1/72. Reversible renal failure and myositis caused by phenytoin hypersensitivity.A 38-year old woman receiving phenytoin (diphenylhydantoin) noticed maculopapular erythema as the first manifestation of a syndrome that included acute renal failure and myositis in addition to fever, lymphadenopathy, exfoliative dermatitis, and hepatitis. Prednisolone sodium phosphate therapy resulted in resolution of this hypersensitivity reaction, and she recovered from renal insufficiency. The occurrence of renal failure and myositis in the spectrum of phenytoin hypersensitivity reactions is discussed, and the importance of a morbilliform rash in a patient receiving phenytoin is emphasized.- - - - - - - - - - ranking = 1keywords = dermatitis (Clic here for more details about this article) |
2/72. Allergic dermatitis due to oral ebrotidine.We report the case of a woman who developed generalized dermatitis after 1 week of treatment with ebrotidine, a new H2-receptor antagonist taken to prevent gastroduodenal lesions caused by nonsteroidal inflammatory drugs. patch tests with ebrotidine and other H2-receptor antagonists ranitidine, cimetidine and famotidine were negative. Oral challenge test with ebrotidine showed the development of lesions similar to those appearing previously. Oral challenge test with ranitidine and cimetidine were negative, possibly due to the difference in the side chain chemical structure of ebrotidine and other H2-receptor antagonists. This is the first reported case of allergic dermatitis caused by ebrotidine.- - - - - - - - - - ranking = 6keywords = dermatitis (Clic here for more details about this article) |
3/72. Type III and type IV hypersensitivity reactions due to mitomycin C.A 71-year-old man developed an exfoliative dermatitis of the palms of the hands and soles of the feet, and a generalized itch, during treatment with intravesical instillations of mitomycin C for an undifferentiated carcinoma of the bladder. patch tests with mitomycin C 0.03%, 0.1% and 0.3% aq. were positive. Because of the serious consequences of this finding, the patient was retested with mitomycin C in pet. (same concentrations), a more stable preparation. This showed clear positive reactions. During this last series of patch tests, he developed palpable purpura on the legs. We postulated that this reaction was an immune-complex-mediated reaction, caused by the 2nd series of patch tests with mitomycin C. To prove this, we performed histopathological and immunofluorescence investigations, and these showed the reaction to be consistent with Henoch-Schonlein-type purpura. We therefore conclude that this patient developed systemic reactions to mitomycin C, characterized by an eczematous dermatitis as well as purpuric reactions. The intravesical installations with mitomycin C have been stopped. The patient's skin problems (the purpura as well as the eczema) have completely resolved and have not recurred.- - - - - - - - - - ranking = 2keywords = dermatitis (Clic here for more details about this article) |
4/72. Medical hazards of the tear gas CS. A case of persistent, multisystem, hypersensitivity reaction and review of the literature.A 30-year-old incarcerated man was sprayed with the "tear gas" ortho-chlorobenzylidene malononitrile (CS). He was hospitalized 8 days later with erythroderma, wheezing, pneumonitis with hypoxemia, hepatitis with jaundice, and hypereosinophilia. During the subsequent months he continued to suffer from generalized dermatitis, recurrent cough and wheezing consistent with reactive airways dysfunction syndrome, and eosinophilia. These abnormalities responded to brief courses of systemic corticosteroid but recurred off therapy. The dermatitis resolved gradually over 6-7 months, but the patient still had asthma-like symptoms a year following exposure. Patch testing confirmed sensitization to CS. The mechanism of the patient's prolonged reaction is unknown but may involve cell-mediated hypersensitivity, perhaps to adducts of CS (or a metabolite) and tissue proteins. This is the first documented case in which CS apparently caused a severe, multisystem illness by hypersensitivity rather than direct tissue toxicity. Both the ethics and safety of CS use remain controversial, in part because of the difficulty documenting sporadic injuries received in the field, and also because the charged circumstances surrounding CS use may lead to both underreporting and exaggerated claims of medical harm. The medical literature on CS focuses mainly on its immediate irritant effects and on transient dermal and ocular injuries, with only 2 prior case reports of acute lung injury related to CS exposure. Given the paucity of documented lasting effects despite its widespread use for more than 3 decades, CS appears to be safe when deployed (outdoors) in a controlled manner, but it can cause important injuries if misused or if applied to a sensitized individual.- - - - - - - - - - ranking = 2keywords = dermatitis (Clic here for more details about this article) |
5/72. Allergic reaction to gemfibrozil manifesting as eosinophilic gastroenteritis.Eosinophilic gastroenteritis (EGE) is a rare condition of unknown etiology characterized by eosinophilic infiltration of the gastrointestinal (GI) tract. Previous associations with a drug or food allergy, allergic rhinitis, atopic dermatitis, and elevated IgE levels suggest an atopic predisposition in the pathogenesis of this disorder. Diagnostic criteria are GI symptoms, eosinophilic infiltration proven by biopsy of the GI tract, and absence of parasitic infection. We describe a case of EGE manifested as an allergy to gemfibrozil.- - - - - - - - - - ranking = 1keywords = dermatitis (Clic here for more details about this article) |
