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A Case of Severe Lethal Allergic Reaction Caused by Iodixanol After Digital Subtraction Angiography.The Journal of Craniofacial Surgery May 2024Severe lethal allergic reactions triggered by iodixanol following digital subtraction angiography (DSA) are rare. The majority of skin reactions associated with...
BACKGROUND
Severe lethal allergic reactions triggered by iodixanol following digital subtraction angiography (DSA) are rare. The majority of skin reactions associated with iodixanol were mild, and the prognosis was favorable. Moreover, a case of serious skin adverse events caused by iodixanol has been documented.
METHODS
A 61-year-old woman underwent surgery for a cerebral hemorrhage in another hospital. Upon the surgery, the patient's state of impaired consciousness did not show any improvement. Head computed tomography angiography on admission: right middle cerebral artery M1 segment enlargement, left posterior cerebral artery P2 stenosis. Following undergoing DSA with iodixanol, the patient experienced severe and fatal drug eruptions, which represents a serious and uncommon complication associated with iodixanol.
RESULTS
This paper describes the experience in the treatment and nursing of severe allergic reactions. Despite the fact that the patient was discharged automatically and eventually died, there are valuable lessons to be learned from this case that can inform and guide future clinical practices.
CONCLUSIONS
Iodixanol adverse reactions were rare, and severe fatal adverse reactions were seldom reported. Consequently, the authors conclude that the potential adverse reaction risk of iodixanol contrast agent should be taken into consideration in future endeavors, and the skin and allergy of patients should be monitored following DSA. In an allergy, prompt and proactive treatment is essential to prevent worsening and dissemination.
PubMed: 38785455
DOI: 10.1097/SCS.0000000000010286 -
Zhonghua Yi Xue Za Zhi May 2024Immune checkpoint inhibitors (ICIs) have emerged as crucial therapeutic agents for various malignancies by activating the host immune system against tumor cells....
Immune checkpoint inhibitors (ICIs) have emerged as crucial therapeutic agents for various malignancies by activating the host immune system against tumor cells. However, many different types of skin adverse reactions may occur during its use, including eruption, pruritus, blistering, hypopigmentation, alopecia, and even severe cases, Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). These cutaneous immune-related adverse events (cirAEs) had a high incidence, which seriously affected patients' quality of life and antitumor treatment decisions. Some severe cutaneous adverse reactions (SCARs) even endanger patients' lives. Therefore, the Chinese Society of Dermatology, the Chinese Dermatologist Association of the Chinese Medical Doctor Association, the Dermatology Division of the Chinese Geriatrics Society, and other relevant experts jointly discussed and formulated the 'Chinese Expert Consensus on the Diagnosis and Treatment of Immune Checkpoint Inhibitor-Related Cutaneous Adverse Reactions'. This consensus covers the name, epidemiology, pathogenesis, clinical features, classification and grading of cirAEs, principles of management and the re-initiation of ICIs. It aims to provide a more scientific and authoritative reference for the diagnosis and treatment of cirAEs in China in the future.
Topics: Humans; Immune Checkpoint Inhibitors; China; Consensus; Stevens-Johnson Syndrome; Drug-Related Side Effects and Adverse Reactions; Quality of Life; Skin; Neoplasms; Drug Eruptions
PubMed: 38782747
DOI: 10.3760/cma.j.cn112137-20240112-00091 -
Cureus Apr 2024is a first-generation anticonvulsant medicine that efficiently cures a wide range of seizures, including status epilepticus, complex partial seizures, and generalized...
is a first-generation anticonvulsant medicine that efficiently cures a wide range of seizures, including status epilepticus, complex partial seizures, and generalized tonic-clonic seizures (GCTS). The major advantage of phenytoin is that its neurological functions are preserved. Phenytoin works by inhibiting voltage-dependent membrane Na channels, which are essential to generate action potential. This function inhibits the positive feedback, leading to high-frequency repeated firing, reducing seizure spread in the focal region. A purple color rash on the chest, abdomen, and trunk developed in a 21-year-old female patient after being treated with phenytoin is being reported. The presentation, pathophysiology, and management are also reviewed.
