Sujet(s)
Syndrome d'hypersensibilité médicamenteuse , Herpèsvirus humain de type 6 , Lymphadénite , Lymphomes , Infections à roséolovirus , Humains , Herpèsvirus humain de type 6/isolement et purification , Lymphadénite/virologie , Lymphadénite/diagnostic , Lymphadénite/étiologie , Infections à roséolovirus/complications , Infections à roséolovirus/diagnostic , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Syndrome d'hypersensibilité médicamenteuse/étiologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Lymphomes/complications , Diagnostic différentiel , Mâle , Femelle , Adulte d'âge moyenSujet(s)
Syndrome d'hypersensibilité médicamenteuse , Hypersensibilité , Pancytopénie , Humains , Pancytopénie/induit chimiquement , Pancytopénie/anatomopathologie , Granulocytes éosinophiles/anatomopathologie , Peau/anatomopathologie , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Syndrome d'hypersensibilité médicamenteuse/étiologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Biopsie , Hypersensibilité/anatomopathologieRÉSUMÉ
BACKGROUND: Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important adverse reaction caused by a few drugs. Reactivation of human herpesvirus 6 (HHV-6) is known to be associated with its pathogenesis. DIHS occasionally manifests as pulmonary lesions with a variety of imaging findings. CASE PRESENTATION: An 83-year-old woman started taking minodronic acid hydrate 5 years before admission. She noticed a generalized skin rash 44 days before admission and started oral betamethasone-d-chlorpheniramine maleate combination tablets for allergic dermatitis. She developed a fever and cough in addition to the rash, and was referred to our hospital. Laboratory data showed a high level of eosinophils and liver and biliary enzymes. Computed tomography (CT) studies revealed bilateral diffuse ground-glass opacities with ill-defined centrilobular nodules from the central to peripheral regions of the lungs. Transbronchial lung cryobiopsy specimens showed that lymphocyte infiltration was observed in the alveolar walls and fibrinous exudates and floating macrophages in the alveolar lumina. Immunohistochemistry of biopsy specimens showed more CD4+ lymphocytes than CD8+ lymphocytes, while few Foxp3+ lymphocytes were recognized. The serum anti-HHV-6 immunoglobulin G titer increased at 3 weeks after the first test. Based on these findings, we diagnosed her with DIHS. We continued care without using corticosteroids since there was no worsening of breathing or skin condition. Eventually, her clinical symptoms chest CT had improved. Minodronic acid hydrate was identified as the culprit drug based on the positive results of the patch test and drug-induced lymphocyte stimulation test. CONCLUSIONS: We described the first case of DIHS caused by minodronic acid hydrate. Lung lesions in DIHS can present with bilateral diffuse ground-glass opacities and ill-defined centrilobular nodules on a CT scan during the recovery phase. Clinicians should be aware of DIHS, even if patients are not involved with typical DIHS/DRESS-causing drugs.
Sujet(s)
Diphosphonates/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/étiologie , Imidazoles/effets indésirables , Sujet âgé de 80 ans ou plus , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Femelle , Humains , Poumon/imagerie diagnostique , Poumon/anatomopathologie , Tests cutanésRÉSUMÉ
Glucocorticoids are the final products of the neuroendocrine hypothalamic-pituitary-adrenal axis, and play an important role in the stress response to re-establish homeostasis when it is threatened, or perceived as threatened. These steroid hormones have pleiotropic actions through binding to their cognate receptor, the human glucocorticoid receptor, which functions as a ligand-bound transcription factor inducing or repressing the expression of a large number of target genes. To achieve homeostasis, glucocorticoid signaling should have an optimal effect on all tissues. Indeed, any inappropriate glucocorticoid effect in terms of quantity or quality has been associated with pathologic conditions, which are characterized by short-term or long-lasting detrimental effects. Two such conditions, the primary generalized glucocorticoid resistance and hypersensitivity syndromes, are discussed in this review article. Undoubtedly, the tremendous progress of structural, molecular, and cellular biology, in association with the continued progress of biotechnology, has led to a better and more in-depth understanding of these rare endocrinologic conditions, as well as more effective therapeutic management.
