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1.
Cardiovasc Pathol ; 44: 107154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31760242

RESUMO

Although the cause of eosinophilic coronary periarteritis (ECPA) remains unclear, an allergic background is present in fewer patients than expected. A 50-year-old man with no history of allergy or symptoms suggestive of cardiac or respiratory disorders suddenly died shortly after oral administration of loxoprofen sodium. Autopsy showed eosinophilic coronary periarteritis in three main branches of the coronary arteries, characterized by eosinophil-predominant inflammation without fibrinoid necrosis or granulomatous change in the adventitia and its surroundings of the three main branches of the coronary arteries, in addition to the localized sign of bronchial asthma in the lung. Immunohistochemical examination showed that many mast cells positive for human mast cell tryptase were evident in the perivascular tissue containing peripheral nerve trunks. Whereas the blood concentration of loxoprofen sodium was within the therapeutic range, significant elevation of the serum histamine and tryptase levels was found. The present case suggests that eosinophilic coronary periarteritis may be caused by a type I allergic reaction in some patients and that loxoprofen sodium can trigger a life-threatening type I allergic reaction, including eosinophilic coronary periarteritis, leading to sudden unexpected death.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doença da Artéria Coronariana/induzido quimicamente , Vasos Coronários/efeitos dos fármacos , Morte Súbita Cardíaca/etiologia , Hipersensibilidade a Drogas/etiologia , Eosinofilia/induzido quimicamente , Fenilpropionatos/efeitos adversos , Dor de Ombro/tratamento farmacológico , Autopsia , Causas de Morte , Doença da Artéria Coronariana/imunologia , Doença da Artéria Coronariana/patologia , Vasos Coronários/imunologia , Vasos Coronários/patologia , Morte Súbita Cardíaca/patologia , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/patologia , Eosinofilia/imunologia , Eosinofilia/patologia , Evolução Fatal , Humanos , Masculino , Mastócitos/efeitos dos fármacos , Mastócitos/imunologia , Mastócitos/patologia , Pessoa de Meia-Idade
2.
Environ Toxicol ; 35(1): 27-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31498972

RESUMO

In 2011, a link between humidifier disinfectants and patients with idiopathic pulmonary fibrosis was identified in Korea, and Kathon was suggested as one of the causative agents. In this study, Kathon induced apoptotic cell death along with membrane damage at 24 h post-exposure. Additionally, on day 14 after a single instillation with Kathon, the total number of pulmonary cells and the levels of TNF-α, IL-5, IL-13, MIP-1α, and MCP-1α clearly increased in the lung of mice. The proportion of natural killer cells and eosinophils were significantly elevated in the spleen and the bloodstream, respectively, and the level of immunoglobulin (Ig) A, but not IgG, IgM, and IgE, dose-dependently increased. Therefore, we suggest that inhaled Kathon may induce eosinophilia-mediated disease in the lung by disrupting homeostasis of pulmonary surfactants. Considering that eosinophilia is closely related to cancer and fibrosis, further studies are needed to understand the relationship between them.


Assuntos
Desinfetantes/toxicidade , Eosinofilia/induzido quimicamente , Pulmão/efeitos dos fármacos , Surfactantes Pulmonares/metabolismo , Tiazóis/toxicidade , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular , Citocinas/imunologia , Eosinofilia/sangue , Eosinofilia/imunologia , Eosinófilos/citologia , Humanos , Imunoglobulina A/sangue , Exposição por Inalação/efeitos adversos , Pulmão/imunologia , Pulmão/metabolismo , Pulmão/patologia , Masculino , Camundongos , Camundongos Endogâmicos ICR
3.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527200

RESUMO

A 57-year-old man presented for an elective pacemaker upgrade, complicated by the discovery of device infection. He had a background of complex congenital heart disease, including replacement of heart valves, and was treated for presumed infective endocarditis that was later confirmed by echocardiography. Antibiotic treatment, with intravenous vancomycin, was given as per the tissue sample sensitivities. On day 24 of treatment he deteriorated clinically, with the evolution of recurrent fever, epigastric pain, diarrhoea, widespread pruritic rash, lymphadenopathy and severe hypoxia over the subsequent 7-10 days. Blood tests revealed development of a marked eosinophilia, transaminitis and rising inflammatory markers. Further radiological imaging was non-diagnostic. On the basis of these clinical and biochemical features a diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome was made. This led to the cessation of vancomycin, the offending agent and the referral for specialist immunology advice. He was subsequently treated with oral prednisolone and made a full recovery.


