scholarly journals Insect bite like rash induced by bendamustine – A common presentation with an uncommon cause

2020 ◽  
Vol 11 (e) ◽  
pp. e152.1-e152.5
Author(s):  
Shibani Bhatia ◽  
Ananth Pai ◽  
Raghavendra Rao ◽  
Srilatha Parampalli Srinivas ◽  
Varsha M Shetty
Keyword(s):  
Chemotherapeutic Agent ◽  
Cutaneous Side Effects ◽  
Common Presentation ◽  
Drug Eruptions ◽  
Johnson Syndrome ◽  
Non Hodgkins Lymphoma ◽  
Cutaneous Reactions ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms ◽  
Favorable Side Effect Profile

Bendamustine has become a popular cancer chemotherapeutic agent in the last couple of years. It has replaced some traditional chemotherapy regimens due to its favorable side effect profile. Various cutaneous side effects have been noted following bendamustine usage. These cutaneous eruptions are to known to occur in 15-24% of patients. Benign cutaneous events include lichenoid drug eruptions, flagellate dermatoses and polymorphic papules and plaques in exposed areas. Rarely, severe adverse cutaneous reactions such as Steven Johnson syndrome, drug rash with eosinophilia and systemic symptoms and toxic epidermal necrolysis have been reported. We report a case of a 48 year-old-female who developed an insect bite like rash after initiation of bendamustine for non-Hodgkins lymphoma.

scholarly journals DRESS Syndrome in a Teenage Male Associated With Hhv-6 Reactivation While on Prolonged TMP-SMX Use

2021 ◽  
Author(s):  
Dalia Conteras ◽  
Iris Pecson ◽  
Alvaro Galvis
Keyword(s):  
Drug Reaction ◽  
Healthcare Providers ◽  
Delay In Diagnosis ◽  
High Clinical Suspicion ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms ◽  
Disseminated Disease ◽  
Systemic Drug

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare and potentially life-threatening systemic drug reaction with skin involvement. We present the unusual case of DRESS in a 16-year-old male that was treated with TMP-SMX for acne and was initially misdiagnosed with Steven Johnson Syndrome. Our case serves as an example to healthcare providers treating adverse drug reactions to having a high clinical suspicion for DRESS as delay in diagnosis and treatment can result in disseminated disease and higher patient mortality risk.

Overlapping of Steven-Johnson syndrome and the drug rash with eosinophilia and systemic symptoms during the treatment of carbamazepine

2021 ◽  
Vol 41 (2) ◽  
pp. 115
Author(s):  
Palanisamy Amirthalingam ◽  
OsamaSalih Mohammed ◽  
Abdelrahman BabikerAbdelrahman Osman ◽  
AmirahSalem Alatawi ◽  
HyderOsman Mirghani ◽  
...  
Keyword(s):  
Johnson Syndrome ◽  
Drug Rash ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms

scholarly journals Association between HLA-B Alleles and Carbamazepine-Induced Maculopapular Exanthema and Severe Cutaneous Reactions in Thai Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Chonlaphat Sukasem ◽  
Chonlawat Chaichan ◽  
Thapanat Nakkrut ◽  
Patompong Satapornpong ◽  
Kanoot Jaruthamsophon ◽  
...  
Keyword(s):  
Case Control Study ◽  
Strong Association ◽  
Case Control ◽  
Stevens Johnson Syndrome ◽  
Thai Population ◽  
Johnson Syndrome ◽  
Cutaneous Reactions ◽  
Systemic Symptoms ◽  
Maculopapular Exanthema ◽  
Control Study

The HLA-B∗15:02 allele has been reported to have a strong association with carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) in Thai patients. The HLA-B alleles associated with carbamazepine-induced maculopapular exanthema (MPE) and the drug reaction with eosinophilia and systemic symptoms (DRESS) among the Thai population have never been reported. The aim of the present study was to carry out an analysis of the involvement of HLA-B alleles in carbamazepine-induced cutaneous adverse drug reactions (cADRs) in the Thai population. A case-control study was performed by genotyping the HLA-B alleles of Thai carbamazepine-induced hypersensitivity reaction patients (17 MPE, 16 SJS/TEN, and 5 DRESS) and 271 carbamazepine-tolerant controls. We also recruited 470 healthy Thai candidate subjects who had not taken carbamazepine. HLA-B∗15:02 showed a significant association with carbamazepine-induced MPE (P=0.0022, odds ratio (OR) (95% confidence interval [CI]) = 7.27 (2.04–25.97)) and carbamazepine-induced SJS/TEN (P=4.46×10−13; OR (95% CI) = 70.91(19.67–255.65)) when compared with carbamazepine-tolerant controls. Carbamazepine-induced SJS/TEN also showed an association with HLA-B∗15:21 allele (P=0.013; OR (95% CI) = 9.54 (1.61–56.57)) when compared with carbamazepine-tolerant controls. HLA-B∗58:01 allele was significantly related to carbamazepine-induced MPE (P=0.007; OR (95% CI) = 4.73 (1.53–14.66)) and DRESS (P=0.0315; OR (95% CI) = 7.55 (1.20–47.58)) when compared with carbamazepine-tolerant controls. These alleles may serve as markers to predict carbamazepine-induced cADRs in the Thai population.

