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1.
Adv Emerg Nurs J ; 43(1): 28-34, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33952873

RESUMO

The CoVID-19 pandemic has impacted all areas of health care, especially emergency medicine. Most commonly, CoVID-19 is associated with respiratory and typical viral presentations. However, nonrespiratory presentations are becoming more common. Reported CoVID-19 dermatological changes include maculopapular and urticarial rashes, chilblain-like and livedo reticularis discolorations, and less commonly vesicular and petechial rashes. As frontline clinicians, emergency nurse practitioners should be aware of these skin findings to recognize potentially infected and otherwise asymptomatic patients. Early recognition could potentially lead to an earlier diagnosis and limit the spread of severe acute respiratory syndrome coronavirus 2.


Assuntos
COVID-19/complicações , Exantema/diagnóstico , COVID-19/virologia , Diagnóstico Diferencial , Exantema/tratamento farmacológico , Exantema/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
2.
Am J Case Rep ; 22: e928930, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33824265

RESUMO

BACKGROUND Iodine contrast allergy can cause acute and delayed allergic reactions. Just like any other sensitivity reaction, the severity can vary from mild to moderate skin manifestations such as erythematous rash to an even more severe presentation or life-threatening event, such as angioedema and anaphylaxis. CASE REPORT This case report discusses a patient who presented to our institution with a diffuse complex rash 2 days after undergoing CT scan imaging with intravenous iodine contrast injection. The rash started by being maculopapular in nature. Later on, the patient developed a purpuric and petechial pattern, and eventually, an acute exanthematous pustulosis rash was noticed. Several attempts to treat the patient with intravenous corticosteroids failed. Three days after admission (5 days after the rash started), topical steroids were used in place of parenteral steroids. The rash showed remarkable improvement in a very short time. The patient was diagnosed with delayed hypersensitivity IV iodine reaction, resistant to parenteral corticosteroids. The workup of such an extensive rash and odd presentation include several laboratory tests and skin testing to be able to rule out more serious differential diagnoses. CONCLUSIONS This case is unique as it enables us to show the importance of substituting topical management, more specifically, topical steroids that might even replace parenteral steroids, to our management in order to treat allergic reactions, especially in the presence of a rash.


Assuntos
Anafilaxia , Exantema , Iodo , Administração Tópica , Exantema/induzido quimicamente , Exantema/tratamento farmacológico , Humanos , Iodo/efeitos adversos , Esteroides
3.
Int J Pediatr Otorhinolaryngol ; 143: 110638, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33561701

RESUMO

OBJECTIVES: To determine whether current guidelines emphasizing antibiotic stewardship in pediatrics have been associated with reduced prevalence of antibiotic allergies in children severely affected by otitis media undergoing bilateral myringotomy with tympanostomy tube insertion (BMT) or by recurrent sinusitis or adenotonsillitis undergoing adenoidectomy with or without tonsillectomy. METHODS: Case series of consecutive patients undergoing BMT or adenoidectomy with/without tonsillectomy for recurrent acute otitis media, recurrent sinusitis, or recurrent tonsillitis during November 2008 or November 2017 at a tertiary care children's hospital. Children with primarily obstructive indications for surgery, with prior tube placement or adenoidectomy, or with surgery by an outside provider were excluded. Demographics, type of surgery, and allergies or allergic symptoms were collected from the electronic medical record. Factors associated with antibiotic allergies were compared using logistic regression, Wilcoxon rank-sum, or Chi-squared test. RESULTS: Seventy-five children who underwent surgery during 2008 and 75 children who underwent surgery in 2017 were included. Overall, median age at surgery was 3.24 years (range 0.56-17.49 years). Seventy-nine (52.7%) patients were female and 95 (63.3%) had private insurance. BMT was the most common surgery (82 children, 54.7%) followed by tonsillectomy with adenoidectomy (46 children, 30.7%), and adenoidectomy without tonsillectomy (39 children, 26.0%). Symptoms of allergic rhinitis were reported by 53 (35.3%) patients, and 11 (7.3%) and 5 (3.3%) had positive environmental and food allergy testing, respectively. Surprisingly, there was not a significant difference between the prevalence of antibiotic allergies in patients undergoing surgery during 2017 (17 patients, 22.7%) compared with 2008 (14 patients, 18.7%) (OR: 1.28, 95% CI: 0.578-2.82, p = 0.546). However, antibiotic allergies were less common in females (OR: 0.413, 95% CI: 0.182-0.937, p = 0.034) and more common in patients with a family history of antibiotic allergies (OR: 36.9, 95% CI: 5.12-∞, p < 0.001). CONCLUSION: Pediatric otolaryngology surgical patients continue to exhibit a similar and high prevalence of antibiotic allergies in 2017 compared with 2008. Future studies are needed to determine whether this is because of overdiagnosis of antibiotic allergies or a failure of antibiotic guideline adherence to reduce antibiotic allergy prevalence.