Assuntos
Endocardite Bacteriana/tratamento farmacológico , Eosinofilia/induzido quimicamente , Doenças das Valvas Cardíacas/tratamento farmacológico , Marca-Passo Artificial/efeitos adversos , Vancomicina/efeitos adversos , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Síndrome de Hipersensibilidade a Medicamentos , Eosinofilia/tratamento farmacológico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Infecções Relacionadas à Prótese/tratamento farmacológico , Valva Tricúspide/microbiologia , Vancomicina/uso terapêutico
4.
Psiquiatr. biol. (Internet) ; 26(2): 60-61, mayo-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-185031

RESUMO

Introducción: Además de agranulocitosis, el tratamiento con clozapina se asocia con eosinofilia. Aunque es un efecto secundario poco conocido, tiene una incidencia similar a la primera y además es potencialmente grave, ya que puede afectar a órganos diana como el hígado. Presentación del caso: Varón con sintomatología psicótica que tras varias semanas de ingreso comienza tratamiento con clozapina por la falta de respuesta farmacológica. Coincidiendo con el inicio de la misma presenta eosinofilia junto con un aumento de las enzimas hepáticas que alcanzan niveles tóxicos, por lo que se procede a su retirada. Discusión: La eosinofilia inducida por la clozapina puede ser periférica y benigna o puede infiltrar órganos diana como el hígado, desencadenando una hepatitis potencialmente mortal. Conclusiones: A pesar de que la hepatitis secundaria al tratamiento con clozapina puede ser fulminante, los controles seriados de las enzimas hepáticas no se incluyen en el protocolo de seguimiento de dicho tratamiento


Introduction: In addition to agranulocytosis, treatment with clozapine is associated with eosinophilia. Although it is a little-known side effect, it has an incidence similar to the former, and is also potentially serious, since it can affect target organs, such as the liver. Presentation of the case: A male with psychotic symptoms, on whom, after several weeks in hospital, it was decided to start clozapine due to the lack of pharmacological response. Coinciding with starting the drug, he presented with eosinophilia, as well as increased liver enzymes that reached toxic levels. The drug was then withdrawn. Discussion: Eosinophilia induced by clozapine may be peripheral and benign, or it may infiltrate target organs such as the liver, triggering potentially life-threatening hepatitis. Conclusions: Although hepatitis secondary to treatment with clozapine may be fulminant, serial liver enzyme tests are not included in the follow-up protocol for this treatment


Assuntos
Humanos , Masculino , Eosinofilia/induzido quimicamente , Clozapina/efeitos adversos , Transtornos Psicóticos/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/complicações , Olanzapina/uso terapêutico , Substituição de Medicamentos/métodos , Testes de Função Hepática/estatística & dados numéricos , Ensaios Enzimáticos/métodos
10.
Pediatr Dermatol ; 36(4): e99-e101, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31132165

RESUMO

Lymphadenopathy is a common sign for drug reaction and eosinophilia with systemic symptoms (DRESS) syndrome, but hilar and mediastinal lymphadenopathy may be underreported. We describe a 7-year-old boy who started taking ethosuximide for absence seizures and presented with diffuse rash, fever, elevated transaminases, facial swelling, and hilar and mediastinal lymphadenopathy. His mediastinal lymphadenopathy was concerning for lymphoma, which led to more invasive testing to rule out malignancy. This report highlights an unusual and likely underreported presenting sign of DRESS syndrome in children.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Epilepsia Tipo Ausência/tratamento farmacológico , Etossuximida/efeitos adversos , Linfadenopatia/induzido quimicamente , Biópsia por Agulha , Criança , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/patologia , Eosinofilia/induzido quimicamente , Eosinofilia/fisiopatologia , Epilepsia Tipo Ausência/diagnóstico , Etossuximida/uso terapêutico , Seguimentos , Humanos , Imuno-Histoquímica , Linfadenopatia/patologia , Linfadenopatia/fisiopatologia , Masculino , Mediastino/patologia , Recidiva , Medição de Risco
11.
Acta Dermatovenerol Croat ; 27(1): 28-32, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31032788

RESUMO

Cutaneous necrotizing eosinophilic vasculitis (CNEV) is a rare type of vasculitis. Eosinophilic vasculitis is a necrotizing vasculitis with eosinophilic vascular infiltration, in which eosinophils mediate vascular damage in the disease process. We present a case of an 18-year-old girl who developed palpable purpura and hemorrhagic bullae over the lower extremities associated with itching, 7 days after the commencement of penicillin therapy. Plasma cryofibrinogen was positive. Histopathology showed an infiltration of eosinophils within and around the vessel walls and a complete absence of nuclear dust and neutrophils. Oral prednisone at 1 mg/kg induced remission in 2 weeks; the prednisone dose was tapered and discontinued after 2.5 months. There was no evidence of recurrence after 37 months of follow-up. Our patient represents a rare case of drug/penicillin-induced CNEV associated with cryofibrinogenemia, without systemic organ involvement.


