RESUMO
Therapeutic immune checkpoint blockade for metastatic melanoma has been associated with vitiligo, pruritus and morbilliform eruptions. Reports of other autoimmune skin disease in this setting are rare. We sought to expand the spectrum of cutaneous immune-mediated effects related to immune checkpoint inhibitor therapy. In this report, we describe two unusual cutaneous reactions related to checkpoint inhibitor therapy, namely bullous pemphigoid (BP) and dermatitis herpetiformis. The development of BP and dermatitis herpetiformis in the context of checkpoint inhibitor therapy is consistent with previous investigations supporting the importance of effector and regulatory T cells in the pathogenesis of these diseases.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Antineoplásicos/efeitos adversos , Dermatite Herpetiforme/induzido quimicamente , Toxidermias/patologia , Penfigoide Bolhoso/induzido quimicamente , Adulto , Doenças Autoimunes/induzido quimicamente , Doenças Autoimunes/patologia , Dermatite Herpetiforme/patologia , Toxidermias/etiologia , Feminino , Humanos , Ipilimumab , Masculino , Melanoma/tratamento farmacológico , Melanoma/secundário , Pessoa de Meia-Idade , Penfigoide Bolhoso/patologia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/secundárioRESUMO
Impetigo herpetiformis (IH) is a rare dermatosis arising during the third trimester of pregnancy which is generally considered as a form of pustular psoriasis of unknown aetiology. Clinically it is characterized by erythematous plaques surrounded by sterile pustules associated with fever, diarrhea, sweating and increasing risk of stillbirth for placental insufficiency. We describe a case of developed erythematous plaques surrounded by pustules localised initially to the trunk of a 35-year-old woman at the 34th week of gestation after 5 days of treatment with N-Butyl-Scopolammonium, and which later involved the upper and lower limbs. Skin histology confirmed the diagnosis of generalised pregnancy pustular psoriasis (impetigo herpetiformis). IH is reported to be associated with hypocalcemia, hypoparathyroidism, use of oral contraceptives and bacterial infections. This is the first report suggesting the potential role of drugs other than oral contraceptives in the pathogenetic mechanism of this disease. In this case an adverse cutaneous reaction to BB could be the cause of the development of Koebner isomorphism.
Assuntos
Brometo de Butilescopolamônio/efeitos adversos , Dermatite Herpetiforme/induzido quimicamente , Dermatite Herpetiforme/complicações , Impetigo/induzido quimicamente , Impetigo/complicações , Adulto , Dermatite Herpetiforme/patologia , Feminino , Humanos , Impetigo/patologia , Masculino , GravidezAssuntos
Anticorpos Monoclonais/efeitos adversos , Dermatite Herpetiforme/induzido quimicamente , Espondilite Anquilosante/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Anticorpos Monoclonais/uso terapêutico , Dermatite Herpetiforme/patologia , Humanos , Infliximab , MasculinoRESUMO
Dermatitis herpetiformis (DH) is a chronic, pruritic, papulovesicular dermatosis on extensor surfaces that is characterized by a neutrophilic infiltrate and granular immunoglobulin A deposition at the dermal papillae. Although the presence of immunoglobulin A in the skin and the severity of DH are known to be associated with gluten intake, few drugs have been implicated in the induction of DH. We report a case of DH triggered by intramuscular injections of leuprolide acetate, a gonadotropin-releasing hormone analog, in a patient with a history of prostate cancer.
Assuntos
Antineoplásicos Hormonais/efeitos adversos , Dermatite Herpetiforme/induzido quimicamente , Leuprolida/efeitos adversos , Idoso , Antineoplásicos Hormonais/administração & dosagem , Humanos , Leuprolida/administração & dosagem , Masculino , Neoplasias da Próstata/tratamento farmacológicoAssuntos
Hipersensibilidade a Drogas/etiologia , Quinolonas/efeitos adversos , Biópsia , Ciprofloxacina/efeitos adversos , Dermatite Herpetiforme/induzido quimicamente , Dermatite Herpetiforme/diagnóstico , Diagnóstico Diferencial , Toxidermias/classificação , Toxidermias/diagnóstico , Eritema Multiforme/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Penfigoide Bolhoso/induzido quimicamente , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/patologia , Pele/patologiaRESUMO
A 57-year-old patient with rheumatoid arthritis, who was being treated with D-penicillamine, developed a bullous eruption 2 months after the onset of treatment. On the basis of the clinical, histological and immunofluorescent findings, the diagnosis of herpetiform pemphigus was made. The eruptions disappeared within 2 weeks after the discontinuation of D-penicillamine treatment. During the 16-month follow-up period there was no recurrence. It is noteworthy that a patch test with potassium iodide was positive and that testing for HLA antigens revealed HLA B8, A1, A2, and BW39.
Assuntos
Dermatite Herpetiforme/induzido quimicamente , Toxidermias/etiologia , Pênfigo/induzido quimicamente , Penicilamina/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Dermatite Herpetiforme/patologia , Antígenos HLA-B/análise , Antígeno HLA-B8 , Humanos , Masculino , Pessoa de Meia-Idade , Pênfigo/patologia , Penicilamina/uso terapêutico , Pele/patologiaRESUMO
We report a 39-year-old patient with Hailey-Hailey disease localized mainly in the genito-femoral and scrotal areas. During hospital treatment the condition worsened due to superinfection with Candida albicans and gram-negative bacteria. Treatment with systemic steroids followed by aromatic retinoids was tried: eczema herpeticum developed in the affected areas, and dissemination of Hailey-Hailey disease ultimately occurred with papulo-vesicular and histologically characteristic lesions.