Assuntos
Gestão de Antimicrobianos , Exantema , Adenoidectomia , Adolescente , Antibacterianos/efeitos adversos , Criança , Pré-Escolar , Exantema/tratamento farmacológico , Feminino , Humanos , Lactente , Masculino , Tonsilectomia/efeitos adversos
4.
Eur J Oncol Nurs ; 50: 101896, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33493993

RESUMO

PURPOSE: To investigate the effectiveness of different interventions for the prevention and treatment of EGFRI treatment-induced rash (EGFRIr) that appeared in the last decade, excluding antibiotics and steroids products alone. METHOD: A systematic review was performed in 2019 and was updated in 2020. The search strategy was limited to studies published within the last 10 years on the Medline database accessed via Pubmed and the Cochrane database. The search was performed using keywords combined with AND, OR. RESULTS: The search yielded thirteen studies. The studies were divided into two categories, based on the intervention method used: four studies used creams containing vitamin K1 or vitamin K3 (henceforth classified as "Category A″) and nine studies ("Category B″) focused on different intervention methods such as laser treatment, Polydatin (PD) cream treatment, treatment with sunscreen, Adapalene gel treatment, topical aloe vera treatment, topical hydration treatment, the impact of a pre-emptive skin treatment and, finally, epidermal growth factor (EGF) ointment treatment. From "Category A″, the results vary as two studies found no benefit from cream use, while two studies indicated a possible improvement on skin reactions from cream use. In "Category B″, a benefit due to laser treatment was indicated, Polydatin-containing moisturizer showed a reduction in the incidence of rash grade ≥ II in patients treated with afatinib, while treatment with sunscreen demonstrated no benefit for the prevention of EGFRIr. Additionally, Adapalene gel use is not recommended as prophylaxis for EGFRIr, topical aloe vera may be used in the management for EGFRIr due to cetuximab, topical hydration resolved the EFGRIr, the pre-emptive skin treatment routine was well tolerated and the epidermal growth factor ointment improved all the symptoms due to EGFRI. CONCLUSIONS: The results from the studies vary, although this study focuses on reviewing treatment interventions that can be utilized, apart from antibiotics and steroids, in order to alleviate the problems of the patients suffering from EGFRIr. More specifically, the authors of this review cannot draw a conclusion from "Category A″, as the efficacy of vitamin K for the management of EGFRIr is controversial. From "Category B″, some of the suggested treatments show encouraging results, while others may prove ineffective and rather harmful for the patients.


Assuntos
Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Erupção por Droga/tratamento farmacológico , Exantema/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Administração Tópica , Receptores ErbB/antagonistas & inibidores , Exantema/induzido quimicamente , Humanos
6.
BMC Infect Dis ; 21(1): 17, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407199

