scholarly journals Symmetrical Drug-related Intertriginous and Flexural Exanthema (Baboon Syndrome)

2021 ◽  
Author(s):  
Olinda Lima Miranda ◽  
João Martins ◽  
Ângela Almeida ◽  
Mariana Formigo ◽  
Olga Pereira ◽  
...  
Keyword(s):  
Emergency Department ◽  
Maculopapular Rash ◽  
Topical Steroids ◽  
Symmetrical Pattern ◽  
Systemic Corticosteroids ◽  
Axillary Region ◽  
Cubital Fossa ◽  
Agent Treatment

Baboon syndrome, also called symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), is an erythematous maculopapular rash that presents in skin folds in a symmetrical pattern. This condition may develop after the patient starts a particular agent. Treatment consists of stopping the associated trigger and medicating with topical or systemic corticosteroids. A 30-year-old man with odynophagia, otalgia and fever was prescribed amoxicillin. He developed erythematous and pruriginous lesions in the cubital fossa and inguinal regions. He attended the emergency department (ED) where he was prescribed penicillin. Lesions continued to progressively worsen with a bilateral symmetrical pattern in the axillary region and later in the nape folds, popliteal regions, and on the perineum and buttocks. The patient presented to the ED for a second time, where he was diagnosed with baboon syndrome and prescribed topical steroids with clear improvement.

scholarly journals Management of carbamazepine induced drug reaction with eosinophlia and systemic symptoms in Mediheal hospital-Nakuru, Kenya: a case report

2018 ◽  
Vol 4 (4) ◽  
pp. 600
Author(s):  
Ramadhan L. Mawenzi ◽  
Dhiren Parikh
Keyword(s):  
Drug Reaction ◽  
Early Recognition ◽  
Oral Prednisone ◽  
Cervical Lymphadenopathy ◽  
Maculopapular Rash ◽  
Topical Steroids ◽  
Positive Serology ◽  
Systemic Corticosteroids ◽  
Systemic Symptoms ◽  
High Index Of Suspicion

<p class="abstract">Adverse drug reactions (ADR) are undesirable events occurring as consequences of an ingested, injected or applied drug. Their spectrum can range from mild to severe reactions. Severe Cutaneous Adverse Reactions (SCARs) are diverse in presentation and in consequence. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a type of life-threatening SCAR which affects the skin as well as the internal organs. Various drugs can cause DRESS, but aromatic anticonvulsants, especially carbamazepine are considered the major culprits. The diagnosis of DRESS requires a high index of suspicion followed by an intense sign-searching clinical examination guided by established criteria. We report a previously healthy 53 year old man of Kenyan ancestry who developed fever, widespread maculopapular rash, swollen eyelids and cervical lymphadenopathy three weeks after carbamazepine. Liver enzymes were markedly elevated and he had lymphocytopenia and a positive serology for human herpes virus type 6 (HHV6). Using the RegiSCAR criteria a probable diagnosis of DRESS secondary to carbamazepine was made. His treatment involved discontinuation of the drug, intravenous hydrocortisone together with mild topical steroids. He remarkably improved and was discharged on oral prednisone and followed up for three consecutive months. The length of his hospitalisation was ten days. Carbamazepine has potential to provoke DRESS in patients of Kenyan ancestry. DRESS should be anticipated before and during use of carbamazepine for early recognition. Treatment of DRESS should involve the immediate withdrawal of offending drug and rapid initiation of systemic corticosteroids as well as application of diluted topical steroids to sooth the skin.</p>

scholarly journals Atypical cutaneous targetoid lesions after bone marrow transplant

2019 ◽  
Vol 12 (8) ◽  
pp. e230142
Author(s):  
Connie S Zhong ◽  
Edward T Richardson ◽  
Alvaro C Laga Canales ◽  
Vinod E Nambudiri
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Oral Prednisone ◽  
B Cell Lymphoma ◽  
Maculopapular Rash ◽  
Marrow Transplant ◽  
Topical Steroids ◽  
Allogeneic Bone ◽  
Graft Versus Host ◽  
Dermatology Clinic

A 69-year-old man with esophageal EBV-positive diffuse large B cell lymphoma status post allogeneic bone marrow transplant (BMT) five months prior presented to his oncologist with three days of maculopapular rash that was initially diagnosed as grade 1 graft-versus-host disease and started on oral prednisone. However, due to worsening of the rash, the patient presented to dermatology clinic, where skin biopsy revealed a diagnosis of erythema multiforme (EM). The patient improved with the use of topical steroids. This case highlights the atypical morphology of post-BMT EM and the potential causes for this atypical appearance.

