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The majority of viral rashes occurring during an antibiotic therapy are considered as a drug hypersensitivity reaction (DHR). Differentiating a viral rash versus a DHR is difficult or even impossible. In delayed DHRs the interplay between viruses and drugs is summarized according to the recent literature. The question is if the same reaction will again occur in case of drug re-exposure in absence of the concomitant viral infection because of persistent immune reactivity. Epstein Barr Virus (EBV) and Human Herpes virus 6 (HHV-6) models are analyzed in case of maculopapular exanthemas (MPEs) and drug reaction with eosinophilia and systemic symptoms (DRESS) over a course of drug therapy. MPEs are the most common skin manifestation during a viral infection and a concomitant drug therapy. In type IVb reactions to drugs a hapten/pro-hapten mechanism and a pharmacological interaction (p-i mechanism) are described as the 2 major ways to make T cells response functional. Rarely the altered repertoire model is involved. The Human Leukocyte Antigen (HLA) predisposition is an additional essential factor that can facilitate DHR. In MPEs rarely a DHR is confirmed by allergy testing. Severity and duration of MPEs, the presence of eosinophilia and systemic symptoms make more reliable the persistent nature of the reaction. Research on this topic is needed in order to provide the clinicians with instruments to decide when to suspect future reactions upon drug re-exposure even in the absence of a viral infection, because those patients should be investigated by a complete drug allergy work up.

Bortezomib is a novel proteasome inhibitor widely used in the treatment of multiple myeloma, especially in the case of recurrent, relapsing, or refractory myeloma. Its common side effects include nausea, vomiting, neuropathic pain, and hemorrhage. Cutaneous manifestations are considered rare. Here we report a case of a 72-year-old female patient, and a known case of multiple myeloma on VRD protocol (bortezomib [Velcade] combined with lenalidominde [Revlimid] and dexamethasone) after relapse. The patient presented with a complaint of raised, itchy, erythematous skin rash, starting in the soles and palms and then spreading to the whole body. A skin biopsy confirmed that the lesions were due to an allergic reaction. The patient was admitted as a case of sepsis and died. Skin rash is considered a rare side effect of bortezomib, with variable presentation and onset. The mainstay of treatment is corticosteroids.

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Dermatologic toxicities, such as urticaria and mucositis, with docetaxel, have been commonly reported; however, fixed-plaque erythrodysesthesia is a rare adverse phenomenon with a reported incidence of less than 5% of patients. Docetaxel-induced psoriasis is extremely rare, and to date, very few cases have been reported in the literature. We present a literature review of psoriasis cases secondary to docetaxel and report our own case of severe docetaxel-induced psoriasis in the setting of treatment of metastatic prostate cancer. Our patient received topical steroids and narrow-band ultraviolet B (NBUVB) light therapy with resolution of their psoriasis and was able to complete their chemotherapy without discontinuation or interruption of their docetaxel.

Acute generalized exanthematous pustulosis (AGEP) is primarily a drug-induced skin eruption, which typically presents within two days of starting an offending medication; it is often self-limiting with spontaneous resolution within two weeks upon medication cessation. We report the case of a patient who presented with generalized desquamation, characteristic pustules, and several morbilliform rashes on the body surface in association with recent amoxicillin-clavulanic acid exposure. This was associated with significant pruritus, which was the associated chief complaint. A multimodal approach to symptomatic management with topical corticosteroids, barrier ointments, oral antihistamines, and analgesics was required, in addition to the cessation of the offending medication.

