1/7. skin eruption with gabapentin in a patient with repeated AED-induced Stevens-Johnson's syndrome.skin eruptions have been reported with the use of all antiepileptic drugs and there is a significant risk of cross-reactivity between these agents in causing serious eruptions such as Stevens-Johnson's syndrome. Gabepentin is usually considered a safe agent for patients with a previous history of drug allergies and there have been no cases of skin eruption reported to the gabapentin post marketing surveillance. We report a patient who had severe Stevens-Johnson's syndrome induced by phenytoin and later by carbamazepine. Subsequent use of gabapentin also resulted in a skin eruption which was limited to the lower extremities but without systemic or mucosal involvement. This case suggests that patients with a strong history of drug-induced idiosyncratic reactions may experience such reactions to gabapentin as well.- - - - - - - - - - ranking = 1keywords = drug-induced (Clic here for more details about this article) |
2/7. The diagnostic role of the in vitro drug-induced interferon-gamma release test in stevens-johnson syndrome.BACKGROUND: Drug-related T-cell activity in cutaneous drug reactions may be assessed by in vitro cytokine release tests. The diagnostic role of in vitro drug-induced interferon-gamma (IFN-gamma) release was evaluated in a patient with stevens-johnson syndrome. CASE REPORT: stevens-johnson syndrome was diagnosed in a 58-year-old man, treated with colchicine (1 mg daily for 39 days) and allopurinol (300 mg daily for 13 days). Based on a clinical-epidemiologic score, allopurinol was more likely to be the causative agent. in vitro drug-induced IFN-gamma release test was conducted on this patient and on two controls, using an enzyme-linked immunoabsorbent assay (ELISA) technique. Increased IFN-gamma release was observed following an in vitro challenge of the patient's lymphocytes with allopurinol, but not following in vitro challenge with colchicine. An in vitro challenge with allopurinol in two control patients, treated with allopurinol without adverse drug reactions, did not induce a significant increase in IFN-gamma release. CONCLUSIONS: The role of allopurinol as the drug responsible for the induction of stevens-johnson syndrome in our patient was confirmed by in vitro allopurinol-induced IFN-gamma release, which may indicate a drug-specific immune response.- - - - - - - - - - ranking = 6keywords = drug-induced (Clic here for more details about this article) |
3/7. The use of recombinant human epidermal growth factor (rhEGF) in a gentleman with drug-induced Steven Johnson syndrome.A case of drug-induced Steven Johnson syndrome in a gentleman is reported. Its course of treatment with rhEGF was compared to conventional treatment in historical control.- - - - - - - - - - ranking = 5keywords = drug-induced (Clic here for more details about this article) |
4/7. Human immunodeficiency virus, pregnancy, and stevens-johnson syndrome.BACKGROUND: stevens-johnson syndrome and toxic epidermal necrolysis are life-threatening dermatologic disorders that are more common in the setting of a compromised immune system. We present the case of a pregnant patient with known human immunodeficiency virus (hiv) infection who presented with stevens-johnson syndrome after treatment with antibiotics for a urinary tract infection. CASE: A young woman at 33 4/7 weeks of gestation with known hiv infection presented to the emergency room with a chief complaint of rash, fever, blisters, and lower abdominal pain. Her symptoms were present for 2 days after ingestion of nitrofurantoin, prescribed for a urinary tract infection. She was diagnosed with preterm labor and possibly stevens-johnson syndrome. Due to active labor, hiv, and vaginal stenosis, a primary cesarean was performed. A skin biopsy performed at the time of admission confirmed the diagnosis of a drug-induced dermatosis (erythema multiforme), evidenced by subepidermal bullae, hemorrhage, and acantolated, dyskeratotic eosinophilic cells. CONCLUSION: stevens-johnson syndrome and toxic epidermal necrolysis represent a spectrum of disease that has been long associated with multiple drugs, recently including many antiretroviral medications. It also seems that the incidence of these conditions is increased in immunocompromised patients. We speculate that the combination of hiv and pregnancy in addition to antibiotic treatment, such as with nitrofurantoin, may induce stevens-johnson syndrome in patients with severely altered immune systems.- - - - - - - - - - ranking = 1keywords = drug-induced (Clic here for more details about this article) |
5/7. Topical tretinoin treatment for severe dry-eye disorders.Despite the diverse causes of dry-eye disorders, the ocular surface epithelia in these diseases all undergo squamous metaplasia, manifested by loss of goblet cells, mucin deficiency, and keratinization. These changes account for tearfilm instability, which leads to various ocular symptoms and corneal complications. This article reviews research in the use of topical tretinoin to treat severe dry-eye disorders. To classify squamous metaplasia into stages, a modified impression cytology technique was used to monitor the therapeutic effect of topical tretinoin ointment (0.01% or 0.1%, w/w) in 22 patients. This population had severe dry-eye disorders, including keratoconjunctivitis sicca, stevens-johnson syndrome, inactive ocular pemphigoid, drug-induced pseudopemphigoid, and surgery- or radiation-induced dry eyes. After treatment, clinical improvements were correlated with the reversal of squamous metaplasia as evidenced by the impression cytology technique. tretinoin may also be effective in treating conjunctival keratinization without dry eyes, as illustrated by a case study. This may represent the first reported attempt to treat ocular surface disorders by reversing diseased epithelium.- - - - - - - - - - ranking = 1keywords = drug-induced (Clic here for more details about this article) |
6/7. Topical retinoid treatment for dry eye disorders.We have demonstrated the clinical efficacy of topical all-trans retinoic acid ointment in the treatment of four severe cases of the following dry eye disorders: keratoconjunctivitis sicca, stevens-johnson syndrome, drug-induced pseudopemphigoid, surgery-induced dry eye. In all four cases, impression cytology confirmed that improvements in symptoms, visual acuity, keratopathy, and Schirmer test resulted from reversal of the process of squamous metaplasia. This treatment represents the first nonsurgical approach with action directed specifically at the diseased ocular surface epithelia.- - - - - - - - - - ranking = 1keywords = drug-induced (Clic here for more details about this article) |
7/7. Topical retinoid treatment for various dry-eye disorders.We evaluated the clinical efficacy of treating various dry-eye disorders using 0.01% and 0.1% (weight/weight) topical all-trans retinoic acid ointment. Twenty-two patients were selected and classified into four major groups: keratoconjunctivitis sicca (6 patients; 11 eyes), stevens-johnson syndrome (9 patients; 17 eyes), ocular pemphigoid or drug-induced pseudopemphigoid (3 patients; 6 eyes), and surgery or radiation-induced dry eye (4 patients; 4 eyes), based on the criterion that they remained symptomatic even under maximum tolerable conventional medical and/or surgical therapies. The results indicated that squamous metaplasia with mucin deficiency secondary to goblet cell loss and keratinization may be the basis for the development of clinical symptoms and morbidities, as these epithelial abnormalities were invariably present before treatment. After treatment, all patients demonstrated clinical improvements in symptoms, visual acuity, rose bengal staining, or Schirmer test. Most importantly, this topical vitamin a treatment caused the reversal of squamous metaplasia as evidenced by impression cytology. Therefore, this treatment may represent the first nonsurgical attempt to treat these disorders by reversing diseased ocular surface epithelium.- - - - - - - - - - ranking = 1keywords = drug-induced (Clic here for more details about this article) |