PubMed: 38774164
DOI: 10.7759/cureus.58665 -
Dermatologie (Heidelberg, Germany) Jun 2024Oncological therapies can cause a variety of mucocutaneous adverse events. Exanthematous adverse events can be challenging in the context of the urgent need for cancer... (Review)
Review
BACKGROUND
Oncological therapies can cause a variety of mucocutaneous adverse events. Exanthematous adverse events can be challenging in the context of the urgent need for cancer treatment due to their spread, sometimes rapid progression, and mucous membrane or organ involvement.
MATERIALS AND METHODS
This article provides an overview of the most important exanthematic dermatoses as side effects of modern drug-based tumor therapies with diagnostic and therapeutic information for clinicians, taking into account the current literature and guidelines.
RESULTS
Exanthematous adverse events of immune checkpoint inhibitors, EGFR antagonists, kinase inhibitors, bispecific T‑cell engagers, and the CCR4 inhibitor mogamulizumab are reviewed in detail.
CONCLUSIONS
Cutaneous side effects are common across all drug classes and cover a broad spectrum. While some adverse events are specific to one drug class, many exanthemas can occur with both oncological immunotherapies and various targeted therapies. A reliable diagnosis, dose adjustment or discontinuation of the offending agent in consultation with the treating oncologists and appropriate symptomatic therapy are important for correct management. In the case of severe, life-threatening drug reactions, however, permanent discontinuation of the drug is essential.
Topics: Humans; Exanthema; Drug Eruptions; Immunotherapy; Immune Checkpoint Inhibitors; Antibodies, Monoclonal, Humanized; Neoplasms; Molecular Targeted Therapy; Antineoplastic Agents; Protein Kinase Inhibitors
PubMed: 38772932
DOI: 10.1007/s00105-024-05350-7 -
American Journal of Clinical Dermatology Jul 2024Cutaneous immune-related adverse events encompass a spectrum of dermatological manifestations, including lichenoid reactions, psoriasiform eruptions, eczematous... (Review)
Review
Cutaneous immune-related adverse events encompass a spectrum of dermatological manifestations, including lichenoid reactions, psoriasiform eruptions, eczematous dermatitis, immunobullous disorders, granulomatous reactions, pruritus, vitiligo, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome. The conventional approach to treating high-grade or refractory cutaneous immune-related adverse events has involved high-dose systemic corticosteroids. However, their use is limited owing to the potential disruption of antitumor responses and associated complications. To address this, corticosteroid-sparing targeted immunomodulators have been explored as therapeutic alternatives. Biologic agents, commonly employed for non-cutaneous immune-related adverse events such as colitis, are increasingly recognized for their efficacy in treating various patterns of cutaneous immune-related adverse events, including psoriasiform, immunobullous, and Stevens-Johnson syndrome-like reactions. This review consolidates findings from the English-language literature, highlighting the use of biologic agents in managing diverse cutaneous immune-related adverse event patterns, also encompassing maculopapular, eczematous, and lichenoid eruptions, pruritus, and transient acantholytic dermatosis (Grover disease). Despite the established efficacy of these agents, further research is necessary to explore their long-term effects on antitumor responses.
Topics: Humans; Immune Checkpoint Inhibitors; Drug Eruptions; Biological Factors; Treatment Outcome; Skin Diseases
PubMed: 38767827
DOI: 10.1007/s40257-024-00866-z -
International Journal of Trichology 2023Graham-Little-Piccardi-Lasseur syndrome (GLPLS) is characterized by diffuse alopecia and a lichenoid follicular eruption affecting the scalp, eyebrows, and...
Graham-Little-Piccardi-Lasseur syndrome (GLPLS) is characterized by diffuse alopecia and a lichenoid follicular eruption affecting the scalp, eyebrows, and intertriginous regions. It is considered a variant of lichen planopilaris. The condition often begins as hyperkeratotic papules on the trunk and extremities followed by the development of alopecia. Several subtypes of lichen planus have been associated with a photodistriubuted eruption including lichenoid drug reactions, actinic lichen planus, and lichen planus pigmentosus; however, there are no reported cases associated with GLPLS. We herein report the first case of GLPLS displaying a photodistributed lichenoid eruption to expand upon the differential diagnosis of photoaggravated conditions. We also use this case to review the pathophysiology and therapeutic modalities to manage GLPLS.
