ABSTRACT
Durante la pandemia por COVID-19 se observaron diversas reacciones adversas a fármacos. Esto pudo haber estado relacionado con una mayor susceptibilidad inmunológica de los pacientes con SARS-CoV-2 a presentar este tipo de cuadros, así como también con la exposición a múltiples medicamentos utilizados en su tratamiento. Comunicamos el caso de un paciente con una infección respiratoria grave por COVID-19, que presentó 2 reacciones adversas graves a fármacos en un período corto de tiempo. (AU)
During the COVID-19 pandemic, various adverse drug reactions were observed. This could have been related to a greater immunological susceptibility of patients with SARS-CoV-2 to present this type of symptoms, as well as exposure to multiple drugs used in their treatment. We report the case of a patient with a severe respiratory infection due to COVID-19, who presented 2 serious adverse drug reactions associated with paracetamol in a short period of time. (AU)
Subject(s)
Humans , Male , Adult , Stevens-Johnson Syndrome/diagnosis , Drug-Related Side Effects and Adverse Reactions/diagnosis , Exanthema/diagnosis , Acute Generalized Exanthematous Pustulosis/diagnosis , COVID-19/complications , COVID-19 Drug Treatment/adverse effects , Patient Care Team , gamma-Globulins/administration & dosage , Methylprednisolone/administration & dosage , Incidence , Risk Factors , Stevens-Johnson Syndrome/drug therapy , Treatment Outcome , Cyclosporine/adverse effects , Drug-Related Side Effects and Adverse Reactions/drug therapy , Exanthema/drug therapy , Acute Generalized Exanthematous Pustulosis/drug therapy , Acetaminophen/adverse effectsABSTRACT
The mutation rate of anaplastic lymphoma kinase (ALK) in patients with non-small cell lung cancer is 3% to 7%. Due to its low mutation rate and better long-term survival compared with epidermal growth factor receptor-positive non-small cell lung cancer patients, therefore, it's called "diamond mutation". At present, there are three generations of ALK tyrosine kinase inhibitor (TKI) drugs in the world. The first-generation ALK-TKI drug approved in China is crizotinib, and the second-generation drugs are alectinib, ceritinib and ensartinib. Among them, ensartinib is an ALK-TKI domestically developed, and its efficacy is similar to that of alectinib. The main adverse event is transient rash, and compliance to ensartinib is better from the perspective of long-term survival of patients. The manifestation of rash caused by ensartinib is different from that of other ALK-TKI drugs. In order to facilitate clinical application and provide patients with more treatment options, under the guidance of the Committee of Cancer Rehabilitation and Palliative Care of China Anti-Cancer Association, this article collects and summarizes the common adverse reactions of ensartinib. Based on the clinical practice, a clear adverse classification and specific treatment plan are formulated, in order to provide a corresponding reference for clinicians to make more comprehensive clinical decisions.
Subject(s)
Humans , Anaplastic Lymphoma Kinase , Carbazoles/adverse effects , Carcinoma, Non-Small-Cell Lung/pathology , Consensus , Exanthema/drug therapy , Lung Neoplasms/pathology , Piperazines , Protein Kinase Inhibitors/adverse effects , PyridazinesABSTRACT
BACKGROUND@#Epidermal growth factor receptor (EGFR) and cellular-mesenchymal to epithelial transition factor (c-Met) are widely expressed on cancer cells. There is a synergistic effect of EGFR and HGF/c-Met pathways on proliferation, downstream activation of signal transduction and an additive effect. Studies show that combination of both signaling pathways could potentially be targeted in a synergistic fashion. Amivantamab, a bispecific monoclonal antibody targeting EGFR and c-Met, yielded robust and durable responses in a variety of clinicals trials. However, few researches have reported its efficacy in Chinese non-small cell lung cancer (NSCLC) patients. This study was conducted to evaluate the effectiveness and tolerance of Amivantamab in NSCLC patients with EGFR/MET gene abnormalities at Peking University Cancer Hospital.@*METHODS@#The study enrolled NSCLC patients who received Amivantamab in our hospital between August 2020 and December 2021, and analyzed the response, survival, and treatment-related adverse events.