn group, as well as an accumulation of organic acids such as lactate. Furthermore, concentrations of the amino acid citrulline were decreased in Lmn samples from all study animals, suggesting that citrulline might be useful as a biomarker to identify critically ill animals that are at risk of developing laminitis. We therefore established normal ranges of plasma citrulline concentrations in a separate group of horses ( n = 36) and tested the ability of citrulline to predict adverse outcomes (laminitis or death) in critically ill horses ( n = 23). Plasma citrulline was significantly lower in critically ill horses that went on to experience adverse outcomes ( n = 6). Further study is required to accurately determine a diagnostic cutoff, but the present data are suggestive of the predictive value of citrulline as a biomarker for laminar failure in equine sepsis.

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