RESUMO
BACKGROUND: The prognosis of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is highly unpredictable. Severe complications, either related or unrelated to cytomegalovirus (CMV) reactivation, are a highly probable cause of death. OBJECTIVES: The aim was to establish a scoring system for DiHS/DRESS that can be used to monitor severity, predict prognosis, and stratify the risk of developing CMV disease and complications. METHODS: A retrospective analysis of 55 patients with DiHS/DRESS was performed. A composite score was created using clinical data. DiHS/DRESS patients were also stratified into 3 groups based on the scores to predict the risk of CMV reactivation and complications. RESULTS: This scoring system made it possible to predict CMV disease and complications. Scores ≥4 were associated with the later development of CMV disease and complications, while no patients with scores <4 developed complications. LIMITATIONS: This was a single-institution study with a relatively small patient cohort that lacked a validation cohort. CONCLUSIONS: Our scoring system may be useful for predicting CMV-related complications, and early intervention with anti-CMV agents should be considered in patients with scores ≥4 or with evidence of CMV reactivation.
Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/complicações , Índice de Gravidade de Doença , Adolescente , Corticosteroides/uso terapêutico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Antivirais/administração & dosagem , Citomegalovirus/fisiologia , Infecções por Citomegalovirus/etiologia , Infecções por Citomegalovirus/mortalidade , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Feminino , Ganciclovir/uso terapêutico , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Tempo para o Tratamento , Valganciclovir/uso terapêutico , Ativação Viral , Adulto JovemRESUMO
BACKGROUND: Cytomegalovirus (CMV) disease induced by reactivation of latent CMV is a fatal viral infection that may develop in a setting of therapy with immunosuppressive agents. There is a clear need to clarify any clinical features and markers of CMV disease. OBJECTIVE: We investigated which clinical markers usually available in a clinical setting can predict CMV disease occurring in bullous pemphigoid (BP) patients receiving corticosteroids. METHOD: We described a BP patient with CMV disease complicated by gastrointestinal hemorrhage and liver dysfunction. Prompted by this patient, we retrospectively analyzed clinical features and laboratory findings in our institutional four BP patients and previously reported nine BP patients with CMV disease. We also compared these patients with our institutional 42 BP patients not complicated by CMV disease. RESULTS: High levels of anti-BP180 antibody titers associated with resistance to corticosteroids are a risk factor for the development of CMV disease. A reduction in platelet (PLT) and white blood cell (WBC) counts and an increase in alanine aminotransferase (ALT) levels 3-4 weeks after the initiation of corticosteroids are useful predictive markers for the onset of CMV disease. CONCLUSIONS: Frequent WBC, PLT, and ALT measurements may identify BP patients at a risk of subsequently developing CMV disease. Careful monitoring of CMV disease in BP refractory to systemic corticosteroids may reduce the risk of fatal outcomes.
Assuntos
Infecções por Citomegalovirus/etiologia , Síndrome Inflamatória da Reconstituição Imune/complicações , Penfigoide Bolhoso/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Evolução Fatal , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Penfigoide Bolhoso/complicações , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Estudos Retrospectivos , Ativação ViralAssuntos
Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/epidemiologia , Síndrome de Hipersensibilidade a Medicamentos/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Humanos , Fatores de RiscoAssuntos
Mycoplasma pneumoniae/patogenicidade , Pneumonia por Mycoplasma/microbiologia , Síndrome de Stevens-Johnson/etiologia , Adulto , Biópsia , Glucocorticoides/administração & dosagem , Interações Hospedeiro-Patógeno , Humanos , Masculino , Pessoa de Meia-Idade , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/imunologia , Fatores de Risco , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/tratamento farmacológico , Síndrome de Stevens-Johnson/imunologia , Síndrome de Stevens-Johnson/microbiologia , Resultado do TratamentoRESUMO
BACKGROUND: Streptococci are the main causative agents of cellulitis, and group G Streptococcus (GGS) shares many important virulent factors with group A Streptococcus (GAS). The difference in the clinical features of GAS- and GGS-induced cellulitis, however, has not been thoroughly characterized. OBJECTIVE: Our aim was to recognize the differences in the clinical manifestations and outcomes of lower limb cellulitis caused by GAS and GGS. METHODS: We retrospectively analyzed a total of 29 patients diagnosed with GAS- or GGS-induced lower limb cellulitis during the period from January 2008 to September 2013. RESULTS: While the clinical manifestations of GAS-induced cellulitis were likely to be uniform, those of GGS-induced cellulitis were variable, depending on the predisposing factors. GGS-induced cellulitis occurred more frequently in older person who had chronic underlying illness. CONCLUSION: We identified clinical predisposing factors that can predict the clinical course and outcomes of GGS-induced cellulitis.