@*RESULTS@#Fifteen patients were enrolled in this research, and six of them received Amivantamab treatment and the other nine patients received Amivantamab plus Lazertinib treatment. The rates of partial response (PR), stable disease (SD), and progressive disease (PD) were 46.7% (7/15), 46.7% (7/15) and 6.7% (1/15), respectively. The overall response rate (ORR) and disease control rate (DCR) were 28.6% (2/7) and 100.0% (7/7) in seven patients with EGFR exon 20 insertion, respectively. The ORR and DCR were 40.0% (2/5) and 100.0% (5/5) in five post-osimertinib EGFR-mutant patients, respectively. After a median follow-up of 8.7 months, the median progression-free survival and overall survival were not reached. The most common treatment-related adverse events were rash (86.7%), paronychia (80.0%), and infusion-related reactions (60.0%), and most of them were graded as 1 to 2. Grade 3 to 4 adverse events included rash (33.3%), alanine aminotransferase elevation (13.3%), gamma-glutamyl transpeptidase elevation (13.3%), peripheral edema (6.7%), thromboembolism (6.7%), interstitial lung disease (6.7%), and thrombocytopenia (6.7%).@*CONCLUSIONS@#Amivantamab was effective in Chinese NSCLC patients with EGFR exon 20 insertion and post-Osimertinib EGFR-mutant patients, similar to the results of clinical trials conducted in western countries. Amivantamab was well tolerated and emphases should be put on adverse events such as rash, paronychia, and infusion-related reactions.
Subject(s)
Humans , Antibodies, Bispecific , Carcinoma, Non-Small-Cell Lung/genetics , ErbB Receptors/genetics , Exanthema/drug therapy , Lung Neoplasms/genetics , Mutation , Paronychia/drug therapy , Protein Kinase Inhibitors/therapeutic useABSTRACT
El exantema laterotorácico unilateral de la infancia (ULE) es una condición benigna, de etiología desconocida, que se caracteriza por un exantema maculopapular que típicamente afecta, de forma unilateral, un pliegue axilar con posterior diseminación centrífuga. Paciente de 19 años, sin antecedentes mórbidos que presentó una erupción cutánea pruriginosa de inicio en la axila derecha con posterior diseminación a la axila contralateral y pliegues inguinales. Acude con exámenes de laboratorios en los que destaca serología positiva para Mycoplasma pneumoniae. El exantema laterotorácico unilateral de la infancia es una erupción benigna de presentación característica en niños pero que también se puede presentar en adultos. Su etiología es desconocida, pero su presentación en relación a fiebre, síntomas infecciosos respiratorios y gastrointestinales antes o durante el exantema, sugieren un origen viral o bacteriano. En este caso, planteamos como posible agente etiológico a Mycoplasma pneumoniae.
Unilateral laterothoracic exanthem of childhood, is a benign condition of unknown etiology that is characterized by a maculopapular exanthema that typically affects one axillary fold followed by centrifugal dissemination. A 19-yearold male patient, healthy, who developed an axillary pruritic rash followed by dissemination to contralateral axillar and inguinal folds. He had laboratory tests with positive serology for Mycoplasma pneumoniae. Unilateral laterothoracic exanthem of childhood is a benign condition that characteristically presents during childhood but can also affect adults. It has an unknown etiology but its presentation in relation with fever, infectious symptoms respiratory and gastrointestinal diseases, suggest a viral or bacterial origin. In this case we raise Mycoplasma pneumoniae as possible etiologic agent.
Subject(s)
Humans , Male , Adult , Pneumonia, Mycoplasma/complications , Exanthema/microbiology , Azithromycin/therapeutic use , Exanthema/etiology , Exanthema/drug therapyABSTRACT
Herpes zoster-associated urinary retention is an uncommon event related to virus infection of the S2-S4 dermatome. The possible major reasons are ipsilateral hemicystitis, neuritis-induced or myelitis-associated virus infection. We report a case of a 65-year-old immunocompetent female patient who presented an acute urinary retention after four days under treatment with valacyclovir for gluteal herpes zoster. The patient had to use a vesical catheter, was treated with antibiotics and corticosteroids and fully recovered after eight weeks.