UNASSIGNED: Skin eruptions are prevalent among patients with inflammatory bowel diseases (IBD), often associated with therapies and frequently leading to dermatological consults and treatment interruptions. We aimed to assess the impact of joint shared decision-making in a multidisciplinary (MDT) IBD-DERMA clinic.
UNASSIGNED: This retrospective cohort study assessed a consecutive group of patients with IBD who were referred for consultation in an MDT clinic at a tertiary referral center in Israel.
UNASSIGNED: Over 1 year, 118 patients were evaluated in the MDT-IBD-DERMA clinic: 68 (57.6%) males; age - 35.2 ± 13.5 years, disease duration - 7.1 (interquartile range: 3.7-13.9) years; Crohn\'s disease - 94/118 (79.6%). Skin eruption induced by an anti-tumor necrosis factor (TNF) were the most common diagnoses [46/118 (39%)], including psoriasiform dermatitis (PD) - 31/46 (67.4%) and inflammatory alopecia (IA) - 15/46 (32.6%). Of these, 18 patients (39.1%) continued the anti-TNF agent concomitantly with a topical or systemic anti-inflammatory agent to control the eruption. The remaining 28 patients (60.9%) discontinued the anti-TNF, of whom 16/28 (57.1%) switched to ustekinumab. These strategies effectively treated the majority [38/46 (82.6%)] of patients. Continuation of the anti-TNF was possible in a significantly higher proportion of patients with PD: 12/31 (38.7%) than only one in the IA group, p = 0.035. There was a higher switch to ustekinumab among the IA 7/15 (46.6%) compared with the PD 7/31 (22.6%) group, P = .09. Following IBD-DERMA advised intervention, IBD deteriorated in 9/4 6(19.5%) patients, 5/9 on ustekinumab (PD versus IA, P = NS).
UNASSIGNED: Shared decision-making in an integrated IBD-DERMA clinic allowed successful control of skin eruptions while preserving control of the underlying IBD in more than 80% of cases. Patients with IA profited from a switch to ustekinumab.

BACKGROUND: Acute hemorrhagic edema is a skin-limited small-vessel leukocytoclastic vasculitis, which affects infants 4 weeks to 2 years of age and remits within 3 weeks. The diagnosis is made clinically in not-ill appearing children with acute onset of raised annular or nummular eruptions and edema. In this vasculitis, type, distribution, and evolution of the rash have never been systemically investigated. To address this issue, we employed the data contained in the Acute Hemorrhagic Edema Bibliographic Database, which incorporates all reports on acute hemorrhagic edema.
CONCLUSIONS: Key features of rash were documented in 383 children. Annular eruptions in a strict sense, usually targetoid, were reported in 375 (98%) cases (many children also presented polycyclic or arciform eruptions). Nummular eruptions were also very common (n = 358; 93%). Purpuric eruptions and ecchymoses were reported in the vast majority of cases. Macules and wheals were described in a minority of cases. Edema, detected in all cases, was mostly painful, indurated and nonpitting. The following regions were affected, in decreasing order, by annular or nummular eruptions: legs, feet, face, arms, ears, trunk, and genitals. With the exception of feet, which were very often affected, the same distribution was reported for edema. The initial eruption was often a wheal or a macule that evolved into a nummular or an annular eruption. Nummular eruptions successively evolved into annular ones.
CONCLUSIONS: This study carefully characterizes type, distribution, and evolution of skin eruption in acute hemorrhagic edema. The data help physicians to rapidly and noninvasively make the clinical diagnosis of this vasculitis.

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Listeria monocytogenes is a foodborne pathogen which causes life-threatening septicemia and meningoencephalitis. Defective cell-mediated immunity is a well-known risk factor of human listeriosis. We herein present a case of 64-year-old Japanese woman with relapsed and refractory follicular lymphoma (FL). Salvage chemoimmunotherapy with cyclophosphamide, vincristine, prednisolone, and obinutuzumab was followed by obinutuzumab maintenance therapy, when a follow-up computed tomography scan revealed recurrent lymphadenopathy. One month later, the patient presented with fever and headache. L. monocytogenes was recovered from an anaerobic blood culture. Cerebrospinal fluid analysis confirmed the presence of meningoencephalitis. The invasive listeriosis was successfully treated with meropenem for three weeks. There were several predisposing factors of invasive listeriosis in our case. Cell-mediated immunity was severely impaired by prior cytotoxic chemotherapy and low-dose prednisolone. Use of a proton pump inhibitor facilitated entry of the microorganism into the host. Under these circumstances, patients with relapsed and refractory FL are susceptible to invasive listeriosis even if they avoid high-level contaminated food products. Of note, physical examination at initial presentation detected periorbital vesiculopustular eruptions with surrounding erythema. Cutaneous listeriosis is a rare but recurrent manifestation which might be occasionally overlooked. Skin eruptions should be carefully examined for early diagnosis.