6/72. Molecular features determining lymphocyte reactivity in allergic contact dermatitis to chloramphenicol and azidamphenicol.BACKGROUND: We report on two cases of allergic contact dermatitis to chloramphenicol and azidamphenicol respectively, with in vivo and in vitro lymphocyte reactivity to both compounds. The molecular features determining lymphocyte reactivity were explored because chloramphenicol, azidamphenicol, and thiamphenicol exhibit almost identical chemical structures. methods: With chloramphenicol, azidamphenicol, and the chemically related thiamphenicol, we performed patch tests and lymphocyte transformation tests with both patients. Furthermore, the interleukin-5 and interferon-gamma concentrations in the cultures of peripheral blood mononuclear cells of one patient were determined. RESULTS: patch tests showed delayed hypersensitivity reactions to chloramphenicol and azidamphenicol, but not to thiamphenicol. These results were confirmed by lymphocyte transformation tests with peripheral blood mononuclear cells of the patients, showing a proliferative T-cell response to azidamphenicol and chloramphenicol. Moreover, lymphocytes from one patient secreted large amounts of interleukin-5, but not of interferon-gamma upon coculture with azidamphenicol. CONCLUSIONS: Since lymphocyte reactivity was observed to chloramphenicol and azidamphenicol, but not to thiamphenicol, the epitope(s) recognized by the allergen-reactive T cells may be formed by the nitro-group of the benzene ring shared by chloramphenicol and azidamphenicol.- - - - - - - - - - ranking = 5keywords = dermatitis (Clic here for more details about this article) |
7/72. Steroid allergy: report of two cases.Corticosteroid preparations have anti-inflammatory and immunosuppressive properties and are widely used in the treatment of asthma and allergic disorders. steroids themselves, however, can induce hypersensitivity reactions. The number of reports on contact allergy or anaphylactic reactions is increasing. Steroid hypersensitivity should be considered in any patient whose dermatitis becomes worse with topical steroid therapy, or in patients who develop systemic allergic reactions after the use of systemic steroids. The diagnosis can be confirmed by skin testing, in vitro evidence of specific IgE, oral or parenteral challenge, or an allergic patch test. The latter may be positive within 20 min, which indicates immediate contact urticaria, or at 72 to 96 h, which indicates delayed contact hypersensitivity. In this article we report two cases of steroid allergy. Case 1 was a 5-year-old asthmatic boy with an anaphylactic reaction to steroids and aspirin. Case 2 was a 2-year-old boy with atopic dermatitis and steroid contact urticaria. Both cases 1 and 2 showed positive results to triamcinolone, dexamethasone, hydrocortisone, and methylprednisolone in the immediate skin allergy test. Case 2 had immediate contact urticaria to hydrocortisone and clobetasone butyrate. Case 1 had a positive systemic allergic reaction to cortisone acetate, prednisolone, and dexamethasone on the oral steroid challenge test, and also had aspirin induced angioedema and urticaria 10 min after challenge with 50 mg aspirin.- - - - - - - - - - ranking = 2keywords = dermatitis (Clic here for more details about this article) |
8/72. biopsy-proved acute tubulointerstitial nephritis and toxic epidermal necrolysis associated with vancomycin.A 70-year-old man receiving vancomycin for a methicillin-resistant staphylococcus aureus (MRSA) abscess developed a drug-induced hypersensitivity reaction with rash, eosinophilia, and acute renal failure requiring dialysis. Renal biopsy revealed diffuse and marked interstitial and tubular infiltration by mononuclear cells and eosinophils; acute tubulointerstitial nephritis (tin) was diagnosed. The rash progressed to erythema multiforme major after rechallenge with vancomycin in the setting of MRSA peritoneal catheter-related peritonitis and then to fatal toxic epidermal necrolysis in the setting of steroid taper and persistent serum vancomycin levels. This case further implicates vancomycin as a drug that infrequently can cause severe acute tin and exfoliative dermatitis. When a renally excreted drug such as vancomycin is administered, serum drug levels should be serially monitored and high-dosage steroids be maintained or tapered slowly until serum drug levels become undetectable.- - - - - - - - - - ranking = 1keywords = dermatitis (Clic here for more details about this article) |
9/72. hypersensitivity to warfarin in a patient with a mechanical aortic prosthesis.The case of a patient with a prosthetic aortic valve and warfarin hypersensitivity is presented. On rechallenging the patient with warfarin, a spongiotic dermatitis with heavy superficial perivascular lymphocytic infiltrates with eosinophils was seen. The patient was finally discharged on aspirin therapy alone and is doing well to date. warfarin hypersensitivity is rare, and only incidental reports exist regarding its incidence and management. It is conceivable that newer antiplatelet agents, whether alone or in combination with aspirin, will provide better control of thromboembolic events in patients with warfarin intolerance.- - - - - - - - - - ranking = 1keywords = dermatitis (Clic here for more details about this article) |
10/72. Cutaneous leucocytoclastic vasculitis associated with omeprazole.omeprazole is a potent proton pump inhibitor and usually is well tolerated. Adverse effects of this drug have been reported in up to 5% of patients, most of which are trivial and disappear rapidly on discontinuation of the drug. skin adverse reactions attributed to omeprazole are uncommon and include rashes, urticaria, angio-oedema, acute disseminated epidermal necrolysis, lichen spinulosus, and contact dermatitis. Cutaneous leucocytoclastic vasculitis (CLV) has not been previously reported in association with omeprazole. The development of CLV in an elderly patient four weeks after starting treatment with omeprazole is described.- - - - - - - - - - ranking = 1keywords = dermatitis (Clic here for more details about this article) |
| | Next -> |