Assuntos
Dapsona/efeitos adversos , Toxidermias/tratamento farmacológico , Toxidermias/etiologia , Hansenostáticos/efeitos adversos , Hanseníase/complicações , Hanseníase/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Toxidermias/patologia , Humanos , Hanseníase/patologia , MasculinoAssuntos
Antineoplásicos/efeitos adversos , Toxidermias/patologia , Dermatoses da Mão/induzido quimicamente , Dermatoses da Mão/patologia , Hidroxiureia/efeitos adversos , Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Toxidermias/tratamento farmacológico , Feminino , Dermatoses da Mão/tratamento farmacológico , Humanos , Pessoa de Meia-IdadeRESUMO
Leprosy is usually well-controlled by multidrug therapy (MDT). However, in case of noncompliance or leprosy reactions, it may present a therapeutically challenge. A 33-year-old Brazilian woman with lepromatous leprosy was treated with MDT for one year, but then discontinued therapy because she wanted to have children. Eight weeks after stopping her medications, she developed a severe and recalcitrant erythema (nodosum) leprosum (ENL) which presented histologically with thrombosed small veins and neutrophilic inflammation in fat septa, but without arteritis. During her pregnancy and ensuing lactation period, glucocorticoids were the only suitable drug. With the use of the shortened WHO/MDT regimen (one year vs. two years of treatment), ENL will probably be seen more often after the end of leprosy therapy. It needs to be rapidly recognized and treated to avoid damage to eyes or kidneys.
Assuntos
Eritema Nodoso/induzido quimicamente , Eritema Nodoso/tratamento farmacológico , Hansenostáticos/administração & dosagem , Hanseníase Virchowiana/tratamento farmacológico , Adesão à Medicação , Prednisolona/administração & dosagem , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Anti-Inflamatórios/administração & dosagem , Esquema de Medicação , Toxidermias/tratamento farmacológico , Toxidermias/etiologia , Feminino , Humanos , Hansenostáticos/efeitos adversos , Hanseníase Virchowiana/complicações , Gravidez , Resultado do Tratamento , TuberculoseRESUMO
Medications used to treat human ailments are known to cause cutaneous reactions which may vary in their severity. Leflunomide, an immunomodulating agent recently introduced to treat rheumatoid arthritis, is reported to cause severe cutaneous reactions. We are reporting five such cases. All our patients were started on leflunomide for rheumatoid arthritis, 4-6 weeks before the onset of cutaneous reaction and were admitted to the hospital with the common complaints of fever, skin rash and generalized weakness. All of them had characteristic pattern of events such as delayed onset of reaction, widespread and long lasting skin rash and internal organ involvement. These features suggest a possibility of drug hypersensitivity syndrome to leflunomide. Careful dosing and periodic monitoring of patients treated with leflunomide for possible adverse drug reaction is recommended.