Assuntos
Celulite (Flegmão)/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Celulite (Flegmão)/diagnóstico , Feminino , Humanos , Extremidade Inferior/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/patogenicidade , Adulto JovemAssuntos
Anti-Inflamatórios/uso terapêutico , Biomarcadores/sangue , Citocinas/sangue , Metilprednisolona/uso terapêutico , Síndrome de Stevens-Johnson/tratamento farmacológico , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Feminino , Humanos , Interferon gama/sangue , Interleucina-10/sangue , Interleucina-6/sangue , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Reepitelização , Estudos Retrospectivos , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/sangue , Fator de Necrose Tumoral alfa/sangueAssuntos
Anti-Infecciosos/efeitos adversos , Dapsona/efeitos adversos , Necrose da Cabeça do Fêmur/induzido quimicamente , Glucocorticoides/efeitos adversos , Vasculite por IgA/tratamento farmacológico , Prednisolona/efeitos adversos , Adulto , Eosinofilia/induzido quimicamente , Eritema/induzido quimicamente , Exantema/induzido quimicamente , Necrose da Cabeça do Fêmur/patologia , Febre/induzido quimicamente , Glucocorticoides/administração & dosagem , Humanos , Leucocitose/induzido quimicamente , Imageamento por Ressonância Magnética , Masculino , Prednisolona/administração & dosagem , SíndromeRESUMO
BACKGROUND: Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe systemic hypersensitivity reaction caused by specific drugs, in which herpesvirus reactivations and organ dysfunction occur during the course of the disease. Although recent reports have documented the development of autoimmune disease after complete resolution of DIHS/DRESS, relatively little is known about long-term outcomes after complete resolution of the disease. OBJECTIVE: The aim of this study was to retrospectively analyze complications and sequelae in the early and late phases of DIHS/DRESS according to treatment. METHODS: In all, 34 patients were classified into 2 groups: 14 patients with oral corticosteroid treatment; and 20 with noncorticosteroid treatment. The disease time course was divided into 2 periods: the first 6 months after onset of the drug reaction (early phase); and the period thereafter (late phase). Investigations to detect the presence of viral/bacterial infectious diseases, organ dysfunction, and autoantibodies were performed in both early and late phases. RESULTS: Herpesvirus infections and pneumonia were detected in 6 and 2 patients, respectively, in the corticosteroid treatment group in the early phase. In the noncorticosteroid treatment group, 2 patients developed autoimmune diseases, namely lupus erythematosus and autoimmune thyroiditis. Autoantibodies were detected in 44.4% of patients examined in the late phase of the disease. LIMITATIONS: This study only evaluated a small number of autoantibodies. CONCLUSION: The need for anti-inflammatory effects from systemic corticosteroids should be balanced with the risk of infectious diseases and the benefits of preventing the appearance of later autoimmune conditions in patients with DIHS/DRESS.
Assuntos
Corticosteroides/uso terapêutico , Toxidermias/tratamento farmacológico , Toxidermias/imunologia , Hipersensibilidade a Drogas/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Adulto , Idoso , Anticorpos Antivirais/sangue , Autoanticorpos/sangue , Toxidermias/complicações , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/imunologia , Eosinofilia/complicações , Eosinofilia/imunologia , Feminino , Herpesvirus Humano 6/imunologia , Herpesvirus Humano 6/isolamento & purificação , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções por Roseolovirus/complicações , Infecções por Roseolovirus/imunologia , Síndrome , Tireoidite Autoimune/complicações , Resultado do TratamentoAssuntos
DNA Viral/sangue , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4 , Linfoma Difuso de Grandes Células B/complicações , Síndrome de Stevens-Johnson/complicações , Carga Viral , Infecções por Vírus Epstein-Barr/virologia , Feminino , Humanos , Linfoma Difuso de Grandes Células B/sangue , Linfoma Difuso de Grandes Células B/virologia , Pessoa de Meia-Idade , Síndrome de Stevens-Johnson/tratamento farmacológicoRESUMO
Dermatomyositis (DM) is an autoimmune disease manifested by muscle weakness and characteristic cutaneous eruptions. Cytomegalovirus (CMV) belongs to the ß-herpesvirinae subfamily of herpesviridae that cause morbidity and mortality in immunocompromised patients. With respect to the relationship between CMV and DM, it remains unknown whether CMV plays a pathogenetic role or whether CMV disease is an opportunistic infection due to immunosuppressive treatment. We report two patients with DM who developed cutaneous CMV ulcers within one month after the initiation of systemic corticosteroid treatment. In this context, we retrospectively studied the clinical characteristics of six DM patients with CMV reactivation and the effect of corticosteroid treatment on CMV reactivation in these patients. We also examined possible predictive parameters of CMV reactivation during the course of DM. Our results suggest that CMV reactivation occurs more frequently in DM patients than previously recognized; CMV reactivation occurs regardless of the dosage and duration of corticosteroid administration or the presence of underlying disease. Furthermore, our study shows that a reduction in platelets, serum globulin and IgG levels during the course of DM may be useful predictive parameters for CMV reactivation in patients with DM.