scholarly journals Acute Jaundice in a Six-year-old: An Unusual Presentation of Atypical Kawasaki Disease

2020 ◽  
Vol 4 (2) ◽  
pp. 142-145 ◽  
Author(s):  
LCDR William Bylund ◽  
Gregory Zarow ◽  
LCDR Daphne Morrison Ponce
Keyword(s):  
Emergency Department ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Maculopapular Rash ◽  
Unusual Presentation ◽  
Morbidity And Mortality ◽  
Cardiac Complications ◽  
Laboratory Studies ◽  
Atypical Kawasaki Disease ◽  
Hands And Feet

Kawasaki disease (KD) is a rare vasculitis of childhood that is critical to recognize and treat due to associated morbidity and mortality. A six-year-old male presented to our emergency department (ED) afebrile but with reported recent fevers. Exam revealed jaundice and erythematous tongue with papules, and laboratory studies indicated a direct hyperbilirubinemia. Admitted for evaluation, he developed continuous fever, increasing maculopapular rash, and subsequent desquamation of hands and feet. He ultimately met criteria for incomplete KD, was treated with intravenous immunoglobulin, and avoided cardiac complications. This presentation of incomplete KD with hyperbilirubinemia is rare because the patient was afebrile at ED presentation.

scholarly journals Increasing the Use of Anti-Inflammatory Agents for Acute Asthma in the Emergency Department: Experience with an Asthma Care Map

2008 ◽  
Vol 15 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Brian H Rowe ◽  
Anthony M Chahal ◽  
Carol H Spooner ◽  
Sandra Blitz ◽  
Ambikaipakan Senthilselvan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inhaled Corticosteroids ◽  
Acute Asthma ◽  
A Priori ◽  
Patient Characteristics ◽  
Primary Diagnosis ◽  
Asthma Care ◽  
Systemic Corticosteroids ◽  
The Mean ◽  
Time Periods

PURPOSE: Acute asthma is a common emergency department (ED) presentation and variation in its management is well recognized. The present study examined the use of an asthma care map (ACM) in one Canadian ED to improve adherence to acute asthma guidelines, emphasizing the use of systemic corticosteroids (SCSs) and inhaled corticosteroids (ICSs).METHODS: Three time periods were studied: the 15 months before ACM introduction (PRE), the 15 months following a three-month introduction of the ACM (POST1) and the 18 months after POST1(POST2). Randomly selected patient charts from each period were included from patients who were 18 to 60 years of age and presented with a primary diagnosis of acute asthma. A priori criteria were established to determine the degree of completion and success of the ACM. Primary outcomes included documentation, use of SCSs in the ED, and prescription of SCSs and ICSs at ED discharge.RESULTS: A total of 387 patient charts were included (PRE, n=150; POST1, n=150; POST2, n=87). Patient characteristics in the three groups were similar; however, patients in POST1and POST2showed higher use of newer agents than those in the PRE group. Overall, more women (n=209; 54%) than men were seen; the mean age was 32.4 years. The care map was used in 67% of cases during POST1and 70% during POST2. The use of peak expiratory flow (PEF) was high during the PRE, POST1and POST2periods (91%, 89% and 91%, respectively); however, documentation of other markers of severity increased in the POST periods. Use of SCSs occurred earlier (P<0.01) and more often (57% PRE, 68% POST1and 75% POST2; P<0.01) in the POST1,2periods than the PRE period. There was a significant increase in use of SCSs on discharge (55% PRE, 66% POST1and 69% POST2; P<0.05), and prescription of ICSs significantly increased (24% PRE, 45% POST1and 61% POST2; P<0.001) in the POST1,2periods. Discharge with-out any corticosteroids decreased over the three periods (32% PRE, 21% POST1and 17% POST2; P<0.05). The length of stay in the ED increased over the study periods (181 min PRE, 209 min POST1and 265 min POST2; P<0.01) and admissions were infrequent (9% PRE, 13% POST1and 6% POST2; P=0.50).CONCLUSIONS: The present study provides evidence that the standardized ED ACM was widely accepted, improved chart documentation, improved some aspects of ED care and increased prescribing of discharge preventive medications.

scholarly journals A Randomized clinical Trial of Inhaled Ciclesonide for Acute Asthma.