RESUMO

BACKGROUND: Hydroa Vacciniforme-like Lymphoproliferative Disorder (HV-LPD) is the name given to a group of Epstein-Barr virus (EBV)-associated diseases. It resembles hydroa vacciniforme (HV), the rarest form of photosensitivity, and is a T-cell disorder associated with an Epstein-Barr virus infection. The majority of diagnosed cases occur in East Asia and South America. It is rare in the United States and Europe. Multiple studies have revealed the clinical manifestation of an enlarged liver, but no gold standard such as pathology has yet supported this as a clinical sign of HV-LPD. CASE PRESENTATION: Here, we report a case of a 34-year-old Asian female with definite liver invasion. The patient had complained of a recurring facial rash for many years. The patient was admitted to the hospital because of an enlarged liver. After hospitalization, she was given an EB virus nucleic acid test. The EB virus nucleic acid test was positive, and pathological examination suggested that HV-LPD had invaded the skin, bone marrow, and liver. After being given antiviral treatment, the patient's symptoms were mitigated. CONCLUSIONS: Our case confirms the liver damage was caused by HV-LPD and the effectiveness of antiviral treatment.


Assuntos
Medula Óssea/patologia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Herpesvirus Humano 4/genética , Hidroa Vaciniforme/complicações , Hidroa Vaciniforme/diagnóstico , Fígado/patologia , Transtornos Linfoproliferativos/complicações , Transtornos Linfoproliferativos/diagnóstico , Adulto , Antivirais/uso terapêutico , Pequim , Medula Óssea/virologia , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Infecções por Vírus Epstein-Barr/virologia , Exantema/complicações , Exantema/tratamento farmacológico , Feminino , Hepatomegalia/tratamento farmacológico , Hepatomegalia/virologia , Humanos , Hidroa Vaciniforme/tratamento farmacológico , Hidroa Vaciniforme/patologia , Fígado/virologia , Linfoma de Células T/complicações , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/virologia , Transtornos Linfoproliferativos/tratamento farmacológico , Transtornos Linfoproliferativos/patologia , Pele/patologia , Resultado do Tratamento
7.
BMJ Case Rep ; 13(10)2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33122237

RESUMO

A 50-year-old man presented to our dermatology clinic with itchy skin rash. The rash began 5 days after systemic symptoms appeared such as mild fever and mild dyspnoea. The rashes were a characteristic of follicular eruption, which started on his stomach and spread all over his body. After a thorough evaluation, he was diagnosed with COVID-19 and was started on COVID-19 regimens. Skin lesions disappeared on the ninth day of treatment. Our findings contribute to the growing awareness of dermatological manifestations in patients with COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Exantema/diagnóstico , Pneumonia Viral/diagnóstico , Dermatopatias Virais/diagnóstico , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Diagnóstico Diferencial , Quimioterapia Combinada , Dispneia/diagnóstico , Dispneia/etiologia , Exantema/tratamento farmacológico , Febre/diagnóstico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Dermatopatias Virais/tratamento farmacológico , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(35): e21810, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871902

RESUMO

RATIONALE: The clinical manifestations of the SARS-CoV-2 infection are mainly respiratory but the virus can cause a variety of symptoms. Dermatological findings are less well-characterized. Data is scarce on their timing, type and correlation with the immune response. PATIENT CONCERNS: We present the case of SARS-CoV-2 infection in a previously healthy woman who presented with respiratory symptoms and developed anosmia, diarrhea, and an erythematous maculo-papular rash on day 15 from symptom onset. DIAGNOSIS: The nasopharyngeal swab tested by real time PCR for COVID-19 was positive. We interpreted this as a viral exanthema likely caused by an immune response to SARS-CoV-2 nucleotides. INTERVENTIONS: She was treated with Hydroxychloroquine, Azithromycin and Lopinavir/Ritonavir, and the rash with topical corticosteroids. OUTCOMES: All symptoms resolved except for anosmia which persisted for 6 weeks. At the 4- and 6-weeks follow-up the IgG titers for SARS-CoV-2 were high. LESSONS: We must consider that SARS-CoV-2 has a multi-organ tropism. In our case, the SARS-CoV-2 infection had lung, nasopharyngeal, neurological, digestive, and skin manifestations. Identifying the different manifestations is useful for understanding the extent of SARS-CoV-2 infection. We not only present a rare manifestation but also suggest that cutaneous manifestations may correlate with immunity.