Assuntos
Antibacterianos/efeitos adversos , Crioglobulinemia/complicações , Eosinofilia/induzido quimicamente , Penicilinas/efeitos adversos , Vasculite/induzido quimicamente , Adolescente , Crioglobulinemia/diagnóstico , Crioglobulinemia/terapia , Eosinofilia/diagnóstico , Eosinofilia/terapia , Feminino , Humanos , Vasculite/diagnóstico , Vasculite/terapia
12.
J Am Acad Dermatol ; 81(1): 143-151, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30825533

RESUMO

BACKGROUND: Dupilumab is the first biologic available to treat atopic dermatitis (AD). Its effectiveness and safety were demonstrated in clinical trials. OBJECTIVE: We sought to assess the effectiveness and safety of dupilumab in adults with AD in a real-life French multicenter retrospective cohort. METHODS: We included patients treated during March 2017-April 2018. Efficacy outcomes, including Scoring Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI) scores, were collected at baseline and 3 months when available. Adverse events (AEs) were recorded at follow-up. RESULTS: We included 241 patients. The median ± interquartile range (IQR) follow-up time was 3.8 ± 3.7 months. A ≥75% improvement in SCORAD was achieved in 27 of 163 (16.6%) patients, and a ≥75% improvement in EASI was achieved in 40 of 82 (48.8%) patients. The median SCORAD and EASI scores at 3 months were significantly lower than those at baseline (SCORAD ± IQR, 25 ± 21 vs 56 ± 27.4, P < 10-9 and EASI ± IQR, 4.1 ± 6.8 vs 17.9 ± 15.4, P < 10-9, respectively). Conjunctivitis was reported in 84 of 241 (38.2%) patients. The proportion with eosinophilia (>500 cells/mm3) during follow-up (57%) was higher than that at baseline (33.7%) (n = 172, P < 10-6). Dupilumab was stopped in 42 cases; 27 patients stopped because of AEs. LIMITATIONS: No control group, missing data. CONCLUSION: This real-life study demonstrated a similar dupilumab effectiveness as that seen in clinical trials, but it also revealed a higher frequency of conjunctivitis and eosinophilia.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Conjuntivite/induzido quimicamente , Dermatite Atópica/tratamento farmacológico , Eosinofilia/induzido quimicamente , Segurança do Paciente/estatística & dados numéricos , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Estudos de Coortes , Conjuntivite/epidemiologia , Dermatite Atópica/diagnóstico , Relação Dose-Resposta a Droga , Esquema de Medicação , Eosinofilia/epidemiologia , Feminino , França , Humanos , Injeções Subcutâneas , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença
13.
Curr Drug Saf ; 14(3): 249-251, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30848209

RESUMO

BACKGROUND: Among the first line Anti-Tubercular Drugs (ATDs), ethambutol has been rarely associated to cause drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. CASE REPORT: A 34-year-old woman presented in an out-patient department of Dermatology with fever, skin eruptions, eosino- philia, hyperinflated lung fields and deranged liver enzymes after 35 days of the initiation of ATDs. The patient recovered completely after stopping ethambutol and administration of topical and sys- temic corticosteroids. RESULTS AND CONCLUSION: Based on the available evidences of de-challenge and re-challenge of suspected drugs, ethambutol was certainly implicated to cause DRESS syndrome.


Assuntos
Eosinofilia/induzido quimicamente , Etambutol/efeitos adversos , Exantema/induzido quimicamente , Adulto , Feminino , Febre/induzido quimicamente , Humanos
14.
PLoS Negl Trop Dis ; 13(3): e0007230, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30860995

RESUMO

BACKGROUND: Strongyloides stercoralis infection, a neglected tropical disease, is widely distributed. Autochthonous cases have been described in Spain, probably infected long time ago. In recent years the number of diagnosed cases has increased due to the growing number of immigrants, travelers and refugees, but endemically acquired cases in Spain remains undetermined. METHODOLOGY: We systematically searched the literature for references on endemic strongyloidiasis cases in Spain. The articles were required to describe Strongyloides stercoralis infection in at least one Spanish-born person without a history of travel to endemic areas and be published before 31st May 2018. Epidemiological data from patients was collected and described individually as well as risk factors to acquisition of the infection, diagnostic technique that lead to the diagnosis, presence of eosinophilia and clinical symptoms at diagnosis. FINDINGS: Thirty-six studies were included, describing a total of 1083 patients with an average age of 68.3 years diagnosed with endemic strongyloidiasis in Spain. The vast majority of the cases were described in the province of Valencia (n = 1049). Two hundred and eight of the 251 (82.9%) patients in whom gender was reported were male, and most of them had current or past dedication to agriculture. Seventy percent had some kind of comorbidity. A decreasing trend in the diagnosed cases per year is observed from the end of last decade. However, there are still nefigw diagnoses of autochthonous cases of strongyloidiasis in Spain every year. CONCLUSIONS: With the data provided by this review it is likely that in Spain strongyloidiasis might have been underestimated. It is highly probable that the infection remains undiagnosed in many cases due to low clinical suspicion among Spanish population without recent travel history in which the contagion probably took place decades ago.