2020 ◽  
Author(s):  
Demétrius Tierno Martins ◽  
Karla Carlos ◽  
Luciane BC Carvalho ◽  
Lucila Bizari Prado ◽  
Carolina Fransolin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Placebo Group ◽  
Randomized Clinical Trial ◽  
Acute Asthma ◽  
Respiratory Effort ◽  
Double Blind ◽  
Asthma Exacerbations ◽  
Systemic Corticosteroids ◽  
Acute Asthma Exacerbations

Abstract Background: Current guidelines for management of acute asthma exacerbations advocate the administration of short-acting bronchodilators and systemic corticosteroids. The use of inhaled corticosteroids for this purpose has been tested since the 1990s, but the optimal agent, dose, and strategy have yet to be defined. Within the context, we designed a double-blind, randomized clinical trial aiming to compare high doses of inhaled ciclesonide to systemic corticosteroids in the treatment of acute asthma exacerbations in the emergency department. Methods: This double-blind, randomized clinical trial enrolled 58 patients with a clinical diagnosis of bronchial moderate and severe asthma by GINA(Global Initiative for Asthma) criteria who presented to the emergency department with peak flow <50% of predicted. Patients were randomized into two groups. Over the course of 4 hours, one group received 1440 mcg inhaled ciclesonide plus hydrocortisone-identical placebo (ciclesonide + placebo group), while the other received 500 mg intravenous hydrocortisone plus ciclesonide-identical placebo (hydrocortisone + placebo group). Both groups received short-acting bronchodilators (fenoterol hydrobromide and ipratropium bromide) as recommended by GINA. The research protocol included spirometry, rigorous and frequent clinical evaluation (dyspnea, accessory muscle use, wheezing, respiratory effort), and vital signs and ECG monitoring. Data were obtained at baseline, 30, 60, 90, 120, 180, and 240 minutes. We compared data from baseline to hour 4 between and within groups. Results: Overall, 31 patients received ciclesonide + placebo and 27 received hydrocortisone + placebo. Inhaled ciclesonide was as effective as intravenous hydrocortisone in improving clinical parameters (Borg-scored dyspnea, p=0.95; sternocleidomastoid muscle use, p=0.55; wheezing, p=0.55; respiratory effort, p=0.95) and spirometric parameters (forced vital capacity, p=0.50; forced expiratory volume in the first second, p=0.83; peak expiratory flow, p=0.51).Conclusions: Inhaled ciclesonide was non-inferior to systemic hydrocortisone for management of acute asthma exacerbations, improving both clinical and spirometric parameters.Trial registration: RBR-6XWC26 - Registro Brasileiro de Ensaios Clínicos (http://www.ensaiosclinicos.gov.br/rg/RBR-6xwc26/). Date of registration: 05/01/2016 'retrospectively registered'.

scholarly journals Commencement of systemic corticosteroids in emergency Department versus in ward in management of acute adult asthma requiring hospitalization: a retrospective cohort study

2016 ◽  
Vol 15 (4) ◽  
pp. 608-614
Author(s):  
Suen Pao Yim
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Acute Asthma ◽  
Length Of Hospital Stay ◽  
Adult Asthma ◽  
Systemic Corticosteroids ◽  
Group A ◽  
The Difference ◽  
Group B

Introduction: Systemic corticosteroids are commonly used in management of acute asthma, sometimes started before admission in emergency department, sometimes in ward after admission. This study is to determine whether commencing systemic corticosteroids in emergency department compared to in ward for managing acute adult asthma requiring hospitalization can improve the outcome: shorter length of hospital stay.Methods: A retrospective cohort study was conducted in an emergency department in Hong Kong. Adults aged 18 to 65 years-old who presented to the emergency department with acute asthma and subsequently hospitalized with use of systemic corticosteroids were recruited and divided into two groups: a group with commencement of systemic corticosteroids in emergency department (Group A, n=139) and the other group with commencement of systemic corticosteroids in ward (Group B, n=209). The outcome measurement was length of hospital stay.Results: A total of 348 subjects were recruited in final analyses. We used Mann-Whitney U test to test the difference in ranking of length of hospital stay (days) between these two groups. The mean rank of length of hospital stay in Group A was 159, and that in Group B was 185 (p=0.014). The difference was statistically significant with commencement of systemic corticosteroids in emergency department resulting in higher ranking-shorter length of hospital stay.Conclusion: It may be possible to result in earlier discharge in acute adult asthma requiring hospitalization when systemic corticosteroids is started before admission in emergency department, instead of in ward after admission.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.608-614

Prevalence and characterization of dermatologic adverse events related to alpelisib (BYL719) in breast cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 1063-1063
Author(s):  
Dulce M. Barrios M.S ◽  
Diana G. Wang ◽  
Victoria Susana Blinder ◽  
Jacqueline Bromberg ◽  
Pamela Drullinsky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adverse Events ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Clinical Laboratory ◽  
Maculopapular Rash ◽  
Breast Cancer Patients ◽  
Systemic Corticosteroids ◽  
Grade 3 ◽  
Dermatologic Adverse Events

