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1.
BMJ Case Rep ; 14(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468501

RESUMO

Herein, we report a case of a 68-year-old woman receiving ibrutinib for chronic lymphocytic leukaemia, who presented with septic shock and a progressive necrotic lesion on her nose. Surgical pathology of the nasal lesion revealed evidence of tissue necrosis, and both tissue and blood culture grew Pseudomonas aeruginosa A diagnosis of ecthyma gangrenosum was made. Additional investigations also led to the discovery of invasive pulmonary aspergillosis. To our knowledge, this is the first case of ecthyma gangrenosum secondary to Pseudomonas sepsis and concurrent invasive pulmonary aspergillosis associated with ibrutinib use.


Assuntos
Adenina/análogos & derivados , Ectima/diagnóstico , Ectima/etiologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Piperidinas/efeitos adversos , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Adenina/efeitos adversos , Idoso , Feminino , Humanos , Necrose , Infecções por Pseudomonas/etiologia , Sepse/diagnóstico , Sepse/etiologia
3.
J Oncol Pharm Pract ; 26(2): 487-491, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31216242

RESUMO

INTRODUCTION: Ibrutinib is an oral inhibitor of Bruton's tyrosine kinase that is used for a variety of B cell hematological malignancies. Skin and subcutaneous tissue manifestations have been reported and were witnessed in up to 32% of the patients on ibrutinib. The mechanism in which ibrutinib can cause skin toxicities has been thought due to the inhibition of epidermal growth factor; c-Kit and platelet-derived growth factor receptor). Here, we report a case of an elderly chronic lymphocytic leukemia patient who developed multiple inflamed lesions and lower limb cellulitis in 100 days after initiating ibrutinib therapy. CASE REPORT: A 68-year-old male patient with relapsed chronic lymphocytic leukemia was started on ibrutinib 420 mg orally daily following multiple lines of therapy. Three months following ibrutinib, the patient developed multiple hyper pigmented lesions over both forearms then over both thighs; buttocks and lower limbs. The lesions were labeled as ecthyma and cellulitis that started as papules, which progressed to pustules. MANAGEMENT AND OUTCOMES: The patient required admission in which he received prolonged course of antibiotics. Biopsy from the wound showed soft tissue fragment infiltrated by acute and chronic inflammatory cells with necrosis; rare foreign body giant cells and granulation tissue formation; suggestive of abscess. Subsequently, ibrutinib was stopped permanently. DISCUSSION: This is the first case description of an ibrutinib-associated sever skin toxicity in Qatar. The provided information regarding the clinical descriptions of toxicity profiles in general and skin-based in particular is valuable information for daily clinical practice, especially when selecting the optimum first-line treatment for the patient.


Assuntos
Tirosina Quinase da Agamaglobulinemia/antagonistas & inibidores , Celulite (Flegmão)/induzido quimicamente , Ectima/induzido quimicamente , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Recidiva Local de Neoplasia/tratamento farmacológico , Pirazóis/efeitos adversos , Pirimidinas/efeitos adversos , Idoso , Celulite (Flegmão)/diagnóstico , Ectima/diagnóstico , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico , Masculino , Recidiva Local de Neoplasia/diagnóstico , Inibidores de Proteínas Quinases/uso terapêutico , Pele/efeitos dos fármacos , Pele/patologia
6.
Transpl Infect Dis ; 21(4): e13131, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31216602

RESUMO

Ecthyma gangrenosum (EG) is a serious bacterial infection in immunocompromised patients. EG in transplant recipients is rarely reported and may go unrecognized, which may delay initiation of appropriate treatment. We report a case of EG in a pediatric heart transplant recipient who was treated successfully with antibiotics and surgical debridement.