scholarly journals Amoxicillin induced erythematous maculopapular rashes: a case report

2020 ◽  
Vol 9 (5) ◽  
pp. 806
Author(s):  
Dhakchinamoorthi Krishna Kumar ◽  
Ravichandran Rajganesh ◽  
Dilli Batcha Jaya Shree ◽  
Sam Nikhil Cherian ◽  
Thayub Mohamed
Keyword(s):  
Adverse Drug Reaction Reporting ◽  
Stevens Johnson Syndrome ◽  
Beta Lactam ◽  
Drug Induced ◽  
Drug Eruptions ◽  
Immune Mediated ◽  
Johnson Syndrome ◽  
Lactam Antibiotic ◽  
Cutaneous Reactions ◽  
Maculopapular Rashes

Cutaneous adverse reactions (CAR) can occur with any class of drugs, however more widely caused by various antibiotics. Amoxicillin is a broad-spectrum, bactericidal, beta-lactam antibiotic, widely used for combating various infections. Cutaneous drug eruptions are known to be reported common while using penicillin class of drugs, specifically among children. These immune-mediated bizarre drug eruptions were range from mild to severe drug-induced cutaneous reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The present case reported with maculopapular, erythematous rashes induced by amoxicillin in a nine-year-old male patient. Amoxicillin was prescribed for his hyperactive respiratory disease and subsequently after three days developed generalized maculopapular erythematous rashes as a result of an antibiotic-induced skin rash. The present case is being reported to add more data, also to emphasize and gather the information for evidence-based practice and to promote efficient pharmacovigilance adverse drug reaction reporting.

Cutaneous Adverse Drug Reactions (CADRs) between Aromatic and Non-Aromatic Antiepileptic Drugs: Clinical Presentation and Severity

2020 ◽  
Vol 103 (10) ◽  
pp. 1017-1021
Keyword(s):  
Antiepileptic Drugs ◽  
Adverse Drug Reactions ◽  
Drug Hypersensitivity ◽  
Common Adverse Effect ◽  
Drug Reactions ◽  
Johnson Syndrome ◽  
Significant Difference ◽  
Cutaneous Drug Reactions ◽  
Steven Johnson Syndrome ◽  
Systemic Symptoms

Background: Drug hypersensitivity is the most common adverse effect of drug use. Major cutaneous adverse drug reactions (CADRs) represent the higher rates of morbidity and mortality, with up to 5.2% of cases. Current reports revealed the non-aromatic antiepileptic drugs had increasing rates of CADRs from the past. Objective: To study the clinical presentations and the severity of CADRs due to aromatic and non-aromatic antiepileptic drugs. Materials and Methods: A retrospective cohort study was conducted with inpatients and outpatients with CADRs receiving antiepileptic drugs in Phramongkutklao Hospital between January 2009 and December 2018. Results: Among 77 patients with CADRs, 61 patients received aromatic antiepileptic drugs and 16 patients took non-aromatic antiepileptic drugs. Among the patients with aromatic antiepileptic drugs 52.46% developed minor cutaneous drug reactions. The rest, 47.54%, developed major cutaneous drug reactions including Steven-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN) 13.11% and drug rash with eosinophil and systemic symptoms (DRESS) 31.15%. Among the patients with non-aromatic antiepileptic drugs, 62.5% developed minor cutaneous drug reactions. The rest, 37.5%, developed major CADRs including SJS/TEN 12.5% and DRESS 25%. Of the patients receiving aromatic antiepileptic, the major CADRs group showed significant higher level of eosinophil compared with minor CADRs (10.35% and 2.1%, respectively, p<0.001). The study showed significant higher alkaline phosphatase (ALP) levels in 138.5 IU/L among patient with major CADRs who received aromatic antiepileptic drugs compared with minor CADRs in 87 IU/L (p=0.006). No significant difference of laboratory was found among CADRs patients in non-aromatic group. Conclusion: Aromatic antiepileptic drugs tended to cause more severe cutaneous drug reactions than non-aromatic antiepileptic drugs, especially DRESS. The internal organ involvements were significantly identified in the aromatic antiepileptic group regarding to serum eosinophil and ALP level. Keywords: Adverse skin reaction, Aromatic antiepileptic drugs, Non-aromatic antiepileptic drug

scholarly journals Treatments for Severe Cutaneous Adverse Reactions

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Yung-Tsu Cho ◽  
Chia-Yu Chu
Keyword(s):  
Sufficient Evidence ◽  
Stevens Johnson Syndrome ◽  
Drug Eruptions ◽  
Cutaneous Adverse Reaction ◽  
Johnson Syndrome ◽  
Fixed Drug ◽  
Choice Of Treatment ◽  
Life Threatening ◽  
Systemic Symptoms ◽  
Exanthematous Pustulosis