Sujet(s)
Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Résistance aux substances/génétique , Glucocorticoïdes/pharmacologie , Erreurs innées du métabolisme/anatomopathologie , Récepteurs aux glucocorticoïdes/déficit , Récepteurs aux glucocorticoïdes/génétique , Animaux , Syndrome d'hypersensibilité médicamenteuse/étiologie , Syndrome d'hypersensibilité médicamenteuse/métabolisme , Humains , Erreurs innées du métabolisme/génétiqueSujet(s)
Ciclosporine/usage thérapeutique , Syndrome d'hypersensibilité médicamenteuse/traitement médicamenteux , Immunosuppresseurs/usage thérapeutique , Méthotrexate/usage thérapeutique , Hormones corticosurrénaliennes/usage thérapeutique , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Association de médicaments , Femelle , Humains , Résultat thérapeutiqueSujet(s)
Anticonvulsivants/effets indésirables , Carbamazépine/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/étiologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Humains , Mâle , Adulte d'âge moyen , Crises épileptiques/traitement médicamenteux , Crises épileptiques/anatomopathologie , Peau/effets des médicaments et des substances chimiques , Peau/anatomopathologieSujet(s)
Benzaldéhydes/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/étiologie , Éosinophilie/induit chimiquement , Agents hématologiques/effets indésirables , Pyrazines/effets indésirables , Pyrazoles/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Éosinophilie/anatomopathologie , Femelle , Humains , Adulte d'âge moyenRÉSUMÉ
Although the incidence of severe cutaneous adverse reactions (SCARs) to medications is very low, SCARs can result in disability or even death if they are not diagnosed and treated properly. As the rapid recognition of SCARs is essential, it is necessary to develop diagnostic markers for them that can also be used to assess severity and predict outcomes in the early phase. In addition, it is important to identify novel therapeutic targets for SCARs. Chemokines are chemotactic cytokines that control the migratory patterns and locations of immune cells and usually exhibit markedly specific associations with certain human diseases. In Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), the Th1-associated chemokines chemokine (C-X-C motif) ligand 9 (CXCL9) and CXCL10 predominate, while in drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS), the levels of the Th2-associated chemokines chemokine (C-C motif) ligand 17 (CCL17) and CCL22 are markedly elevated. We suggest that the distinct chemokine profiles of SJS/TEN and DIHS/DRESS can be used to aid their differential diagnosis. CXCL10 has also been reported to be associated with the development of long-term sequelae in DIHS/DRESS. This review focuses on the chemokines involved in the pathogenesis and adjuvant diagnosis of SCARs, particularly SJS/TEN and DIHS/DRESS, but also provides a brief overview of SCARs and the chemokine superfamily. As it is being increasingly recognized that an association exists between human herpesvirus 6 (HHV-6) and DIHS/DRESS, the possible roles of the chemokine/chemokine receptor homologs encoded by HHV-6 in the pathogenesis of DIHS/DRESS are also discussed.
Sujet(s)
Chimiokines/métabolisme , Cicatrice/métabolisme , Cicatrice/anatomopathologie , Peau/métabolisme , Peau/anatomopathologie , Animaux , Syndrome d'hypersensibilité médicamenteuse/métabolisme , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Humains , Syndrome de Stevens-Johnson/métabolisme , Syndrome de Stevens-Johnson/anatomopathologieRÉSUMÉ
Azathioprine is an immunosuppressant drug used in many dermatological and nondermatological pathologies. Azathioprine hypersensitivity syndrome (AHS) is a rare idiosyncratic reaction that is not related to dose or thiopurine methyltransferase activity. Up to half of cases of AHS can present with variable cutaneous manifestations besides fever, malaise and other systemic symptoms. It is important to be aware of AHS, as continuance or reintroduction of the drug can led to multiorgan failure and cardiovascular collapse.