1063 Background: Rash develops in approximately 50% of breast cancer patients receiving alpelisib, often requiring dose modifications. Herein, we describe the characteristics of alpelisib-related dermatologic adverse events (dAEs). Methods: A single center retrospective analysis was conducted via review of electronic medical records. We collected clinical, laboratory and management data relevant to patients treated with alpelisib for advanced breast cancer under four different randomized clinical trials or post approval by regulatory agencies from 6/1/2013 to 7/31/2019. Type and severity of dAEs was recorded using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE v5.0). Results: A total of 102 patients (mean age 56 years, range 27-83) receiving alpelisib from 200 to 350 mg daily, most frequently in combination with endocrine therapy (79, 77.5%) were included. We identified 41 (40.2%) patients with all-grade rash [CTCAE grade 1/2 = 22 (21.6%); CTCAE grade 3 = 19, (18.6%)] distributed primarily along the trunk (18, 78%) and developing, on average, within 12.8 +/- 1.5 days of treatment initiation (n = 38). Mean duration of rash was 7.1 +/- 3.8 days; and no grade 4 dAEs were observed. Of 29 patients with documented morphology of alpelisib-related dAEs, the majority (26, 89.7%) had maculopapular rash. Thirteen (68%) of 19 patients with any-grade rash and report of any associated symptoms had pruritus (7, 36%) or burning pain (6, 32%). All-grade dAEs correlated with an increase in serum eosinophils from 2.7% to 4.4% (p < 0.05), and prophylaxis with non-sedating antihistamines (n = 43) was correlated with a reduction of grade 1/2 rash onset (OR 0.39, p = 0.09). Sixteen (84.2%) of 19 patients with grade 3 dAEs had interruption of alpelisib, followed by management with antihistamines, topical and/or systemic corticosteroids. We did not observe rash recurrence in 12 (75%) of these 16 patients who re-initiated therapy; and the majority (9, 56.3%) were re-challenged without a dose reduction. Conclusions: Pruritus and increased blood eosinophils occur with maculopapular rash within the first two weeks of initiating alpelisib and persists for approximately seven days. To reduce onset of grade 1/2 rash, non-sedating antihistamines (i.e. cetirizine) are recommended during the first eight weeks. While grade 3 rash leads to interruption of alpelisib, dermatologic improvement is evident with systemic corticosteroids; and most patients can resume therapy at a maintained or reduced dose upon re-challenge.

scholarly journals Asthma Management in the Emergency Department

2000 ◽  
Vol 7 (3) ◽  
pp. 255-260 ◽  
Author(s):  
John Reid ◽  
Darcy D Marciniuk ◽  
Donald W Cockcroft
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Asthma Management ◽  
Emergency Department Visits ◽  
Management Guidelines ◽  
Systemic Corticosteroids ◽  
Acute Exacerbations ◽  
Emergency Department Management ◽  
Patient Assessments ◽  
Tertiary Care Hospitals

OBJECTIVES:To evaluate various aspects of the management of adult patients who present to the emergency department with acute exacerbations of asthma and who are discharged from the emergency department without hospital admission. Further, to compare the results with accepted management guidelines for the emergency department treatment of asthma.DESIGN:A retrospective chart collection and review until each site contributed 50 patients to the survey.SETTING:Three tertiary care hospitals in the Saskatoon Health District, Saskatoon, Saskatchewan. The study period was from July 1, 1997 to November 18, 1997.POPULATION:Patients aged 17 years or older, who were discharged from the emergency department with the diagnosis of asthma.METHODS:Data were collected on 130 patients from 147 emergency department visits.RESULTS:A number of important physical examination findings were frequently not documented. In contrast to management guidelines, peak expiratory flow rates (44%) and spirometry (1%) were not commonly used in patient assessments. Only 59% of patients received treatment in the emergency departments with inhaled or systemic corticosteroids. Furthermore, specific follow-up plans were infrequently documented in the emergency department charts (37%).CONCLUSIONS:Adherence with published Canadian guidelines for the emergency department management of acute asthma exacerbations was suboptimal. Corticosteroid use in the emergency department was significantly less than recommended. Increased emphasis on education and implementation of accepted asthma management guidelines is necessary.

scholarly journals Early emergency department treatment of acute asthma with systemic corticosteroids

2001 ◽  
Author(s):  
Brian H Rowe ◽  
Carol Spooner ◽  
Francine Ducharme ◽  
Jennifer Bretzlaff ◽  
Gary Bota
Keyword(s):  
Emergency Department ◽  
Acute Asthma ◽  
Systemic Corticosteroids
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