Assuntos
Antivirais/efeitos adversos , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/efeitos adversos , Polietilenoglicóis/efeitos adversos , Ribavirina/efeitos adversos , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Quimioterapia Combinada , Feminino , Humanos , Interferon alfa-2 , Pessoa de Meia-Idade , Proteínas RecombinantesRESUMO
Thalidomide is successfully used in the treatment of multiple myeloma, leprosy and various autoimmune diseases due to its anti-angiogenic, immunomodulatory and anti-inflammatory effects. Thalidomide's most common side effects are constipation, neuropathy, fatigue, sedation, rash, tremor and peripheral edema. We achieved complete response with a 400 mg/day dose thalidomide therapy in a 58-year-old male patient diagnosed with relapsing refractory multiple myeloma. While continuing thalidomide for sustainable response, the therapy was terminated at the ninth month due to development of leukocytoclastic vasculitis. We describe the case and discuss the place of thalidomide in the treatment of multiple myeloma and the rare occurrence of leukocytoclastic vasculitis during thalidomide therapy in multiple myeloma, since only one such case has been reported in the literature thus far.
Assuntos
Inibidores da Angiogênese/efeitos adversos , Antineoplásicos/efeitos adversos , Mieloma Múltiplo/tratamento farmacológico , Talidomida/efeitos adversos , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Vasculite Leucocitoclástica Cutânea/diagnóstico , Inibidores da Angiogênese/administração & dosagem , Antineoplásicos/administração & dosagem , Conservadores da Densidade Óssea/efeitos adversos , Difosfonatos/efeitos adversos , Humanos , Imidazóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva , Talidomida/administração & dosagem , Vasculite Leucocitoclástica Cutânea/patologia , Ácido ZoledrônicoRESUMO
Multibacillary, lepromatous or borderline leprosy patients may present two types of vasculonecrotic reactions: Lucio phenomenon and that associated with erythema nodosum leprosum. Despite they can be distinguished through clinical and histological characteristics; both are often used as synonyms. It is said that leprosy reaction should be properly classified for therapeutic reasons, since it is well known that in Lucio phenomenon there is not a good response to thalidomide. The authors reported two cases of vasculonecrotic phenomena in lepromatous leprosy sharing clinical and histopathological characteristics of both reaction subtypes. The findings may indicate the spectral nature of the reaction phenomena in leprosy and emphasize the importance of the clinic-pathological correlation for proper classification. Our findings may contribute to the understanding of leprosy reactions pathogenesis, broaden the knowledge about their outcome with standard treatment, and provide the scientific background to design better therapeutic strategies for these complications.
Assuntos
Eritema Nodoso/patologia , Hansenostáticos/efeitos adversos , Hanseníase Virchowiana/patologia , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Adolescente , Adulto , Eritema Nodoso/tratamento farmacológico , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Necrose , Vasculite Leucocitoclástica Cutânea/patologiaRESUMO
Multibacillary, lepromatous or borderline leprosy patients may present two types of vasculonecrotic reactions: Lucio phenomenon and that associated with erythema nodosum leprosum. Despite they can be distinguished through clinical and histological characteristics; both are often used as synonyms. It is said that leprosy reaction should be properly classified for therapeutic reasons, since it is well known that in Lucio phenomenon there is not a good response to thalidomide. The authors reported two cases of vasculonecrotic phenomena in lepromatous leprosy sharing clinical and histopathological characteristics of both reaction subtypes. The findings may indicate the spectral nature of the reaction phenomena in leprosy and emphasize the importance of the clinic-pathological correlation for proper classification. Our findings may contribute to the understanding of leprosy reactions pathogenesis, broaden the knowledge about their outcome with standard treatment, and provide the scientific background to design better therapeutic strategies for these complications.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Eritema Nodoso/patologia , Hansenostáticos/efeitos adversos , Hanseníase Virchowiana/patologia , Vasculite Leucocitoclástica Cutânea/induzido quimicamente , Eritema Nodoso/tratamento farmacológico , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/tratamento farmacológico , Necrose , Vasculite Leucocitoclástica Cutânea/patologiaRESUMO
We describe clinical and pathological features of kidney and skin involvement in a patient with hypersensitivity vasculitis associated with dapsone. Although visceral damage occurs rarely, similar skin and kidney histopathologic and immunohistochemical findings indicate that this organ is a target for type IV cell-mediated dapsone reaction. To our knowledge, this is the first reported case of renal hypersensitivity vasculitis associated with dapsone.