Sujet(s)
Azathioprine/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/étiologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Immunosuppresseurs/effets indésirables , Peau/anatomopathologie , Diagnostic différentiel , Oedème/anatomopathologie , Humains , Mâle , Adulte d'âge moyen , Granulocytes neutrophiles/anatomopathologieRÉSUMÉ
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is a severe type of adverse drug eruption associated with multiorgan involvement and the reactivation of human herpesvirus 6, which arises after prolonged exposure to certain drugs. Typically, two waves of disease activity occur during the course of DIHS/DRESS; however, some patients experience multiple waves of exacerbation and remission of the disease. Severe complications, some of which are related to cytomegalovirus reactivation, can be fatal. DIHS/DRESS is distinct from other drug reactions, as it involves herpes virus reactivation and can lead to the subsequent development of autoimmune diseases. The association between herpesviruses and DIHS/DRESS is now well established, and DIHS/DRESS is considered to arise as a result of complex interactions between several herpesviruses and comprehensive immune responses, including drug-specific immune responses and antiviral immune responses, each of which may be mediated by distinct types of immune cells. It appears that both CD4 and CD8 T cells are involved in the pathogenesis of DIHS/DRESS but play distinct roles. CD4 T cells mainly initiate drug allergies in response to drug antigens, and then herpesvirus-specific CD8 T cells that target virus-infected cells emerge, resulting in tissue damage. Regulatory T-cell dynamics are also suggested to contribute to the diverse symptoms of DIHS/DRESS. However, the pathomechanisms of this complex disease remain largely unknown. In particular, how viral infections contribute to the pathogenesis of DIHS/DRESS and why autoimmune sequelae arise in DIHS/DRESS are yet to be elucidated. This review describes the clinical features of DIHS/DRESS, including the associated complications and sequelae, and discusses recent advances in our understanding of the immunopathogenic mechanisms of DIHS/DRESS.
Sujet(s)
Syndrome d'hypersensibilité médicamenteuse/immunologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Éosinophilie/complications , Présentation d'antigène/immunologie , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Syndrome d'hypersensibilité médicamenteuse/virologie , Antigènes HLA/métabolisme , Humains , Lymphocytes T/immunologieSujet(s)
Antibactériens/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Syndrome d'hypersensibilité médicamenteuse/génétique , Prédisposition génétique à une maladie , Vancomycine/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/étiologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Femelle , Humains , Adulte d'âge moyenSujet(s)
Alvéolite allergique extrinsèque/complications , Syndrome d'hypersensibilité médicamenteuse/complications , Dyspnée/étiologie , Exanthème/étiologie , Isocyanates/effets indésirables , Exposition professionnelle/effets indésirables , Adulte , Alvéolite allergique extrinsèque/induit chimiquement , Alvéolite allergique extrinsèque/traitement médicamenteux , Alvéolite allergique extrinsèque/anatomopathologie , Syndrome d'hypersensibilité médicamenteuse/traitement médicamenteux , Syndrome d'hypersensibilité médicamenteuse/étiologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Glucocorticoïdes/usage thérapeutique , Humains , Mâle , Prednisolone/usage thérapeutiqueSujet(s)
Antibactériens/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Lymphohistiocytose hémophagocytaire/induit chimiquement , Ostéomyélite/microbiologie , Association de pipéracilline et de tazobactam/effets indésirables , Antibactériens/usage thérapeutique , Antifongiques/usage thérapeutique , Candida albicans/effets des médicaments et des substances chimiques , Candida albicans/isolement et purification , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Syndrome d'hypersensibilité médicamenteuse/thérapie , Éosinophilie/induit chimiquement , Éosinophilie/anatomopathologie , Fluconazole/usage thérapeutique , Humains , Lymphohistiocytose hémophagocytaire/anatomopathologie , Ostéomyélite/traitement médicamenteux , Association de pipéracilline et de tazobactam/usage thérapeutique , Pseudomonas aeruginosa/effets des médicaments et des substances chimiques , Pseudomonas aeruginosa/isolement et purification , Staphylococcus aureus/effets des médicaments et des substances chimiques , Staphylococcus aureus/isolement et purification , Inhibiteurs des bêta-lactamases/usage thérapeutiqueSujet(s)
Syndrome d'hypersensibilité médicamenteuse/diagnostic , Prédisposition génétique à une maladie , Infections à VIH/traitement médicamenteux , VIH-1 (Virus de l'Immunodéficience Humaine de type 1) , Antigènes HLA-B/génétique , Raltégravir de potassium/usage thérapeutique , Allèles , , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Femelle , Humains , Mâle , Raltégravir de potassium/effets indésirablesRÉSUMÉ
Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare delayed drug reaction that often occurs 2-6 weeks after initiation of therapy and may develop into a life-threatening systemic reaction. Besides immediate discontinuation of the suspected inciting drug, initiation of high dose systemic corticosteroids has long been the mainstay of treatment for severe cases. Nevertheless, significant drawbacks associated with systemic corticosteroid therapy, such as the requirement of a long tapering period post resolution and extensive adverse side effects profile, have motivated clinicians to seek alternative treatment options. Over the past decade, an undisputed increasing number of favorable case reports has highlighted cyclosporine as an emerging, safe, and effective alternative despite inconsistent dosing regimens reported. Herein, we report a severe case of vancomycin-induced DRESS syndrome in which the patient failed initial intervention with cyclosporine and needed rescue with methylprednisolone. To the best of our knowledge, this constitutes the first unsuccessful report of cyclosporine treatment for DRESS syndrome.
