1/6. Erythrodermia to pseudoephedrine in a patient with contact allergy to phenylephrine.BACKGROUND: phenylephrine and pseudoephedrine are sympathomimetic drugs belonging to the phenylamine family. Adverse cutaneous effects associated with these drugs have been reported but, in view of their frequent use, appear to be rare. The very close chemical structures of these drugs could explain potential cross-reactions among them but the results reported in the literature are controversial. CASE REPORT: An 18-year-old woman developed blepharoconjunctivitis after application of phenylephrine and tropicamide eye drops. Four years after this reaction, she took 1 tablet of Narine (pseudoephedrine and loratadine) and 3-4 hours later developed a generalized erythrodermic reaction. Cutaneous biopsy revealed hydropic changes in the basal layer and, in the dermis, moderate edema with slight perivascular lymphocyte and eosinophil infiltrates. patch tests with European standard series, commercial eye drops, tropicamide, phenylephrine, pseudoephedrine and other sympathomimetic agents were applied to the patient's back. After 47 and 96 hours, only the patches with pseudoephedrine and phenylephrine were positive. CONCLUSIONS: We believe that our patient has presented two different reactions with different clinical outcome and histopathology, which are unlikely to be due to cross-reactivity between the drugs involved. We have found no similar coincidences reported int the literature.- - - - - - - - - - ranking = 1keywords = allergy (Clic here for more details about this article) |
2/6. The sulfone syndrome secondary to dapsone prophylaxis in a patient undergoing unrelated hematopoietic stem cell transplantation.dapsone is commonly used for pneumocystis carinii pneumonia (PCP) prophylaxis in immunocompromised patients. It has been used as an alternative therapy in the hematopoietic stem cell transplant (HSCT) setting in patients who can't tolerate trimethoprim-sulfamethoxazole. The Sulfone syndrome is not a well-known sequela of dapsone therapy and occurs at various doses, ranging from 50-300 mg/d. In all cases the syndrome occurs within 2 months of initiating therapy. Its clinical manifestations include: fever, methemoglobinemia, hemolytic anemia, exfoliative dermatitis and transaminits. A 51-year old female underwent a matched unrelated hematopoiectic stem cell transplant for acute mylogenous leukemia. dapsone therapy was initiated on day 28 at a dose of 100 mg/day for PCP prophylaxis secondary to the patient's history of a sulfonamide allergy. On day 59, one month after initiation of therapy she developed hepatitis, hemolytic anemia, fever and methemoglobinemia of 8%. She was transferred to the intensive care unit and subsequently developed an exfoliative dermatitis. We conclude that the clinical presentation of this patient after HSCT on dapsone therapy coincide with the sulfone syndrome not previously described in a patients after HSCT.- - - - - - - - - - ranking = 0.25keywords = allergy (Clic here for more details about this article) |
3/6. Psoriasiform intradermal test reaction to ABPC in a patient with psoriasis and ABPC allergy.We experienced a case of psoriasis with ABPC allergy which showed a psoriasiform intradermal test reaction to ABPC. A 22-year-old man with a history of psoriasis since the age of 17 was admitted to our department because he developed erythrodermic psoriasis after oral administration of ABPC. About 1 year later, he again developed erythroderma after administration of ABPC. Intradermal testing with 2% ABPC was performed. We found infiltrating erythema at day 2, followed by a gradually increasing psoriasiform reaction at 6 days on the site of ABPC skin test. We examined the infiltrating cells in the skin test reaction immunohistochemically. Most of the infiltrating cells in the dermis were activated helper/DTH-type T cells. Among the infiltrating cells in the epidermis, we observed more cytotoxic/suppressor-type T cells than helper/DTH-type T cells. A possible role of a DH reaction to ABPC in inducing the psoriatic lesion is discussed in relation to the pathomechanisms of psoriasis.- - - - - - - - - - ranking = 1.25keywords = allergy (Clic here for more details about this article) |
4/6. Clinical, histological, and immunohistological studies of postoperative erythroderma.We report 7 cases of acute fatal illness characterized by fever, diffuse erythematous rash, and progressive leukopenia occurring 10 days after surgical operation. The outcome was uniformly fatal. The biopsy findings consisted of eosinophilic individual necrosis of epidermal cells, satellite cell necrosis, basal liquefaction degeneration, and scanty cell infiltration into the dermis. T lymphocytes were found in the epidermis but langerhans cells disappeared. These findings are compatible with acute graft-vs-host disease following blood transfusion. Explanations based upon drug allergy, infection, toxic shock syndrome, or toxic epidermal necrolysis seem less reasonable.- - - - - - - - - - ranking = 0.25keywords = allergy (Clic here for more details about this article) |
5/6. Erythroderma from systemic contact dermatitis: a complication of systemic gentamicin in a patient with contact allergy to neomycin.A patient who was sensitive to potassium dichromate and neomycin showed a universal exfoliative erythroderma following intravenous gentamicin therapy. When his ear canals were later treated with a neomycin-containing topical medication, he reacted so severely that the skin of his ears was temporarily depigmented. Withdrawal of aminoglycoside antibiotics along with use of a topical steroid preparation under occlusion brought the eruption under control. Since approximately half of the persons with contact allergy to neomycin will also react to gentamicin, it seems unwise to treat such patients with other intravenous aminoglycosides that are closely related chemically. In our patient, multiple patch tests to other aminoglycosides caused positive reactions to all reagents containing a deoxystreptamine ring, but there was no reaction to streptomycin, which lacks that structure.- - - - - - - - - - ranking = 1.25keywords = allergy (Clic here for more details about this article) |
6/6. A case of eosinophilic pustular folliculitis (Ofuji's disease) induced by patch and challenge tests with indeloxazine hydrochloride.A 73-year-old male developed disseminated erythema over his entire body after exposure to indeloxazine hydrochloride, a cerebral activator. Patch testing with indeloxazine hydrochloride showed a positive reaction, and plaques, vesicles and pustules developed on the face after the patch test. These had the pathologic feature of eosinophilic pustular folliculitis (EPF, Ofuji's disease). A challenge test also provoked eruptions on the face, trunk, arms and legs, which were compatible with EPF. Moreover, both the patch and challenge tests with indeloxazine hydrochloride induced eosinophilia. This is the first report of drug allergy-induced EPF, where drug sensitivity induced an abnormal eosinophilic response mimicking EPF.- - - - - - - - - - ranking = 0.25keywords = allergy (Clic here for more details about this article) |