Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Pioderma Gangrenoso , Quinolinas , Humanos , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Compostos de Fenilureia/efeitos adversosRESUMO
In dermatology, biologics that block signaling pathways of TNF-α, IL-4/IL13, IL-17s, and IL-23 are widely used for the treatment of several inflammatory skin diseases, such as atopic dermatitis and psoriasis. They have shown excellent efficacy with an acceptable safety profile. However, these biologics targeting pathogenic cytokines and their receptors could modulate immunological balance, leading to the development of other inflammatory or autoimmune skin diseases in some cases. In this study, we present a patient who suffered pemphigus vegetans and showed an exacerbation of pemphigus foliaceus after secukinumab loading for the treatment of complicated generalized pustular psoriasis and pyoderma gangrenosum.
Assuntos
Dermatite Atópica , Pênfigo , Psoríase , Pioderma Gangrenoso , Dermatopatias Vesiculobolhosas , Humanos , Pênfigo/complicações , Pênfigo/tratamento farmacológico , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/complicações , Psoríase/complicações , Psoríase/tratamento farmacológico , Dermatopatias Vesiculobolhosas/complicações , Dermatite Atópica/complicaçõesRESUMO
OBJECTIVE: To summarize clinical outcomes of paradoxical pyoderma gangrenosum (PG) onset in patients on biologic therapy. METHODS: The authors conducted MEDLINE and EMBASE searches using PRISMA guidelines to include 57 patients (23 reports). RESULTS: Of the included patients, 71.9% (n = 41/57) noted PG onset after initiating rituximab, 21.1% (n = 12/57) noted tumor necrosis factor α (TNF-α) inhibitors, 5.3% (n = 3/57) reported interleukin 17A inhibitors, and 1.8% (n = 1/57) reported cytotoxic T-lymphocyte-associated protein 4 antibodies. The majority of patients (94.3%) discontinued biologic use. The most common medications used to resolve rituximab-associated PG were intravenous immunoglobulins, oral corticosteroids, and antibiotics, with an average resolution time of 3.3 months. Complete resolution of PG in TNF-α-associated cases occurred within an average of 2.2 months after switching to another TNF-α inhibitor (n = 1), an interleukin 12/23 inhibitor (n = 2), or treatment with systemic corticosteroids and cyclosporine (n = 3), systemic corticosteroids alone (n = 1), or cyclosporine alone (n = 1). CONCLUSIONS: Further investigations are warranted to determine whether PG onset is associated with underlying comorbidities, the use of biologic agents, or a synergistic effect. Nevertheless, PG may develop in patients on rituximab or TNF-α inhibitors, suggesting the need to monitor and treat such adverse effects.
Assuntos
Terapia Biológica , Pioderma Gangrenoso , Corticosteroides/uso terapêutico , Terapia Biológica/efeitos adversos , Ciclosporinas/uso terapêutico , Humanos , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/terapia , Rituximab/efeitos adversos , Inibidores do Fator de Necrose Tumoral/efeitos adversosRESUMO
Pyoderma gangrenosum is a rare ulcerative dermatosis. It may be caused by some drugs, including small molecule tyrosine kinase inhibitors (TKIs). The aim of this study was to evaluate the reported evidence of pyoderma gangrenosum associated with the use of these drugs. A systematic electronic literature search of PubMed and Embase was conducted. In these databases, search terms describing pyoderma gangrenosum were combined with TKIs. Fifteen case reports (eight cases associated with sunitinib, two with imatinib, two with ibrutinib, one with gefitinib, one with pazopanib, and one with dabrafenib and trametinib) were identified over the 14 years. The average Naranjo score of these cases is 6.6, which indicates a probable adverse drug reaction. Pyoderma gangrenosum is a probable and reversible drug reaction associated with some TKIs. Detailed medical history can help to prompt diagnosis of drug-induced pyoderma gangrenosum. Clinicians should be aware of TKI-associated pyoderma gangrenosum when caring for the skin of oncologic patients undergoing therapy with kinase inhibitors.
