RESUMO
Antibiotics are known to cause severe cutaneous adverse reactions, such as the rare acute generalized exanthematous pustulosis (AGEP). Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides with a mild elevation of the hepatic enzymes and a decrease in renal function. Hence, AGEP is known to have a good prognosis and to be life-threatening only in elderly patients or patients with chronic diseases. Herein, we report a case of AGEP in a young healthy male leading to systemic inflammatory response syndrome and to treatment in an intensive care unit after being treated with 5 different antibiotics. Initial symptoms were not indicative for AGEP and the patient's course of disease led promptly to critical cardiorespiratory symptoms and systemic inflammatory response syndrome. We assume that the administration of the 5 different antibiotics resulted in type IV allergy as well as secondary infection with Enterococcus faecium and Staphylococcus aureus, while the underlying periodontitis also contributed to the severity of this case.
Assuntos
Pustulose Exantematosa Aguda Generalizada/diagnóstico , Pustulose Exantematosa Aguda Generalizada/patologia , Antibacterianos/efeitos adversos , Antibacterianos/imunologia , Síndrome de Resposta Inflamatória Sistêmica/patologia , Adulto , Amoxicilina/efeitos adversos , Amoxicilina/imunologia , Amoxicilina/uso terapêutico , Ampicilina/efeitos adversos , Ampicilina/imunologia , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Ciprofloxacina/efeitos adversos , Ciprofloxacina/imunologia , Ciprofloxacina/uso terapêutico , Enterococcus faecium/isolamento & purificação , Humanos , Masculino , Penicilina G/efeitos adversos , Penicilina G/imunologia , Penicilina G/uso terapêutico , Periodontite/tratamento farmacológico , Periodontite/microbiologia , Infecções Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Sulbactam/efeitos adversos , Sulbactam/imunologia , Sulbactam/uso terapêuticoRESUMO
Rituximab is a monoclonal antibody directed against the CD20 antigen of B cells, which has been developed for the treatment of lymphomas and has been successfully used in the treatment of recalcitrant pemphigus vulgaris. Here, we report on a 26-year-old patient with an 18 month history of pemphigus vulgaris of the oral mucosa where treatment with rituximab led to a delayed but sustained therapeutic response. This case is of interest since most of the previous reports have described a more rapid clinical improvement of refractory pemphigus by rituximab treatment. The delayed clinical response to rituximab of the present case may be explained by the persistence of long-lived plasma cells that continued to produce pathogenic autoantibodies against desmoglein 3.