Fixed Drug Eruption Associated with Nonsteroidal Anti-Inflammatory Drugs for Menstrual Pain: A Case Report

Fixed drug eruption (FDE) is a type of drug reaction in which cutaneous or mucocutaneous lesions recur at the same site due to repeated administration of the causative drug. The most reported FDE-inducing drugs are nonsteroidal anti-inflammatory drugs (NSAIDs). We report a case of FDE associated with the use of NSAIDs for menstrual pain. A 33-year-old woman was referred to our department with blisters and soreness on her lips, tongue, and labial mucosa. The results of blood examination helped rule out herpes simplex virus infection, pemphigus, and pemphigoid. An FDE was suspected because these symptoms coincided with the use of NSAIDs for menstrual pain. Thus, the patient was advised not to use these NSAIDs but to use acetaminophen instead. No recurrence has been observed since the patient began avoiding these NSAIDs.

Antituberculosis Drug-induced Linear IgA Dermatosis

Introduction: Linear IgA dermatosis is a rare autoimmune vesiculobullous disease characterized by homogeneous linear IgA deposits in basement membrane of epidermis, and it can be idiopathic or drug-induced. The pathogenesis of drug-induced linear IgA dermatosis is not fully known yet, but it is associated with specific T cells. The clinical manifestations of the disease include vesiculobullous eruption, erythematous plaques, or string of pearls. Most cases still need additional therapy to avoid the expansion of the disease. Case Presentation: In this study, we present a 17-year-old male patient with erythema plaques, vesicles, and bullae with erosion in facial, oral, neck, trunk, genital, and extremities, pruritus, and burning sensation. The patient was undergoing pulmonary tuberculosis (TB) treatment for one week. Physical examination was done, and total BSA 10% and negative Asboe-Hansen sign were seen. The treatment consisted of delaying administration of TB drugs, desoximetasone cream 0.25%, cetirizine 10 mg, and aspiration of bullae. Conclusions: Drug-induced linear IgA dermatosis can occur at any age due to the administration of rifampicin and other antibiotics, angiotensin-I converting enzyme (ACE) inhibitors, or nonsteroidal anti-inflammatory drugs (NSAIDs). The drug can stimulate specific T cells that release Th2 cytokines to produce IgA antibodies against the basement membrane of epidermis. Drugs may cause an autoimmune response by cross-reaction with the target epitope, altering the conformation of epitopes, or exposing previously sequestered antigens to the immune system. The causative drug was stopped, and methyl prednisolone 0.5 - 1 mg/kg/day was given as initial therapy. In this study, we reported a rare case of a 17-year-old male with anti-TB drug-induced linear IgA dermatosis. Diagnosis was done based on clinical manifestation, histopathology, and immunofluorescence. The causative drug was stopped, the patient was given topical and systemic steroid therapy and drug desensitization. Remission was noted after six weeks of therapy, and oral steroid was slowly tapered and stopped on day 42. After stopping oral steroids, no lesions were reported. A 6-month follow-up revealed no signs of recurrence.

Tacrolimus Induced Organ Failure: Reversal by Activation of the Cytochrome P450-3a System

Tacrolimus is the cornerstone component of all immunosuppressive regimens. Despite its long record of use, very little is known about its acute toxicity syndrome. We describe five patients with acute organ failure, involving both native and transplanted organs, which was reversed by inducing the cytochrome P450-3A system. In all patients, the causative drug was stopped and phenytoin was given intravenously to accelerate tacrolimus metabolism. Within 24 h, tacrolimus trough levels fell daily at a significant level (p < 0.05) and all failed organs recovered their normal function within 48–72 h. Therefore, phenytoin metabolic induction appears to be a safe therapeutic option for patients with acute tacrolimus toxicity.

Eosinophilic Pneumonia in a Patient With Ulcerative Colitis Treated With Mesalazine: a Case Report

Background: Mesalazine, also known as mesalamine or 5-ASA, is considered a safe drug and thus widely prescribed for Inflammatory bowel disease (IBD) patients. Mesalazine was previously recognized as a drug that can rarely cause pneumonia because lacking a sulfa component. Nevertheless, although still a rare complication, more and more cases have been reported nowadays. Case presentation: We describe the case of eosinophilic pneumonia (EP) in a 39-year-old woman with ulcerative colitis during treatment with mesalazine. We discontinued mesalazine after drug-induced EP was identified, and she made a prompt recovery.Conclusions: The diagnosis of EP is readily missed due to the rarity and the pulmonary complications of IBD. Since the treatment of pulmonary complications of IBD and EP varies, it is crucial to differentiate them. A prompt recovery can be expected in patients with EP after discontinuing the causative drug.