Severe cutaneous adverse reaction (SCAR) is life-threatening. It consists of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and generalized bullous fixed drug eruptions (GBFDE). In the past years, emerging studies have provided better understandings regarding the pathogenesis of these diseases. These diseases have unique presentations and distinct pathomechanisms. Therefore, theoretically, the options of treatments might be different among various SCARs. However, due to the rarity of these diseases, sufficient evidence is still lacking to support the best choice of treatment for patients with SCAR. Herein, we will provide a concise review with an emphasis on the characteristics and treatments of each SCAR. It may serve as a guidance based on the current best of knowledge and may shed light on the directions for further investigations.

An update on HLA alleles as pharmacogenetic markers for antiepileptic drug-induced cutaneous adverse reaction

2019 ◽  
Vol 2 (2) ◽  
pp. 1-17
Author(s):  
Sue-Mian Then ◽  
Azman Ali Raymond
Keyword(s):  
Single Gene ◽  
Hypersensitivity Syndrome ◽  
Allelic Frequency ◽  
Stevens Johnson Syndrome ◽  
Case Control Studies ◽  
Drug Induced ◽  
Hla Alleles ◽  
Exfoliative Dermatitis ◽  
Johnson Syndrome ◽  
Systemic Symptoms

Epilepsy is a common neurological disorder affecting approximately 50 million people worldwide. Antiepileptic drugs (AEDs) are commonly used to treat the disease depending, mainly on the type of seizure. However, the use of AEDs may also lead to cutaneous adverse drug reactions (cADR) such as toxic epidermal necrolysis (TEN), Stevens–Johnson syndrome (SJS), exfoliative dermatitis (ED) and drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS), which are unwanted comorbidities in epilepsy. It was first discovered that the HLA-B*15:02 allele was strongly associated with carbamazepine (CBZ)-induced SJS/TEN among Han Chinese and this led to the discovery of other HLA alleles and cytochrome P450 (CYP) genes that were significantly associated with various AED-induced cADRs across various populations.  This mini review is an update on the latest findings of the involvement of various HLA alleles and CYP alleles in cADRs caused by CBZ, phenytoin (PHT), oxcarbazepine (OXC) and lamitrogine (LTG) in different case-control studies around the world. From our review, we found that CBZ- and PHT-induced cADRs were more commonly reported than the other AEDs. Therefore, there were more robust pharmacogenetics studies related to these AEDs. OXC- and LTG-induced cADRs were less commonly reported, and so more studies are needed to validate the reported association of the newer reported HLA alleles with these AEDs. It is also important to take into account the allelic frequency within a given population before drawing conclusions about the use of these alleles as genetic markers to prevent AED-induced cADR. Overall, the current body of research point to a combination of alleles as a better pharmacogenetic marker compared to the use of a single gene as a genetic marker for AED-induced cADR.

Genetic susceptibilities and prediction modeling of carbamazepine and allopurinol-induced severe cutaneous adverse reactions in Vietnamese

2020 ◽  
Author(s):  
Dinh van Nguyen ◽  
Hieu Chi Chu ◽  
Christopher Vidal ◽  
Richard B Fulton ◽  
Nguyet Nhu Nguyen ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Surrogate Marker ◽  
Hypersensitivity Syndrome ◽  
Stevens Johnson Syndrome ◽  
Strongly Correlated ◽  
Drug Induced ◽  
Johnson Syndrome ◽  
Severe Cutaneous Adverse Reactions ◽  
Systemic Symptoms ◽  
Cutaneous Adverse Reactions

Aims: To determine genetic susceptibility markers for carbamazepine (CBZ) and allopurinol-induced severe cutaneous adverse reactions (SCARs) in Vietnamese. Methods: A case control study was performed involving 122 patients with CBZ or allopurinol induced SCARs and 120 drug tolerant controls. Results: HLA-B*58:01 was strongly associated with allopurinol-induced SCARs and strongly correlated with SNP rs9263726. HLA-B*15:02 was associated with CBZ-induced Stevens–Johnson syndrome/toxic epidermal necrolysis but not with drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms. No association was found between HLA-A*31:01 and CBZ-induced SCARs. HLA-B*58:01 and rs3909184 allele A with renal insufficiency were shown to increase the risk of allopurinol-induced SCARs. Conclusion: HLA-B*58:01 and HLA-B*15:02 confer susceptibility to allopurinol-induced SCARs and CBZ-induced SJS/TEN in Vietnamese. Single nucleotide polymorphism rs9263726 can be used as a surrogate marker in identifying HLA-B*58:01.

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