Stevens Johnson Syndrome versus Jarisch Herxheimer Reaction in an HIV Positive Patient with Secondary Syphilis.

BACKGROUND: HIV positive patients can suffer many complications due to infectious diseases. A sever drug reaction to some of the drugs involved in the treatment can overlap the symptoms of the infections, making the diagnosis very difficult. We present the case of a 28-year-old-man, HIV positive, with secondary syphilis, who developed a Stevens Johnson Syndrome (SJS) caused by one of the many drugs he received. The SJS was overlapped with a possible Jarisch Herxheimer Reaction, which complicated the diagnosis of the skin reaction. OBJECTIVE: In HIV+ patients, the overlapping of severe drug reactions and infectious diseases could be fatal, thus an accurate diagnosis is mandatory. MATERIAL AND METHODS: A Rapid Plasma Reagin Test (RPR), an ELISA test, a blood laboratory test, chest radiography and a skin biopsy were realized in order to diagnose the infectious disease and the cause of skin lesions. Intradermal tests and double blind challenge tests were realized in the allergy study. RESULTS: The laboratory tests confirmed the diagnosis of syphilis; the skin biopsy confirmed the cause of lesions, a severe allergic reaction as a SJS. The allergy study discharged all the drugs involved, except dypirone which wasn't proved in the study because of the severity of reaction, the high possibility to be the causative drug and the alternative of other similar drugs available. For the inflammatory response, HIV+ patients are especially susceptible to severe reaction, both infectious and allergic, as in this case. Thus, recent patents emphasize the interest in inflammatory molecules that cause inflammatory symptoms. CONCLUSIONS: Although the diagnose of SJS has established criteria, the possibility of overlapping with infectious illness and/or with its treatment, may complicate the diagnosis.

Anafilaxia: diagnóstico etiológico / Anaphylaxis: etiological diagnosis

Objetivos: El objetivo de este estudio es describir la epidemiología y las características clínicas de los casos de anafilaxia diagnosticados a lo largo de tres años en nuestra unidad de alergia. Material y métodos. Estudio observacional, retrospectivo y transversal considerando la etiología y las características clínicas de los pacientes mayores de 16 años diagnosticados de anafilaxia a lo largo de tres años en nuestra unidad de alergia. Resultados. De 10.047 pacientes revisados, 394 (3.92%) fueron diagnosticados de anafilaxia; 240 (61%) eran mujeres y 154 (39%), hombres. Edad media: 43 años (desviación estándar: 17). Antecedentes familiares (AF) y antecedentes personales (AP) de atopia: 24 y 32%, respectivamente. Diagnóstico etiológico: 214 (54.3%) casos provocados por medicamentos (101 [47%] por betalactámicos; 34 [15.9%] por pirazolonas), 86 (21.8%) por alergia a Anisakis simplex, 46 (11.7%) casos de sensibilización a alimentos (14 [30.4%] frutas, 11 [23.9%] frutos secos,7 [15.2%] crustáceos, 4 [8.7%] moluscos y 3 [6.5%] pescado), 16 (4.1%) de sensibilización a veneno de himenópteros, 9 (2.3%) de anafilaxia por ejercicio, 6 (1.5%) por látex y 5 (1.3%) por otras causas. En 12 pacientes (3%) no se encontró causa alguna de la anafilaxia. Sólo el 21,7% fue tratado con adrenalina. Conclusiones. Los medicamentos fueron la primera causa de anafilaxia en nuestro estudio. Anisakis fue el alérgeno individual identificado en mayor número de casos. El 3% de los casos correspondió a anafilaxia idiopática. Aunque la adrenalina es el fármaco de elección en el tratamiento de la anafilaxia, fue utilizado en menos de la cuarta parte de los casos.

Currant allergy and the Rosaceae-grass pollen allergy syndrome: a case report.

BACKGROUND: Despite the increasing use of currants in culinary recipes, currant allergy has rarely been reported. OBJECTIVES: To study a case of currant allergy and to explore cross-reactivity between grass pollen and Rosaceae family fruit allergens. METHODS: Skin prick tests to pollen and skin prick-to-prick tests with currants and peach were performed. Specific IgE levels were determined using the CAP method. We prepared a protein extract of 0.1 mg/mL in phosphate-buffered saline using red currant in the presence of protease inhibitors. Immunoblot inhibition studies were performed to explore cross-reactivity between grass pollen and currant allergens. RESULTS: Skin prick test results were positive to Dactylis, arizonic, and olive pollens. Results of skin prick-to-prick tests with fresh red and black currants were negative and positive, respectively, to peach. The specific IgE level was 5.7 KU/L to red currant and 2.92 KU/L to peach (CAP). Western blot analysis with red currant extract revealed specific IgE protein bands of 37 and 26 kDa. Preincubation of sera with extracts from red currant and peach inhibited both IgE bands, and preincubation with Dactylis pollen inhibited the 37-kDa band only. CONCLUSIONS: We report a case of allergy to grass pollen with an oral allergy syndrome involving several fruits from 2 different families of the Rosidae subclass confirmed by in vitro tests. Inhibition studies demonstrated cross-reactivity between different fruits (currant and raspberry) from the Rosidae subclass and were incomplete with grass pollen allergens.