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7.
Actas dermo-sifiliogr. (Ed. impr.) ; 113(8): 765-772, sept. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-208301

RESUMO

Antecedentes La eritrodermia es un cuadro caracterizado por un eritema y descamación que compromete al menos el 90% de la superficie corporal. Su etiología puede ser variable. La mayor parte de sus características clínicas y alteraciones del laboratorio son inespecíficas, lo que hace que el diagnóstico sea un desafío. Materiales y métodos Se realizó un estudio retrospectivo en el periodo comprendido entre el 1 de enero de 2010 y el 1 de junio de 2020. Se revisaron los antecedentes, las características clínicas, los hallazgos de laboratorio e histopatológicos, así como la evolución de todos los pacientes con una eritrodermia hospitalizados en el Hospital Italiano de Buenos Aires, con un seguimiento mínimo de 6 meses. Resultados Se incluyeron 70 pacientes. La edad media de aparición fue de 63 años con una relación hombre:mujer de 1,2:1. La principal causa de eritrodermia fueron las reacciones adversas a fármacos (48%), siendo la vancomicina el principal medicamento involucrado (30%), mientras que la segunda causa fueron las dermatosis preexistentes, dentro de las cuales la psoriasis fue la más común (42%). En el 40% de los pacientes se observó una adecuada correlación clínico-patológica con la primera biopsia, mientras que el rédito diagnóstico aumentó a un 76% con la segunda. El número máximo de biopsias requerido para efectuar el diagnóstico etiológico fue de 8 (2 pacientes). La evolución fue favorable en el 92% de los casos. Conclusión Las reacciones adversas a fármacos fueron la primera causa de eritrodermia y la vancomicina el fármaco responsable más frecuente. No se encontraron asociaciones estadísticamente significativas entre las variables estudiadas, ni se identificaron predictores de una determinada etiología, marcadores de mala evolución o factores de riesgo asociados a mortalidad (AU)


Background Erythroderma, characterized by erythema and scaling that affects at least 90% of the body, has diverse causes. Most of the clinical manifestations and laboratory findings are nonspecific, making diagnosis challenging. Material and methods Retrospective study of patients treated between January 1, 2010, and June 1, 2020. We reviewed the records to identify all patients with erythroderma who were hospitalized in Hospital Italiano de Buenos Aires and followed for at least 6 months. We extracted information on clinical histories, the characteristics of the episodes, laboratory and histopathologic findings, and clinical course. Results Seventy patients were studied. The mean age at onset was 63 years, and the ratio of men to women was 1.2:1. Adverse drug reactions caused the largest proportion of the rashes (48%), and vancomycin was the most common culprit (involved in 30% of the cases). The next most frequent cause was a preexisting skin disease, psoriasis being the most common (in 42%). The clinicopathologic correlation was adequate for diagnosis after the first biopsy in 40% of patients, but the diagnostic yield increased to 76% with the second biopsy. The largest number of biopsies required was 8, in 2 patients. The outcome was favorable in 92% of the cases. Conclusion Adverse reactions to medications accounted for the largest proportion of erythroderma cases in this series, and vancomycin was the main culprit. We found no statistically significant associations among the variables studied. Nor did we identify potential predictors of causes, poor outcomes, or mortality (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dermatite Esfoliativa/etiologia , Erupção por Droga , Estudos Retrospectivos , Hospitais Universitários , Fatores de Risco , Argentina
8.
Actas dermo-sifiliogr. (Ed. impr.) ; 113(8): t765-t772, sept. 2022. tab
Artigo em Inglês | IBECS | ID: ibc-208302

RESUMO

Background Erythroderma, characterized by erythema and scaling that affects at least 90% of the body, has diverse causes. Most of the clinical manifestations and laboratory findings are nonspecific, making diagnosis challenging. Material and methods Retrospective study of patients treated between January 1, 2010, and June 1, 2020. We reviewed the records to identify all patients with erythroderma who were hospitalized in Hospital Italiano de Buenos Aires and followed for at least 6 months. We extracted information on clinical histories, the characteristics of the episodes, laboratory and histopathologic findings, and clinical course. Results Seventy patients were studied. The mean age at onset was 63 years, and the ratio of men to women was 1.2:1. Adverse drug reactions caused the largest proportion of the rashes (48%), and vancomycin was the most common culprit (involved in 30% of the cases). The next most frequent cause was a preexisting skin disease, psoriasis being the most common (in 42%). The clinicopathologic correlation was adequate for diagnosis after the first biopsy in 40% of patients, but the diagnostic yield increased to 76% with the second biopsy. The largest number of biopsies required was 8, in 2 patients. The outcome was favorable in 92% of the cases. Conclusion Adverse reactions to medications accounted for the largest proportion of erythroderma cases in this series, and vancomycin was the main culprit. We found no statistically significant associations among the variables studied. Nor did we identify potential predictors of causes, poor outcomes, or mortality (AU)