Assuntos
Doenças Endêmicas , Eosinofilia/diagnóstico , Eosinofilia/epidemiologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/epidemiologia , Idoso , Animais , Eosinofilia/induzido quimicamente , Eosinofilia/parasitologia , Fezes/parasitologia , Feminino , Humanos , Masculino , Fatores de Risco , Espanha/epidemiologia , Escarro/parasitologia , Estrongiloidíase/parasitologia
15.
J Am Acad Dermatol ; 81(1): 123-128, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30738120

RESUMO

BACKGROUND: Although hypersensitivity reactions are well characterized for certain medications, vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), has yet to be defined. OBJECTIVE: To better define the clinical phenotype of vancomycin-associated DIHS. METHODS: A retrospective case series was conducted over an 8-year period at a single, academic institution. A total of 29 cases of DIHS/DRESS were identified, of which 4 were attributed to vancomycin. A literature review was performed; it identified 28 additional cases of vancomycin-induced DIHS. Vancomycin-associated acute interstitial nephritis was also reviewed to detect additional, previously uncharacterized cases of systemic hypersensitivity. The review yielded 11 additional cases. RESULTS: In this literature review and retrospective series, the incidence of renal dysfunction among vancomycin-induced cases (75% and 68% of cases in the series and literature, respectively) was notably higher than the overall reported incidence in DIHS (10%-40%). The degree of renal impairment was also significantly increased in the retrospective series (a median 4.98-fold change in baseline creatinine level vs a 2.25-fold increase in non-vancomycin-associated cases [P = .011]). LIMITATIONS: The principal limitation of this study is the small sample size. Other notable limitations include the retrospective nature of the study and absence of confirmatory renal biopsies. CONCLUSION: Although the current understanding of DIHS/DRESS is imperfect, our findings suggest that vancomycin-induced cases present with a unique phenotype characterized by a higher burden of renal involvement.


Assuntos
Síndrome de Hipersensibilidade a Medicamentos/epidemiologia , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Vancomicina/efeitos adversos , Centros Médicos Acadêmicos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Síndrome de Hipersensibilidade a Medicamentos/fisiopatologia , Eosinofilia/induzido quimicamente , Eosinofilia/epidemiologia , Eosinofilia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Estados Unidos , Vancomicina/uso terapêutico , Adulto Jovem
20.
J Pharm Pract ; 32(2): 228-230, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29390946

RESUMO

PURPOSE: Drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiepileptic drug use and is a rare but life-threatening side effect. We present a case of phenobarbital-induced DRESS in a patient who subsequently required phenobarbital and was successfully desensitized. SUMMARY: A 5-year-old male presented with medically refractory status epilepticus (SE). He had been trialed on several antiepileptic medications without achieving burst suppression. Burst suppression was achieved with a pentobarbital infusion, and thus, phenobarbital was initiated as the pentobarbital was weaned. After five days of phenobarbital, the patient developed signs and symptoms concerning for DRESS; a punch biopsy confirmed the drug reaction. Two months later, he again developed SE unresponsive to antiepileptic infusions. Burst suppression was achieved with pentobarbital, and it was decided to transition the patient to phenobarbital. Due to concerns of phenobarbital-induced DRESS, the patient underwent a phenobarbital desensitization consisting of 6 doses sequentially administered in 10-fold increasing concentrations before achieving therapeutic dosing. Three days later, the patient achieved therapeutic phenobarbital levels, was weaned off of pentobarbital, and remained seizure-free without recurrence of DRESS. CONCLUSIONS: Graded desensitization may be an option to minimize recurrence of DRESS in patients where avoidance of the offending agent is not possible.


Assuntos
Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/terapia , Eosinofilia/induzido quimicamente , Fenobarbital/efeitos adversos , Fenobarbital/uso terapêutico , Estado Epiléptico/tratamento farmacológico , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Pré-Escolar , Hipersensibilidade a Drogas/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Masculino , Resultado do Tratamento
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