PDF(Pubmed)
Abstract：
UNASSIGNED: RegiSCAR validation criteria for drug reaction with eosinophilia and systemic symptoms (DRESS) includes lymphadenopathy, a frequent feature of both tuberculosis (TB) and human immunodeficiency virus (HIV). TB is the most common HIV-associated coinfection. Advanced HIV is associated with lymph node (LN) fibrosis. It is not clear if this negatively affects case validation in HIV-associated DRESS. To answer this question, we designed a prospective descriptive study to assess lymphadenopathy in various combinations of comorbid HIV, TB, and DRESS.
UNASSIGNED: We sought to describe the prevalence of DRESS-associated lymphadenopathy and characterize LN quality, size, and distribution in a high HIV-TB burden setting over time.
UNASSIGNED: We prospectively and systematically examined LN in 25 consecutive acute DRESS cases hospitalized at a South African tertiary-care center and 10 hospitalized non-DRESS HIV-TB coinfected controls.
UNASSIGNED: Fourteen (56%) of 25 patients were HIV infected, with a median (interquartile range) CD4 count of 254 (66-478) cells/mm³, and 7 of 14 were coinfected with TB. Using RegiSCAR criteria, 12 (46%) of 25 were definite DRESS cases, 8 (31%) of 25 probable, and 5 (23%) of 25 possible. Possible cases were excluded in the analysis. Fifteen (75%) of 20 subjects had LN in ≥2 anatomic sites, including all 7 patients with HIV-TB coinfection. In contrast, 1 (20%) of 5 hospitalized non-DRESS HIV-TB coinfected controls had LN. Cervical LN, in 15 (88%) of 17, was most common, followed by axillary (76%) and inguinal (59%). Cervical LN ranged between 1 and 2 cm in size. Among the 8 (32%) of 25 subjects with follow-up data, LN had regressed in all within 6 weeks of stopping the offending drug and initiating TB treatment. There was no correlation with CD4 cell count and LN.
UNASSIGNED: Lymphadenopathy is a common feature of acute DRESS, even among HIV-TB-coinfected patients with advanced immunosuppression.
UNASSIGNED: We sought to describe the prevalence of DRESS-associated lymphadenopathy and characterize LN quality, size, and distribution in a high HIV-TB burden setting over time.
UNASSIGNED: We prospectively and systematically examined LN in 25 consecutive acute DRESS cases hospitalized at a South African tertiary-care center and 10 hospitalized non-DRESS HIV-TB coinfected controls.
UNASSIGNED: Fourteen (56%) of 25 patients were HIV infected, with a median (interquartile range) CD4 count of 254 (66-478) cells/mm³, and 7 of 14 were coinfected with TB. Using RegiSCAR criteria, 12 (46%) of 25 were definite DRESS cases, 8 (31%) of 25 probable, and 5 (23%) of 25 possible. Possible cases were excluded in the analysis. Fifteen (75%) of 20 subjects had LN in ≥2 anatomic sites, including all 7 patients with HIV-TB coinfection. In contrast, 1 (20%) of 5 hospitalized non-DRESS HIV-TB coinfected controls had LN. Cervical LN, in 15 (88%) of 17, was most common, followed by axillary (76%) and inguinal (59%). Cervical LN ranged between 1 and 2 cm in size. Among the 8 (32%) of 25 subjects with follow-up data, LN had regressed in all within 6 weeks of stopping the offending drug and initiating TB treatment. There was no correlation with CD4 cell count and LN.
UNASSIGNED: Lymphadenopathy is a common feature of acute DRESS, even among HIV-TB-coinfected patients with advanced immunosuppression.
摘要：
■与嗜酸性粒细胞增多和全身症状（DRESS）的药物反应的RegiSCAR验证标准包括淋巴结病，结核病（TB）和人类免疫缺陷病毒（HIV）的常见特征。结核病是最常见的HIV相关合并感染。晚期HIV与淋巴结（LN）纤维化有关。目前尚不清楚这是否会对HIV相关DRESS的病例验证产生负面影响。为了回答这个问题,我们设计了一项前瞻性描述性研究来评估HIV合并症的各种组合中的淋巴结病，TB,和连衣裙。
■我们试图描述DRESS相关淋巴结病的患病率并表征LN质量，尺寸,以及随着时间的推移在高HIV-TB负担环境中的分布。
我们前瞻性和系统性地检查了在南非三级护理中心住院的25例连续急性DRESS病例和10例住院的非DRESSHIV-TB合并感染对照的LN。
■25名患者中有14名（56%）感染了艾滋病毒，中位数（四分位数范围）CD4计数为254（66-478）个细胞/毫米，14人中有7人同时感染了结核病。使用RegiSCAR标准，25例中有12例(46%)是明确的DRESS病例，25个可能性中的8个（31%），和5（23％）的25可能。分析中排除了可能的病例。20名受试者中有15名(75%)在≥2个解剖部位有LN，包括所有7例HIV-TB合并感染患者。相比之下,5例住院非DRESSHIV-TB共感染对照中有1例（20％）患有LN。子宫颈LN,在17人中的15人中（88%）最常见，其次是腋窝（76％）和腹股沟（59％）。宫颈LN大小在1至2cm之间。在有随访数据的25名受试者中的8名(32%)中，LN在停止违规药物并开始结核病治疗后的6周内全部消退。与CD4细胞计数和LN无相关性。
■淋巴结肿大是急性DRESS的共同特征，甚至在HIV-TB合并感染的晚期免疫抑制患者中。
■我们试图描述DRESS相关淋巴结病的患病率并表征LN质量，尺寸,以及随着时间的推移在高HIV-TB负担环境中的分布。
我们前瞻性和系统性地检查了在南非三级护理中心住院的25例连续急性DRESS病例和10例住院的非DRESSHIV-TB合并感染对照的LN。
■25名患者中有14名（56%）感染了艾滋病毒，中位数（四分位数范围）CD4计数为254（66-478）个细胞/毫米，14人中有7人同时感染了结核病。使用RegiSCAR标准，25例中有12例(46%)是明确的DRESS病例，25个可能性中的8个（31%），和5（23％）的25可能。分析中排除了可能的病例。20名受试者中有15名(75%)在≥2个解剖部位有LN，包括所有7例HIV-TB合并感染患者。相比之下,5例住院非DRESSHIV-TB共感染对照中有1例（20％）患有LN。子宫颈LN,在17人中的15人中（88%）最常见，其次是腋窝（76％）和腹股沟（59％）。宫颈LN大小在1至2cm之间。在有随访数据的25名受试者中的8名(32%)中，LN在停止违规药物并开始结核病治疗后的6周内全部消退。与CD4细胞计数和LN无相关性。
■淋巴结肿大是急性DRESS的共同特征，甚至在HIV-TB合并感染的晚期免疫抑制患者中。