Antecedentes La eritrodermia es un cuadro caracterizado por un eritema y descamación que compromete al menos el 90% de la superficie corporal. Su etiología puede ser variable. La mayor parte de sus características clínicas y alteraciones del laboratorio son inespecíficas, lo que hace que el diagnóstico sea un desafío. Materiales y métodos Se realizó un estudio retrospectivo en el periodo comprendido entre el 1 de enero de 2010 y el 1 de junio de 2020. Se revisaron los antecedentes, las características clínicas, los hallazgos de laboratorio e histopatológicos, así como la evolución de todos los pacientes con una eritrodermia hospitalizados en el Hospital Italiano de Buenos Aires, con un seguimiento mínimo de 6 meses. Resultados Se incluyeron 70 pacientes. La edad media de aparición fue de 63 años con una relación hombre:mujer de 1,2:1. La principal causa de eritrodermia fueron las reacciones adversas a fármacos (48%), siendo la vancomicina el principal medicamento involucrado (30%), mientras que la segunda causa fueron las dermatosis preexistentes, dentro de las cuales la psoriasis fue la más común (42%). En el 40% de los pacientes se observó una adecuada correlación clínico-patológica con la primera biopsia, mientras que el rédito diagnóstico aumentó a un 76% con la segunda. El número máximo de biopsias requerido para efectuar el diagnóstico etiológico fue de 8 (2 pacientes). La evolución fue favorable en el 92% de los casos. Conclusión Las reacciones adversas a fármacos fueron la primera causa de eritrodermia y la vancomicina el fármaco responsable más frecuente. No se encontraron asociaciones estadísticamente significativas entre las variables estudiadas, ni se identificaron predictores de una determinada etiología, marcadores de mala evolución o factores de riesgo asociados a mortalidad (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dermatite Esfoliativa/etiologia , Erupção por Droga , Estudos Retrospectivos , Hospitais Universitários , Fatores de Risco , Argentina
10.
Clin. transl. oncol. (Print) ; 23(7): 1474-1480, jul. 2021. ilus
Artigo em Inglês | IBECS | ID: ibc-221987

RESUMO

Background Immune checkpoint inhibitors (ICI) have been associated with several immune-related adverse events, including sarcoidosis-like reactions (SLR). SLR, which has a low prevalence but an increasing incidence, is similar to sarcoidosis in terms of histology, and clinical and radiological manifestations. The most commonly affected organs are hilar and mediastinal lymph nodes and skin. SLR is an exclusion diagnosis, so a lymph node biopsy can be useful to distinguish between tumor progression and SLR, particularly in tumors in which nodal involvement is very common. Patients and methods We performed a retrospective analysis of SLR in all cancer patients receiving ICIs in our institution between January 2016 and June 2020. Results Among the 1063 treated patients, seven experienced SLR, four of whom were symptomatic (cough, skin lesions, arthralgia), with time to onset ranging from 1.5 to 6.7 months after ICI initiation. All seven patients had bilateral hilar lymphadenopathy, and granulomatous reactions in five of the six patients with lymph node biopsies. SLR improved in all patients, including four patients who continued with ICI. Three patients received corticosteroids and/or stopped ICI therapy. Four of these patients had partial responses at the time SLR was identified. Conclusion Management of SLR lacks a consensus recommendation, although corticosteroids and/or stopping the ICI are generally implemented. The potential consequences of stopping anticancer treatment should be taken into consideration, particularly in the absence of clear management recommendations (AU)


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Erupção por Droga/etiologia , Linfadenopatia/induzido quimicamente , Neoplasias/tratamento farmacológico , Sarcoidose/induzido quimicamente , Antineoplásicos/efeitos adversos , Estudos Retrospectivos , Espanha
13.
J. investig. allergol. clin. immunol ; 31(4): 322-331, 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-215224

RESUMO

Background: Severe cutaneous adverse reactions to drugs (SCARs) are associated with high morbidity and mortality and with sequelae. Objective: To characterize patients with SCARs in 8 health care institutions in Latin America. Methods: We performed a cross-sectional, descriptive, multicenter study of patients diagnosed with SCARs in Latin America between January 2009 and December 2018. The analysis was carried out using a database in BD Clinic. Results: We collected 70 patients, of whom 42 (60%) were women. Mean age was 38.7 years. Forty-two patients (60%) had DRESS-DIHS, 12 (17.1%) TEN, 5 (7.1%) SJS, 6 (8.5%) AGEP, 4 (5.7%) other reactions not classified as SCARs, and 1 (1.4%) overlapping SJS-TEN. The main causative drugs were aromatic anticonvulsants in 31 cases (44.3%), ß-lactam antibiotics in 11 cases (15.7%), and non–ß-lactam antibiotics in 6 cases (8.6%). In all of the cases, the suspected drug was withdrawn at the first sign of a SCAR. Sixty-six patients (94.2%) received anti-inflammatory treatment, mostly systemic corticosteroids. Complications occurred in 53 cases (75.7%), and 3 patients died (4.3%). Thirteen patients (18.6%) had sequelae. Conclusions: This is the first multicenter report on SCARs in Latin America. DRESS-DIHS was the most frequently reported clinical entity, and anticonvulsants were the main triggers. Most of the patients received systemic corticosteroids. Complications were frequent, and 3 patients died (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Erupção por Droga/epidemiologia , Índice de Gravidade de Doença , Estudos Transversais , América Latina/epidemiologia , Análise de Sobrevida
17.
Allergol. immunopatol ; 48(6): 798-800, nov.-dic. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-199272

RESUMO

With the help of a routine clinical case about delayed urticaria induced by drug, we have analyzed the scientific societies reports published during the last 5 years on this topic. We highlighted the differences between the EAACI consensus and documents on drug allergy, commenting their positions and some of their definitions on delayed urticaria. However, the question of disagreement between definitions of delayed urticaria can generate confusion. It would be beneficial to have more and "official" clearness about this topic because of its important clinical application to our patients


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Assuntos
Humanos , Feminino , Criança , Urticária/induzido quimicamente , Erupção por Droga/etiologia , Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Hipersensibilidade Tardia/induzido quimicamente , Fatores de Tempo , Testes Cutâneos
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