A Review of Fixed Drug Eruption with a Special Focus on Generalized Bullous Fixed Drug Eruption

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive care, topical and/or systemic steroids, and, recently, cyclosporine, the mainstay of management involves identifying and discontinuing the causative drug. This review article will provide an overview of FDE with an emphasis on its generalized bullous variant.

Surfactant protein D: a useful marker for differentiation of drug-induced pneumonia and bacterial pneumonia

Background Drug-induced pneumonia (d-pneumonia) and bacterial pneumonia (b-pneumonia) are often difficult to differentiate; therefore, this study examined the possibility of differentiating them using serum biomarkers. Methods The study included 22 and 16 patients diagnosed with b- and d-pneumonia, respectively, at our institution or affiliated institutions. For d-pneumonia, the causative drug was minocycline hydrochloride in four patients, gefitinib in two patients, nivolumab in two patients, pembrolizumab in two patients, sulfasalazine in two patients, loxoprofen in one patient, Bouiougitou in one patient, edoxaban tosilate hydrate in one patient, and abemaciclib in one patient. White blood cell (WBC), C-reactive protein (CRP), Krebs von den Lungen-6 (KL-6), surfactant protein (SP)-D, and SP-A levels were measured in each patient and compared between the groups. Results Significant differences were noted in the WBC and SP-D levels between the two groups (P < 0.05, P < 0.001), but not in the CRP, KL-6, or SP-A levels. Conclusion The study results suggest that SP-D is a useful marker for differentiating b-pneumonia and d-pneumonia.

Interfering with Host Proteases in SARS-CoV-2 Entry as a Promising Therapeutic Strategy

: Due to its fast international spread and substantial mortality, the coronavirus disease COVID-19 evolved to a global threat. Since currently, there is no causative drug against this viral infection available, science is striving for new drugs and approaches to treat the new disease. Studies have shown that the cell entry of coronaviruses into host cells takes place through the binding of the viral spike (S) protein to cell receptors. Priming of the S protein occurs via hydrolysis by different host proteases. The inhibition of these proteases could impair the processing of the S protein, thereby affecting the interaction with the host-cell receptors and preventing virus cell entry. Hence, inhibition of these proteases could be a promising strategy for treatment against SARS-CoV-2. In this review, we discuss the current state of the art of developing inhibitors against the entry proteases furin, the transmembrane serine protease type-II (TMPRSS2), trypsin, and cathepsin L.

A PROSPECTIVE OBSERVATIONAL STUDY ON THE INCIDENCE OF DRUG-RELATED HOSPITAL ADMISSIONS IN A TERTIARY CARE HOSPITAL

Objectives: The objective of the study is to identify the incidence of drug-related problems coming to the EMD, classify, and identify the risk factor for DRP. Methods: This was a prospective observational study conducted in the emergency department for a period of 6 months. The patients admitted through EMD with DRP were identified and then were classified according to Hepler and Strand, 1990 and Classen et al., 1997. Results: A total of 109 patients were identified with DRP in our study. Among them, major part was contributed by ADRs (69.7%), non-adherence (27.5%) followed by sub-therapeutic dosage, and untreated indication and overdosage (0.91%). The major organ system involved in DRPs was found to be neurological system (26.60%) and gastrointestinal system (23.85%). The major causative drug class for DRP was found to be anti-thrombotic agents (27%), and the major risk factor for the development of DRP was found to be polypharmacy. Conclusion: Drug-related problems are becoming one of the major reasons for the EMD admissions in the hospitals. It can cause significant burden to the society and to the health of the people.