PubMed: 38765727
DOI: 10.4103/ijt.ijt_47_22 -
Dermatology Online Journal Mar 2024Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a rare immunologic hypersensitivity reaction to stimuli that presents as widespread eruption with...
Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a rare immunologic hypersensitivity reaction to stimuli that presents as widespread eruption with mucocutaneous detachment and involvement of other organs. Multiple causes have been noted in literature, including numerous medications. In this report, we present a 52-year-old woman who arrived at the emergency department with a complaint of rash, malaise, and pruritus. She subsequently developed diffuse cutaneous and mucosal detachment. Work-up supported a diagnosis of SJS/TEN secondary to her thyroid replacement therapy, derived from desiccated pig thyroid glands. The patient's natural thyroid medication was discontinued and she responded well to appropriate treatment. This case is unique in that thyroid replacement therapy is not a commonly reported trigger of SJS/TEN. Providers should be aware of the potential for natural thyroid and other animal-derived natural medications to cause adverse reactions such as SJS/TEN.
Topics: Stevens-Johnson Syndrome; Humans; Female; Middle Aged; Animals; Swine; Thyroid Gland
PubMed: 38762864
DOI: 10.5070/D330163294 -
Dermatology Online Journal Mar 2024Tumor necrosis factor (TNF) inhibitors may paradoxically induce pustular eruptions, most of which are classified as pustular psoriasis. Amicrobial pustulosis of the...
Tumor necrosis factor (TNF) inhibitors may paradoxically induce pustular eruptions, most of which are classified as pustular psoriasis. Amicrobial pustulosis of the folds (APF) is a much rarer entity that was recently recognized to occur in the setting of chronic anti-TNF therapy and inflammatory bowel disease, with 12 existing cases in the literature. Amicrobial pustulosis of the folds is a neutrophilic dermatosis characterized by aseptic pustules involving the major and minor skin folds, genital regions, and scalp. Herein, we report an additional case of paradoxical APF induced by chronic infliximab therapy in a patient with Crohn disease.
Topics: Humans; Infliximab; Crohn Disease; Adult; Skin Diseases, Vesiculobullous; Male; Female; Tumor Necrosis Factor-alpha
PubMed: 38762858
DOI: 10.5070/D330163286 -
American Journal of Clinical Dermatology Jul 2024Drug reaction with eosinophilia and systemic symptoms (DReSS) is known to cause mortality and long-term sequelae in the pediatric population, however there are no... (Review)
Review
Drug reaction with eosinophilia and systemic symptoms (DReSS) is known to cause mortality and long-term sequelae in the pediatric population, however there are no established clinical practice guidelines for the management of pediatric DReSS. We conducted a scoping review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to summarize the currently available data on treatment, mortality, and long-term sequelae of DReSS in children (aged 0-18 years). Data from 644 individuals revealed that various treatment strategies are being used in the management of pediatric DReSS, and strategies were often used in combination. The diversity in treatment approaches cannot be solely attributed to age or disease severity and reflects the lack of evidence-based management guidelines for DReSS. Children are also at risk of developing autoimmune sequelae following DReSS, most commonly thyroid disease and type 1 diabetes mellitus. We found that the eventual development of autoimmune disease was more often associated with DReSS caused by antibiotics, especially minocycline and sulfamethoxazole, in comparison with individuals who did not develop sequelae. In this study, we identify strengths and weaknesses in the currently available literature and highlight that future prospective studies with structured and long-term follow-up of children with DReSS are needed to better understand potential risk factors for mortality and development of sequelae after DReSS.
Topics: Humans; Drug Hypersensitivity Syndrome; Child; Adolescent; Child, Preschool; Infant; Risk Factors; Anti-Bacterial Agents; Treatment Outcome; Autoimmune Diseases; Severity of Illness Index
PubMed: 38755503
DOI: 10.1007/s40257-024-00867-y -
Journal of the American Academy of... Jul 2024
Topics: Etanercept; Humans; Stevens-Johnson Syndrome; Treatment Outcome
PubMed: 38754630
DOI: 10.1016/j.jaad.2024.04.072