Assuntos
Azitromicina/administração & dosagem , Betacoronavirus , Infecções por Coronavirus , Exantema , Glucocorticoides/administração & dosagem , Hidroxicloroquina/administração & dosagem , Lopinavir/administração & dosagem , Pandemias , Pneumonia Viral , Ritonavir/administração & dosagem , Administração Tópica , Adulto , Antivirais/administração & dosagem , Betacoronavirus/imunologia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Combinação de Medicamentos , Exantema/diagnóstico , Exantema/tratamento farmacológico , Exantema/etiologia , Exantema/imunologia , Feminino , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Avaliação de Sintomas/métodos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(21): e20389, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481338

RESUMO

RATIONALE: Acute generalized exanthematous pustulosis (AGEP) is a severe pustular cutaneous adverse drug reaction. Sterile, non-follicular pustules overlying the erythematous skin characterize this reaction. PATIENT CONCERNS: A 30-year-old Asian women presented with sterile, non-follicular lesions with pus-fluid levels on her back 2 days after taking clindamycin. Skin biopsy revealed a spongiotic change in the epidermis with a focal subcorneal pustule and perivascular eosinophil and lymphocyte infiltration. DIAGNOSIS: Clindamycin-induced AGEP. INTERVENTIONS: We discontinued clindamycin treatment and prescribed systemic corticosteroids. OUTCOMES: The pustule stopped spreading within 1 day and the rash improved within 2 days. LESSONS: AGEP is a pustular cutaneous adverse drug reaction that can appear with pus-fluid levels, clinically mimicking Sneddon-Wilkinson disease. The differentiation between both conditions is a history of drug use, characteristic skin lesions and histopathology.


Assuntos
Pustulose Exantematosa Aguda Generalizada/etiologia , Clindamicina/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Clindamicina/uso terapêutico , Exantema/tratamento farmacológico , Exantema/etiologia , Exantema/fisiopatologia , Feminino , Humanos , Faringite/tratamento farmacológico
13.
J Immunother Cancer ; 8(1)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32066648

RESUMO

BACKGROUND: Immune checkpoint inhibitors such as nivolumab and targeted BRAF inhibitors have dramatically altered the treatment outcomes of metastatic melanoma over the past few years. Skin toxicity is the most common adverse event (AE) related to the commonly used BRAF inhibitor vemurafenib, affecting more than 90% of patients. Vemurafenib-related severe AEs with early onset are reported in patients who were previously treated with anti-programmed cell death-1 (anti PD-1) antibodies. A prolonged administration of systemic steroids is the first-line treatment of severe or life-threatening AEs. We report the case of a woman suffering from vemurafenib-related severe, rapidly worsening Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome, resolved in a few hours after single-dose administration of a combination of TNF-α antagonist infliximab with interleukin (IL)-6 receptor antagonist tocilizumab. CASE PRESENTATION: A 41-year-old woman treated with single-agent nivolumab presented with a melanoma progression. Biopsy samples were revised, revealing a BRAF V600E mutation. The patient was started on vemurafenib and cobimetinib treatment only 10 days after the last administration of nivolumab. On the third day of anti-BRAF therapy, profound lymphopenia was detected, and maculopapular eruption appeared afterward. Subsequently, the clinical conditions deteriorated further, and the woman was admitted on an emergency basis with high fever, respiratory and cardiocirculatory failure, diffuse rash, generalized edema, and lymphadenopathy. Diagnosis of DRESS syndrome with overexpressed capillary leakage was made. A single dose of tocilizumab was administered with an improvement of cardiocirculatory and renal function in a few hours. Because of worsening of liver function, skin lesions and mucositis, a single dose of infliximab was prescribed, and dramatic improvement was noted over the next 24 hours. Dabrafenib and trametinib were initiated, and coinciding with washout of infliximab from the patient's blood, the drug toxicity recurred. CONCLUSION: Anti-IL-6 and anti-TNF-α target treatment of very severe AEs may afford an immediate resolution of potentially life-threatening symptoms and reduce the duration and the costs of hospitalization. Maintenance of therapeutic infliximab blood concentrations permits an early switch to dabrafenib after vemurafenib-related AEs.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Eosinofilia/tratamento farmacológico , Exantema/tratamento farmacológico , Infliximab/uso terapêutico , Melanoma/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Eosinofilia/induzido quimicamente , Exantema/induzido quimicamente , Feminino , Humanos , Melanoma/imunologia , Nivolumabe/administração & dosagem , Prognóstico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/imunologia , Vemurafenib/administração & dosagem
16.
J Dermatol ; 47(2): 121-127, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31803963