Sujet(s)
Ciclosporine/usage thérapeutique , Syndrome d'hypersensibilité médicamenteuse/étiologie , Vancomycine/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/traitement médicamenteux , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Résistance aux substances , Éosinophilie/induit chimiquement , Éosinophilie/anatomopathologie , Exanthème/induit chimiquement , Femelle , Avant-bras/anatomopathologie , HumainsRÉSUMÉ
BACKGROUND: There are conflicting reports on the association between interface dermatitis and hepatic involvement in DRESS. METHODS: A cross-sectional analysis of the clinical and the histopathologic features of DRESS was performed to study the association between the histopathology of the skin rash and hepatic involvement. RESULTS: The clinical and the histopathologic findings were evaluated in 40 cases of DRESS. Thirty patients (75%) had a hepatic involvement. Thirty (75%) biopsy specimens showed a combination of different inflammatory patterns. The interface dermatitis was noted in 24 specimens (60%). Twenty-one patients with the interface dermatitis had a hepatic involvement (P = .04). CONCLUSIONS: The skin rash of DRESS often shows the coexistence of different inflammatory patterns. The interface dermatitis showed a statistically significant association with the hepatic involvement in DRESS.
Sujet(s)
Dermatite/anatomopathologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Éosinophilie/induit chimiquement , Exanthème/induit chimiquement , Foie/effets des médicaments et des substances chimiques , Adulte , Biopsie , Études transversales , Dermatite/immunologie , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Exanthème/anatomopathologie , Femelle , Humains , Hyperbilirubinémie/induit chimiquement , Foie/enzymologie , Foie/anatomopathologie , Mâle , Adulte d'âge moyen , Transaminases/sang , Transaminases/effets des médicaments et des substances chimiquesSujet(s)
Syndrome d'hypersensibilité médicamenteuse/diagnostic , Éosinophilie/induit chimiquement , Exanthème/induit chimiquement , Vaccins antigrippaux/effets indésirables , Sujet âgé de 80 ans ou plus , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Éosinophilie/anatomopathologie , Exanthème/anatomopathologie , Humains , MâleSujet(s)
Pustulose exanthématique aigüe généralisée/génétique , Azathioprine/effets indésirables , Protéines adaptatrices de signalisation CARD/génétique , Syndrome d'hypersensibilité médicamenteuse/génétique , Guanylate cyclase/génétique , Protéines membranaires/génétique , Pyrophosphatases/génétique , Pustulose exanthématique aigüe généralisée/diagnostic , Pustulose exanthématique aigüe généralisée/immunologie , Pustulose exanthématique aigüe généralisée/anatomopathologie , Adulte , Azathioprine/pharmacocinétique , Protéines adaptatrices de signalisation CARD/immunologie , Analyse de mutations d'ADN , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Syndrome d'hypersensibilité médicamenteuse/immunologie , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Femelle , Guanylate cyclase/immunologie , Humains , Protéines membranaires/immunologie , Mutation , Pyrophosphatases/métabolisme , Peau/immunologie , Peau/anatomopathologieSujet(s)
Cholécystite/diagnostic , Syndrome d'hypersensibilité médicamenteuse/diagnostic , Indométacine/effets indésirables , Sujet âgé , Anti-inflammatoires non stéroïdiens/effets indésirables , Syndrome d'hypersensibilité médicamenteuse/anatomopathologie , Femelle , Glucocorticoïdes/usage thérapeutique , Humains , Prednisolone/usage thérapeutiqueRÉSUMÉ
Drug-induced hypersensitivity syndrome (DIHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a severe hypersensitivity drug reaction affecting the skin and multiple internal organ systems. We report a 47-year-old man with DIHS/DRESS and comorbidities (fulminant type 1 diabetes mellitus, valsartan-induced photosensitivity, vitiligo and acute interstitial nephritis). Although acute interstitial nephritis usually appears in the early phase, his is a rare case of acute interstitial nephritis more than 2 years after the onset of DIHS/DRESS.