Koronavírusvakcina-vademecum

Összefoglaló. A SARS-CoV-2 okozta megbetegedés (COVID–19) a cikk megírásáig a világon több mint 82 millió embert érintett, a halálos áldozatok száma 1,8 millió (2,2%). Hazánkban eddig 300 000 feletti esetszámot regisztráltak, a cikk megjelenésének idején már várhatóan több mint 10 000 halottal (3%). Habár a megbetegedésnek oki gyógyszeres terápiája egyelőre nincs, egyes antivirális szerek és a rekonvaleszcens plazma alkalmazása a tapasztalatok szerint csökkentik a vírusterhelést, és ezzel hozzájárulnak a beteg gyógyulásához. Az eddig példa nélküli epidemiológiai rendelkezések nem tudták megállítani, csak lelassítani a betegség terjedését, ezért a megelőzés tűnik az egyetlen, a közeljövőben tömegek számára is elérhető megoldásnak. A jelen cikk nem egy virológiai vagy biotechnológiai szakmunka, sokkal inkább egy összefoglaló házi- és általános orvosok számára, amely ismerteti a jelenleg engedélyezett, illetve a közeljövőben forgalomba kerülő védőoltások előnyeit és hátrányait a COVID–19 tágabb kontextusában. Írásunkban bemutatjuk a leggyakoribb álhíreket, rémhíreket is, valamint ezek cáfolatát is annak érdekében, hogy kollégáink felkészültebben tudják betegeiket informálni, valamint segíteni a vakcináció fontosságával kapcsolatos döntéshozatalt. Egy járvány megfékezésének legkézenfekvőbb módja a társadalmi szintű védettség megvalósítása. A nyájimmunitás kialakulása nélkül nagy valószínűséggel e jelenlegi pandémia sem állítható meg. Amennyiben egyéni és társadalmi szinten is vissza szeretnénk térni a vírus előtti életünkhöz, újra élvezve az akadálytalan áru- és kereskedelmi forgalom jelentette előnyöket, akkor a tömeges oltás tűnik a leghatékonyabb eszköznek ennek eléréséhez. A fertőző betegségek számának és mortalitásának a 20. században tapasztalt jelentős csökkenése egyértelműen a társadalmi szintű átoltottságnak, valamint a higiénés körülmények javulásának köszönhető. Az oltás ugyan önkéntes, de felvételének kérdése pandémiás helyzetben valószínűleg nemcsak egyéni döntés, de társadalmi felelősségvállalás kérdése is. Orv Hetil. 2021; 162(8): 283–292. Summary. Out of more than 82 million people worldwide, 1.8 million (2.2%) succumbed to SARS-CoV-2 disease (COVID–19). In 2020, more than 300 000 cases were registered in Hungary, and by the time of publication of this article, the death toll would probably exceed 10 000 (3%). Currently no causative drug therapy is available, however, observational evidence suggests that certain antivirals and the use of convalescent plasma may change the disease course. The unprecedented, strict epidemiological provisions managed to slow down the spread of the disease though they could not stop it. It seems that prevention remains the only readily available option to beat COVID–19. This is not a virology or biotechnology paper, but an unbiased review for general practitioners, aiming to summarize the advantages/disadvantages of the (emergency) authorized and soon-to-be-launched vaccines in the wider context of COVID–19. We also intended to address and debunk the most common misconceptions, aiming to help both doctors and patients to make a fact-based, informed decision about vaccination. Herd immunity is paramount to combat COVID pandemic. Without population-level vaccination, we are unlikely to regain the quality of life, the freedom of travel and the unrestricted economy/commerce we enjoyed before. It is obvious that the significant reduction in morbity/mortality of infectious diseases in the 20th century was achieved through advancements in vaccinology and improved hygiene. Albeit voluntary, vaccination in a pandemic situation is probably not only an individual decision, but social responsibility as well. Orv Hetil. 2021; 162(8): 283–292.

Skin testing and drug challenge in the evaluation of drug hypersensitivity reactions

Immediate hypersensitivity to drugs is characterized by symptoms such as hives, swelling, and wheezing. To prevent a negative impact on care, assessment by an allergist is important. Evaluation requires a clear clinical history, but it is often lacking or vague, which makes a diagnosis difficult. Allergists instead can use skin testing and drug challenge to evaluate drug hypersensitivity reactions, which help the patient and provider understand the causative drug(s) and, more importantly, enables the use of the exonerated drug(s). Although penicillin skin testing is standardized, well described, and widely used, skin testing for most other drugs requires the use of a nonirritating skin testing concentration that can have a low negative predictive value. Drug challenges are the criterion standard for confirming tolerance. The allergist must obtain an in-depth clinical history and then follow with skin testing and/or drug challenges when indicated to determine which drugs can be de-labelled and which should be avoided. In this review, we focused on the evaluation of drug hypersensitivity reactions to antibiotics, perioperative agents, biologics, and chemotherapeutics.