Subject(s)
Aged , Female , Humans , Exanthema/virology , Herpes Zoster/complications , Immunocompetence , Urinary Retention/virology , Acyclovir/analogs & derivatives , Acyclovir/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Antiviral Agents/therapeutic use , Exanthema/drug therapy , Herpes Zoster/drug therapy , Herpes Zoster/immunology , Immunocompetence/immunology , Treatment Outcome , Valine/analogs & derivatives , Valine/therapeutic useABSTRACT
Although the World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) system has been suggested as a practical tool for classifying adverse drug reactions (ADRs), verification of such system has not been examined. The objective of this study was to evaluate the usefulness of the WHO-UMC classification for the diagnosis of ADRs. The gold standard was the results of drug challenges and serum tryptase in cases of anaphylaxis. Twenty-seven children had ADRs classified by the WHO-UMC system. The causality terms were 'certain' in 4/27, 'probable' in 6/27, 'possible' in 10/27 and 'unlikely' in 7/27 of the patients. Skin prick tests and intradermal tests were positive in 1/20 and 1/5 of the patients, respectively. Drug challenges and serum tryptase were positive in 8/26 and 1/3 of the patients, respectively. After complete evaluation, the positive and negative ADRs were documented in 9/27 patients (33.33%) and 18/27 patients (66.67%), respectively. The multi-level likelihood ratios for ADRs using the WHO-UMC system were infinity in causality term 'certain', 2 in 'probable', 0.5 in 'possible', and 0 in 'unlikely'. In conclusion, causality term 'certain' and 'unlikely' of the WHO-UMC system had large impact on the likelihood of ADRs. In contrast, the causality term 'probable' and 'possible' had small impact on the likelihood of ADRs. Drug challenges and serum tryptase were helpful to confirm ADRs categorized by WHO-UMC system.
Subject(s)
Adolescent , Adverse Drug Reaction Reporting Systems/statistics & numerical data , Anaphylaxis/drug therapy , Causality , Child , Child, Hospitalized/statistics & numerical data , Drug Hypersensitivity/epidemiology , Drug Monitoring , Drug-Related Side Effects and Adverse Reactions/classification , Exanthema/drug therapy , Female , Histamine Antagonists/adverse effects , Humans , Male , Skin Tests , Thailand , Tryptases/blood , Urticaria/drug therapy , World Health OrganizationABSTRACT
An 8-year-old girl with acquired immunodeficiency syndrome presented with fever and alteration of consciousness. She had a history of persistent cryptococcal meningitis. She developed multiple discrete umbilicated papules that resembled cutaneous cryptococcosis on the second day of admission. Skin biopsy revealed an ulcer with a wedge-shaped necrosis of the dermis. The edge of the ulcer showed intracellular edema, margination of nucleoplasm and multinucleated cells, consistent with herpes infection. The diagnosis of varicella-zoster virus infection was confirmed by the identification of herpesvirus DNA from the lesion and differentiation from other herpesviruses by restriction fragment length polymorphism (RFLP) method. Intravenous acyclovir was given at a dose of 500 mg/m2, three times daily for 14 days which resulted in resolution of the skin lesions within 2 weeks.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Chickenpox/complications , Child , DNA, Viral/isolation & purification , Exanthema/drug therapy , Fatal Outcome , Female , Herpesvirus 3, Human/genetics , Humans , Polymorphism, Restriction Fragment Length , Skin Ulcer/drug therapyABSTRACT
La pustulosis exantémica aguda generalizada (PEAG) es una entidad poco frecuente, caracterizada por un exantema pustular superficial no folicular que se considera una forma de reacción cutánea frente a diferentes agentes, fundamentalmente fármacos, infecciones víricas y contacto con mercurio. Presentamos una serie de cinco casos de PEAG, tres de ellos probablemente causados por drogas, aunque no se pudo descartar un proceso infeccioso concomitante. Un caso ocurrió tras vacunación BCG y en el otro no se encontró agente causal