Assuntos
Antraz/diagnóstico , Bacillus megaterium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Dermatopatias Bacterianas/microbiologia , Adulto , Ciprofloxacina/administração & dosagem , Diagnóstico Diferencial , Feminino , Seguimentos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Medição de Risco , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Resultado do TratamentoAssuntos
Aspirina/efeitos adversos , Dermatite Esfoliativa/induzido quimicamente , Dermatoses da Mão/induzido quimicamente , Inibidores da Agregação Plaquetária/efeitos adversos , Água/efeitos adversos , Adolescente , Dermatite Esfoliativa/patologia , Feminino , Dermatoses da Mão/patologia , Humanos , Fatores de RiscoRESUMO
An adverse cutaneous reaction to a systemically administered drug may rarely manifest as acute generalized exanthematous pustulosis (AGEP). Several recent reports have documented positive patch test results in patients with a history of AGEP, while two have demonstrated drug-specific in vitro lymphocyte proliferative responses. These findings suggest that drug-specific T cells mediate AGEP. We describe two patients with a history of AGEP who each demonstrated positive patch test results specific for the inciting drug: Patient #1 to the antibiotic metronidazole, and Patient #2 to the calcium channel-blocker diltiazem. Histologic examination of biopsy specimens taken from the patch test sites of these patients revealed spongiotic dermatitis and perivascular lymphocytes consistent with a delayed-type hypersensitivity reaction, rather than demonstrating subcorneal neutrophilic pustules more typical of AGEP. In vitro testing by measuring peripheral T cell proliferative responses to chemically purified drug correlated with the clinical response. In a direct cross-comparison, patch test results were shown to correlate with in vitro lymphocyte proliferative responses in two patients with a history of AGEP to different drugs. These findings provide additional evidence that the pathogenesis of AGEP involves a T cell-mediated immune response.