RESUMO

Papulopustular rash, an acneiform rash, appears on the seborrheic region during the first to second week of treatment with an epidermal growth factor receptor inhibitor (EGFRi). The rash gradually disappears after the fourth week; however, it persists or newly develops in other regions during EGFRi treatment. Because Staphylococcus aureus is frequently isolated from late-phase papulopustular rash, we assessed the incidence of bacterial infection and treatment outcomes of patients with late-phase papulopustular rash. Sixty-four cases treated with an EGFRi over 4 weeks who presented with papulopustular rash were assessed retrospectively. The median duration of EGFR inhibitor treatment was 5 months. Grade 2 and 3 papulopustular rash was observed in 47 and eight cases, respectively. Bacterial culture was performed in 51 cases, 50 of which yielded positive results: methicillin-sensitive S. aureus in 29, methicillin-resistant S. aureus in 14, Staphylococcus species in five, Pseudomonas aeruginosa in three, and other in four cases. Of the S. aureus isolates, 42% were resistant to minocycline and 40% to levofloxacin. After treatment with topical and/or oral antibiotics without topical corticosteroids, the papulopustular rash rapidly improved by an average of 2.9 ± 3.4 weeks. However, use of a combination of antibiotics and a topical corticosteroid prolonged the recovery period to an average of 18.9 ± 11.4 weeks. In conclusion, folliculitis that develops over 4 weeks after the initiation of EGFRi treatment is typically caused by staphylococcal infection. Bacterial culture is necessary due to the high rate of antibiotic resistance. It is important to distinguish late- from early-phase papulopustular rash and to treat using different approaches.


Assuntos
Antibacterianos/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Exantema/diagnóstico , Foliculite/diagnóstico , Infecções por Pseudomonas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Cetuximab/efeitos adversos , Farmacorresistência Bacteriana , Receptores ErbB/antagonistas & inibidores , Exantema/tratamento farmacológico , Exantema/imunologia , Exantema/microbiologia , Feminino , Foliculite/tratamento farmacológico , Foliculite/imunologia , Foliculite/microbiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Panitumumabe/efeitos adversos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/imunologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/imunologia , Pseudomonas aeruginosa/isolamento & purificação , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/imunologia , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo
19.
Am J Dermatopathol ; 42(2): e22-e25, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31313693

RESUMO

Herein, we report a case of an adult male patient with a chronic and recurrent papulopustular eruption mainly involving the trunk and lower extremities. A dense superficial perifollicular inflammatory infiltrate with palisading necrobiotic granuloma formation and infundibular perforation was observed at the histological examination, with no granulomatous inflammatory infiltrates in deeper areas. The possibility that this peculiar clinicopathological presentation constitutes a case of generalized perforating granuloma annulare (PGA) or an individualized skin condition is discussed. The observation of a pustular follicular generalized PGA represents an exceedingly rare phenomenon and constitutes an infrequent subtype of PGA that can mimic pustular eruptions secondary to many different etiologies. The clinicopathological features of this rare variant may represent a diagnostic challenge, often requiring multiple biopsies to establish a definite diagnosis.


Assuntos
Exantema/patologia , Granuloma Anular/patologia , Acitretina/uso terapêutico , Idoso , Exantema/tratamento farmacológico , Granuloma Anular/tratamento farmacológico , Humanos , Ceratolíticos/uso terapêutico , Masculino
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