Asunto(s)
Clorhidrato de Fingolimod , Molusco Contagioso , Niño , Humanos , Clorhidrato de Fingolimod/efectos adversos , Clorhidrato de Fingolimod/uso terapéutico , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Molusco Contagioso/inducido químicamente , Molusco Contagioso/tratamiento farmacológico , Molusco Contagioso/diagnósticoRESUMEN
Fingolimod treatment has been associated with opportunistic infections, most notably PML and cryptococcal meningitis. There are rare reports of other infections like molluscum contagiosum which are typically associated with impaired cellular immunity as seen in AIDS. Upon review of our multiple sclerosis patient database, we identified eight patients undergoing fingolimod treatment who developed molluscum contagiosum infections. We suspect that this association is a class effect and may also be observed with other S1P receptor modulators. While molluscum contagiosum infection is not life-threatening, it can be extremely distressing for patients, and resolution may require discontinuation of fingolimod.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Molusco Contagioso , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Clorhidrato de Fingolimod/efectos adversos , Humanos , Molusco Contagioso/inducido químicamente , Molusco Contagioso/complicacionesAsunto(s)
Betametasona/efectos adversos , Calcitriol/análogos & derivados , Fármacos Dermatológicos/efectos adversos , Glucocorticoides/efectos adversos , Molusco Contagioso/inducido químicamente , Anciano , Calcitriol/efectos adversos , Quimioterapia Combinada/efectos adversos , Eccema/tratamiento farmacológico , Humanos , Masculino , Molusco Contagioso/patología , Molusco Contagioso/terapia , Piel/patologíaAsunto(s)
Azetidinas/efectos adversos , Dermatitis Atópica/tratamiento farmacológico , Fármacos Dermatológicos/uso terapéutico , Inhibidores de las Cinasas Janus/efectos adversos , Molusco Contagioso/inducido químicamente , Molusco Contagioso/tratamiento farmacológico , Sulfonamidas/efectos adversos , Administración Tópica , Adulto , Azetidinas/uso terapéutico , Dermatitis Atópica/diagnóstico , Estudios de Seguimiento , Humanos , Inhibidores de las Cinasas Janus/uso terapéutico , Masculino , Molusco Contagioso/fisiopatología , Purinas , Pirazoles , Medición de Riesgo , Sulfonamidas/uso terapéutico , Resultado del TratamientoRESUMEN
Fingolimod-related viral infections have been described on several occasions since its introduction in 2010. We hereby add a report on an otherwise immunocompetent, 18-year old Caucasian man with relapsing-remitting multiple sclerosis who developed a protracted and extensive molluscum contagiosum (MC) virus infection shortly after being started on fingolimod. Wide-spread cutaneous MC infections in adult patients are considered indicative of underlying immunosuppression. Neurologists prescribing fingolimod ought to be aware of a possibly increased risk of MC, but also need to know about its relative benignity, lack of extra-cutaneous complications, and adequate treatment options.
Asunto(s)
Clorhidrato de Fingolimod/efectos adversos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Molusco Contagioso/inducido químicamente , Virus del Molusco Contagioso/inmunología , Esclerosis Múltiple Recurrente-Remitente/tratamiento farmacológico , Infecciones Oportunistas/inducido químicamente , Adolescente , Biopsia , Humanos , Masculino , Molusco Contagioso/diagnóstico , Molusco Contagioso/inmunología , Molusco Contagioso/virología , Esclerosis Múltiple Recurrente-Remitente/diagnóstico , Esclerosis Múltiple Recurrente-Remitente/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/virología , Factores de RiesgoAsunto(s)
Adalimumab/efectos adversos , Azatioprina/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Molusco Contagioso/inducido químicamente , Adulto , Antiinflamatorios no Esteroideos/efectos adversos , Quimioterapia Combinada , Humanos , Inmunosupresores/efectos adversos , MasculinoRESUMEN
We describe an HIV-infected South African man who experienced two distinct episodes of disseminated giant molluscum contagiosum immune reconstitution inflammatory syndrome (IRIS) over a six-year period. The first episode of molluscum contagiosum IRIS occurred with rapid virologic suppression following antiretroviral therapy initiation. The second episode occurred during a rapid increase in CD4 cells following stable viral suppression with second-line antiretroviral therapy. His molluscum contagiosum lesions then completely resolved during a reduction in CD4 count, despite maintaining virologic suppression. Nearly one year after the resolution of his giant molluscum contagiosum IRIS lesions, he maintains an undetectable viral load, but his level of immune deficiency has not improved. In the absence of well-controlled therapeutic trials, molluscum contagiosum IRIS presents important management challenges.
Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Molusco Contagioso/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/virología , Adulto , Linfocitos T CD4-Positivos , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Huésped Inmunocomprometido , Masculino , Molusco Contagioso/inducido químicamente , Molusco Contagioso/virología , Recurrencia , Sudáfrica , Resultado del Tratamiento , Carga Viral/efectos de los fármacosRESUMEN
Molluscum contagiosum (MC) is common and often numerous and recalcitrant in immunocompromised children. The response to available treatments is frequently unsatisfactory. Cidofovir is a nucleoside analog of the deoxycytidine antiviral drug approved for the intravenous treatment of cytomegalovirus retinitis in AIDS patients. We report four cases of children, 5-8 years old, who developed extensive MC in the context of chemotherapy for acute lymphoid leukemia and who were treated with a cream containing cidofovir 1%. In all patients, the lesions began to regress within 2 to 4 months. For three patients, complete regression was observed in 7 to 9 months, and the children remained clear of recurrence. For one patient, partial regression was obtained after 17 months of treatment. No side effects have been observed. Treatment of MC in immunocompromised children is difficult because the usual treatments are inappropriate. Successful use of either topically or intralesionally administered cidofovir in several virally induced cutaneous diseases has been demonstrated and recently documented in the treatment of MC in immunocompromised adults. Conversely, its use in children is not documented. Although intravenous use of cidofovir may lead to severe adverse effects, one single case of a systemic side effect has been reported after topical use at a greater concentration, but no changes in laboratory data were observed. Topical cidofovir offers an effective and well-tolerated therapeutic alternative option for the treatment of MC in immunosuppressed children.
Asunto(s)
Antivirales/administración & dosificación , Citosina/análogos & derivados , Molusco Contagioso/tratamiento farmacológico , Infecciones Oportunistas/tratamiento farmacológico , Organofosfonatos/administración & dosificación , Administración Tópica , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Niño , Preescolar , Cidofovir , Terapia Combinada , Criocirugía , Citosina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Molusco Contagioso/inducido químicamente , Infecciones Oportunistas/inducido químicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológicoRESUMEN
Molluscum contagiosum is a common viral skin infection in children with atopic diathesis and not rare in HIV patients. We report a 45-year-old psoriasis patient who developed eruptive mollusca contagiosa during an antipsoriatic treatment with efalizumab.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Factores Inmunológicos/efectos adversos , Inmunosupresores/efectos adversos , Molusco Contagioso/inducido químicamente , Piel/patología , Anticuerpos Monoclonales Humanizados , Femenino , Humanos , Persona de Mediana Edad , Molusco Contagioso/inmunología , Molusco Contagioso/patología , Psoriasis/tratamiento farmacológicoAsunto(s)
Inmunoglobulina G/efectos adversos , Inmunosupresores/efectos adversos , Molusco Contagioso/inducido químicamente , Virus del Molusco Contagioso/efectos de los fármacos , Infecciones por Papillomavirus/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales/uso terapéutico , Artritis Psoriásica/tratamiento farmacológico , Etanercept , Femenino , Humanos , Inmunoglobulina G/uso terapéutico , Inmunosupresores/uso terapéutico , Infliximab , Molusco Contagioso/inmunología , Infecciones por Papillomavirus/patología , Psoriasis/tratamiento farmacológico , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Recurrencia , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
Immune reconstitution inflammatory syndrome (IRIS) is a recently described entity in which severely immunodepressed HIV patients, after being started on HAART, develop inflammatory reactions to several pathogens. We present a patient who developed extensive Molluscum Contagiosum (MC) lesions shortly after being started on HAART. With the progression of immunoreconstitution, the lesions healed spontaneously. Molluscum contagiosum lesions are presumably common in IRIS but underreported. We point out this case for its striking clinical picture and well-documented relation to immunoreconstitution to draw attention to this IRIS manifestation.
Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Antígenos HLA-D/inmunología , Huésped Inmunocomprometido , Inflamación/inmunología , Molusco Contagioso/inmunología , Anciano , Terapia Antirretroviral Altamente Activa/métodos , Estudios de Seguimiento , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , Humanos , Tolerancia Inmunológica , Inflamación/fisiopatología , Inflamación/terapia , Masculino , Molusco Contagioso/inducido químicamente , Molusco Contagioso/terapia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Síndrome , Carga ViralRESUMEN
BACKGROUND: Tacrolimus applied locally is a non-steroid anti-inflammatory drug with proven efficacy in atopic dermatitis. Skin infections can occur, especially viral infections. CASE-REPORT: A 35-year-old male patient had been treated for extensive atopic dermatitis for several months with tacrolimus (Protopic). After six months of treatment, he presented a large eruption of molluscum contagiosum, in particular on the zones that had received a substantial amount of tacrolimus. The treatment was discontinued and application of a preparation containing cidofovir led to the patient's quick complete recovery, without recurrence in the ensuing months. DISCUSSION: Viral skin infections, in particular poxvirus infections, are prompted by topical immunosuppressant treatments such as tacrolimus, usually in dose-dependent fashion. Paradoxically, they provide protection against bacterial infections by restoring the integrity of the cutaneous barrier. Application of cidofovir successfully treated a severe form of molluscum contagiosum rapidly without any noticeable adverse effects. This confirms several observations about the efficacy and the good safety of this drug in the treatment of infections by DNA viruses. It provides an additional therapeutic prospect for immunodepressed patients who often present extensive and resistant forms of infections that are usually common.
Asunto(s)
Dermatitis Atópica/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Molusco Contagioso/inducido químicamente , Tacrolimus/uso terapéutico , Adulto , Cara , Humanos , Inmunosupresores/efectos adversos , Masculino , Molusco Contagioso/patología , Tacrolimus/efectos adversosRESUMEN
A case of molluscum contagiosum arising on the face and neck of a woman using topical tacrolimus over a period of 6 weeks for the treatment of atopic dermatitis is presented. Of particular note, these lesions remained confined to areas treated with tacrolimus and did not extend to adjacent regions treated with topical corticosteroids.