Assuntos
Ectima/diagnóstico , Transplante de Coração/efeitos adversos , Infecções por Pseudomonas/diagnóstico , Antibacterianos/uso terapêutico , Pré-Escolar , Desbridamento , Ectima/tratamento farmacológico , Ectima/microbiologia , Ectima/cirurgia , Humanos , Hospedeiro Imunocomprometido , Masculino , Infecções por Pseudomonas/tratamento farmacológico
8.
BMC Infect Dis ; 19(1): 85, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683071

RESUMO

BACKGROUND: Ecthyma gangrenosum is a cutaneous infectious usually associated with P. aeruginosa. It usually develops In patients with an underlying immunodeficiency. CASE PRESENTATION: A 50-year old mentally disabled white male with a history of epilepsy presented with fever and a painless red macule on his right arm which rapidly progressed to a painful ulcer. Blood and lesion cultures revealed P.aeruginosa, confirming our clinical diagnosis of ecthyma gangrenosum. Subsequently an underlying immune deficit was found, namely patient was diagnosed with hairy-cell leukemia. Despite adequate antibiotics no infection control could be achieved. After treating the underlying immune deficit as well, the infection and hairy-cell leukemia resolved completely. CONCLUSION: Ecthyma gangrenosum is an important cutaneous infection to recognize, because it is it is typically associated with P.aeruginosa bacteremia. Recognizing this skin leasion should prompt empiric antimicrobial therapy including an agent with antipseudomonal activity. Furthermore, just like in our case, the presence of ecthyma gangrenosum can signal the presence of an occult immune deficit, warranting further investigation.


Assuntos
Ectima/diagnóstico , Leucemia de Células Pilosas/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa , Antibacterianos/uso terapêutico , Ectima/microbiologia , Febre/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/tratamento farmacológico
12.
Artigo em Inglês | MEDLINE | ID: mdl-30559311

RESUMO

X-linked agammaglobulinemia (XLA, OMIM#300300) is a rare monogenic primary immunodeficiency caused by mutations in the Bruton tyrosine kinase (BTK) gene. XLA is characterized by insufficient immunoglobulin levels and susceptibility to life-threatening bacterial infections. We report on a patient that presented with ecthyma gangrenosum and septicemia. Rapid trio whole-genome sequencing (rWGS) revealed an apparently de novo hemizygous pathogenic variant (c.726dupT; p.Ile243TyrfsTer15) in the BTK gene. Metagenomic analysis of rWGS sequences that did not align to the human genome revealed 770 aligned to the Pseudomonas aeruginosa PAO1 genome. The patient was diagnosed with XLA and pseudomonal sepsis.


Assuntos
Tirosina Quinase da Agamaglobulinemia/genética , Agamaglobulinemia/genética , Ectima/genética , Doenças Genéticas Ligadas ao Cromossomo X/genética , Tirosina Quinase da Agamaglobulinemia/metabolismo , Agamaglobulinemia/diagnóstico , Bacteriemia , Ectima/diagnóstico , Gangrena/microbiologia , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Humanos , Síndromes de Imunodeficiência , Lactente , Masculino , Infecções por Pseudomonas/genética , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/patogenicidade , Sepse/genética , Sepse/metabolismo , Pele/microbiologia , Sequenciamento Completo do Genoma/métodos
14.
Pan Afr Med J ; 30: 95, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30344879

RESUMO

Ecthyma gangrenosum (EG) is a severe potentially lethal cutaneous infection that progresses sequentially from maculopapular rash to haemorrhagic bulla and then to necrotic ulceration with surrounding erythema. It usually occurs in immunocompromised patients (aplasia secondary to chemotherapy, HIV infection, neutropenia or functional deficit of neutrophils, agammaglobulinemia). It rarely affects healthy people. Differential diagnosis includes leishmaniasis, pyoderma gangrenosum, eschars and papulonecrotic tuberculides. Blood cultures and/or local sample allow the isolation of P. aeruginosa, which is the causative germ. Treatment is based on suitable parenteral antibiotic therapy according to results of susceptibility tests (third-generation cephalosporins, fluoroquinolones). We here report the case of a 2-year old child with no particular past medical history presenting with multiple necrotic ulcers on the back with erythematous border evolving in a febrile context. Blood culture was negative. Laboratory tests showed sedimentation rate 30 mm, CRP 80mg/l. Bacteriological sampling of pus revealed pseudomonas aeruginosa. The diagnosis of ecthyma gangrenosum was made. The patient underwent parenteral third-generation cephalosporins. Complete patient recovery with healing occurred after 4 weeks.


Assuntos
Ectima/diagnóstico , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Pré-Escolar , Diagnóstico Diferencial , Ectima/tratamento farmacológico , Ectima/microbiologia , Humanos , Masculino , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Resultado do Tratamento
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