Assuntos
Infecções por Citomegalovirus/epidemiologia , Dermatomiosite/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Citomegalovirus/fisiologia , Dermatomiosite/sangue , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Evolução Fatal , Glucocorticoides/administração & dosagem , Humanos , Imunoglobulina G/sangue , Neoplasias Pulmonares/epidemiologia , Masculino , Contagem de Plaquetas , Prednisolona/administração & dosagem , Recidiva , Ativação ViralRESUMO
Toxic epidermal necrolysis (TEN) is a life-threatening, drug-induced disorder characterized by severe epidermal injury. Although there is no standard therapeutic intervention in TEN, plasmapheresis (PP) is being used increasingly to treat extremely ill TEN patients. In addition to conventional PP, double-filtration PP (DFPP) has been recently used for severe and refractory TEN. In this review, we focus on the clinical usefulness of PP by both demonstrating three cases of TEN refractory to conventional therapies, who were successfully treated with conventional PP or DFPP, and evaluating its therapeutic efficiency. We also provide evidence to suggest the mechanisms of action of PP by investigating the correlation between disease intensity and serum cytokine levels before and after treatment with PP or DFPP in these patients with TEN. At present, PP is a much more effective option for treatment of severe and/or recalcitrant TEN than any other treatment, such as pulsed corticosteroids and i.v. immunoglobulin.
Assuntos
Citocinas/sangue , Plasmaferese/métodos , Síndrome de Stevens-Johnson/terapia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/sangue , Resultado do TratamentoRESUMO
Drug-induced hypersensitivity syndrome (DIHS) is a severe systemic reaction with several herpesvirus reactivations. Multiple organ failures appear during the course of the disease. The severity of DIHS is determined by the degree of visceral involvement. Autoimmune diseases also develop several months to years after the apparent clinical resolution of DIHS.
Assuntos
Doenças Autoimunes/induzido quimicamente , Doenças do Sistema Digestório/induzido quimicamente , Hipersensibilidade a Drogas/complicações , Insuficiência de Múltiplos Órgãos/induzido quimicamente , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Diabetes Mellitus Tipo 1/induzido quimicamente , Doenças do Sistema Digestório/etiologia , Hipersensibilidade a Drogas/diagnóstico , Cardiopatias/induzido quimicamente , Herpesviridae/fisiologia , Infecções por Herpesviridae/induzido quimicamente , Infecções por Herpesviridae/virologia , Nefropatias/induzido quimicamente , Pneumopatias/induzido quimicamente , Lúpus Eritematoso Sistêmico/induzido quimicamente , Meningoencefalite/induzido quimicamente , Insuficiência de Múltiplos Órgãos/virologia , Fatores de Risco , Escleroderma Sistêmico/induzido quimicamente , Síndrome , Tireoidite/induzido quimicamente , Fatores de Tempo , Ativação ViralAssuntos
Aciclovir/análogos & derivados , Corticosteroides/efeitos adversos , Antivirais/efeitos adversos , Eritema Multiforme/induzido quimicamente , Eritema Multiforme/virologia , Herpes Labial/complicações , Herpes Labial/tratamento farmacológico , Valina/análogos & derivados , Aciclovir/administração & dosagem , Aciclovir/efeitos adversos , Adolescente , Corticosteroides/administração & dosagem , Antivirais/administração & dosagem , Humanos , Masculino , Valaciclovir , Valina/administração & dosagem , Valina/efeitos adversosAssuntos
Alelos , Hipersensibilidade a Drogas/genética , Antígenos HLA-B/genética , Síndrome de Stevens-Johnson/genética , Alopurinol/efeitos adversos , Anticonvulsivantes/efeitos adversos , Povo Asiático/genética , Carbamazepina/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas , Supressores da Gota/efeitos adversos , Humanos , Japão , Síndrome , Ativação Viral/efeitos dos fármacosRESUMO
Mycoplasma pneumoniae infection is one of the most common etiologic agents of respiratory tract diseases. Although the respiratory symptoms of this infection commonly are mild, it often is accompanied by various extrapulmonary complications including arthritis and cutaneous manifestations. We report 3 patients with M pneumoniae infection in a single family who revealed erythema nodosum, anaphylactoid purpura, and acute urticaria, respectively. We discuss the similarity between these cutaneous manifestations caused by this infection and those caused by viral infections, and the responsible factors for producing different cutaneous lesions by a single infectious agent in people with common genetic background. Age-related variations in cutaneous manifestations of M pneumoniae infections can be attributed to the immaturity of the adaptive immunity of a host, as has been suggested in viral infections.