Assuntos
Inibidores de Proteínas Quinases/efeitos adversos , Pioderma Gangrenoso/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidade do PacienteAssuntos
Antineoplásicos/efeitos adversos , Mesilato de Imatinib/efeitos adversos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/patologia , Feminino , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Pessoa de Meia-IdadeAssuntos
Colite Ulcerativa , Pioderma Gangrenoso , Anticorpos Monoclonais Humanizados , Criança , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Ciclosporina/uso terapêutico , Humanos , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/tratamento farmacológicoAssuntos
Colite Ulcerativa , Pioderma Gangrenoso , Anticorpos Monoclonais Humanizados , Criança , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Ciclosporina/uso terapêutico , Humanos , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/tratamento farmacológicoRESUMO
Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic dermatosis that has been reported in association with certain medications. Recognition of medications that trigger PG may help to better understand the pathogenesis of the condition and to provide earlier diagnosis and treatment for affected patients. Herein, we report a case of new-onset PG following initiation of the checkpoint inhibitor pembrolizumab for the treatment of metastatic cutaneous squamous cell carcinoma. Our case was resistant to intralesional corticosteroid therapy, but ultimately improved with systemic corticosteroids and cessation of pembrolizumab.
Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Carcinoma de Células Escamosas/tratamento farmacológico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Pioderma Gangrenoso/induzido quimicamente , Neoplasias Cutâneas/patologia , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/secundário , Humanos , Masculino , Micrometástase de Neoplasia/tratamento farmacológico , Neoplasias Parotídeas/secundário , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/patologia , Pele/patologiaRESUMO
Abstract Pyoderma gangrenosum associated to the use of cocaine/levamisole is a rare condition associated to their consumption. Cocaine use is frequent in Colombia, and the substance is contaminated with levamisole, an anthelmintic that increases the psychotropic effects and enhances its side effects. We present three clinical cases of patients with ulcerated lesions, in which the diagnosis was pyoderma gangrenosum secondary to the use of cocaine contaminated with levamisole. This called the attention of the health staff to investigate the abuse of substances in gangrenous pyoderma and also evidence that the interruption of consumption was the basis of management.
Assuntos
Humanos , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/tratamento farmacológico , Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Levamisol , ColômbiaRESUMO
Pyoderma gangrenosum associated to the use of cocaine/levamisole is a rare condition associated to their consumption. Cocaine use is frequent in Colombia, and the substance is contaminated with levamisole, an anthelmintic that increases the psychotropic effects and enhances its side effects. We present three clinical cases of patients with ulcerated lesions, in which the diagnosis was pyoderma gangrenosum secondary to the use of cocaine contaminated with levamisole. This called the attention of the health staff to investigate the abuse of substances in gangrenous pyoderma and also evidence that the interruption of consumption was the basis of management.
Assuntos
Transtornos Relacionados ao Uso de Cocaína , Cocaína , Pioderma Gangrenoso , Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Colômbia , Humanos , Levamisol , Pioderma Gangrenoso/induzido quimicamente , Pioderma Gangrenoso/tratamento farmacológicoRESUMO
Pyoderma gangrenosum (PG) is an inflammatory, ulcerative condition that is characterized by painful ulcers that commonly present on the lower extremities. Up to half of PG cases are associated with underlying systemic disease, including inflammatory bowel disease, various autoimmune conditions, and malignancy. Another well-known association is the manifestation of PG with recreational cocaine use, especially cocaine contaminated with the adulterant agent levamisole. Once utilized for its immunomodulatory capabilities, levamisole was withdrawn from the market in 2002. It has since been repurposed to potentiate the amphetamine-like effects and duration of cocaine and has reduced preparation cost. We present a 52-year-old woman with chronic maxillary sinusitis and cocaine use disorder presenting with a two-week history of painful ulcers on bilateral lower extremities, each with a purulent base and undermined, violaceous borders. Urine toxicology was positive for cocaine and serologic studies were positive for cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) and lupus anticoagulant. Underlying conditions, especially that of granulomatosis with polyangiitis, were considered and ultimately ruled out. The patient's lesions exhibited a marked response with a short course of oral corticosteroids, typical of PG associated with levamisole. This case highlights the crucial role that drug abstinence plays in the prevention of recurrence.