Consideration of the spectrum of erythema multiforme in the polymedication era
Erythema multiforme (EM) is an acute, self-limited, immune-mediated disease characterized by a pleomorphic rash with erythematous macules, papules, urticarial plaques, vesicles, and blisters. EM includes EM minor, EM major, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2022
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/39109 |
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I10-R327-article-39109 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| format |
Artículo revista |
| topic |
erythema multiforme stevens-johnson carbamazepine polymedication eritema multiforme stevens-johnson carbamazepina polimedicación |
| spellingShingle |
erythema multiforme stevens-johnson carbamazepine polymedication eritema multiforme stevens-johnson carbamazepina polimedicación Ferro, AA Palacio, C Mazzotta, MM Zalazar, EV Cabalier, ME Consideration of the spectrum of erythema multiforme in the polymedication era |
| topic_facet |
erythema multiforme stevens-johnson carbamazepine polymedication eritema multiforme stevens-johnson carbamazepina polimedicación |
| author |
Ferro, AA Palacio, C Mazzotta, MM Zalazar, EV Cabalier, ME |
| author_facet |
Ferro, AA Palacio, C Mazzotta, MM Zalazar, EV Cabalier, ME |
| author_sort |
Ferro, AA |
| title |
Consideration of the spectrum of erythema multiforme in the polymedication era |
| title_short |
Consideration of the spectrum of erythema multiforme in the polymedication era |
| title_full |
Consideration of the spectrum of erythema multiforme in the polymedication era |
| title_fullStr |
Consideration of the spectrum of erythema multiforme in the polymedication era |
| title_full_unstemmed |
Consideration of the spectrum of erythema multiforme in the polymedication era |
| title_sort |
consideration of the spectrum of erythema multiforme in the polymedication era |
| description |
Erythema multiforme (EM) is an acute, self-limited, immune-mediated disease characterized by a pleomorphic rash with erythematous macules, papules, urticarial plaques, vesicles, and blisters. EM includes EM minor, EM major, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Factors related to its development involve infections, medications, neoplasms, autoimmune diseases. Associated drugs can be nonsteroidal anti-inflammatory drugs, sulfonamides, antiepileptics, and antibiotics. SJS is applied to severe cases with oral involvement. The lesions are disseminated or limited to the trunk, are usually associated with drugs and present systemic symptoms. EM major presents localized lesions on the extremities and/or face and usually occurs secondary to herpes. TEN is considered the most severe form and presents as a generalized erythema that rapidly progresses to a bullous phase with extensive skin detachment. Mortality approaches 35%. The objective is to present a clinical case of SJS associated with polypharmacy with its clinical and pathological findings.
CLINICAL CASE: A 23-year-old woman with polypharmacy. She initially took minocycline 200 mg/day due to acne, reporting headache and fine tremor after 7 days, for which she was derived to neurology service, and phenobarbital was indicated. A few days later, she presented urticarial lesions that were treated with desloratadine, and after that she presented erythema and facial edema, painful and bleeding blisters on the lips, lesions on the buccal mucosa and meliceric crusts with intense odynophagia. On palms and soles, she presented target lesions and edema and painful erythema in extremities. Also, she presented tachycardia, fever and hypertension. Skin biopsy: interface dermatitis with prominent epidermal apoptosis and mild perivascular inflammation with some eosinophils and bullous detachment. These findings were consistent with major EM/SSJ spectrum. Directed treatment was performed in the intensive care unit with excellent clinical evolution.
This case is related to avoidable polypharmacy with adequate interdisciplinary management and knowledge of adverse drug reactions. In this context, it is important to maintain an agile relationship between different services to avoid potentially fatal drug reactions; or once produced the same, to be able to act with the efficiency required to avoid mortality
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| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2022 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/39109 |
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I10-R327-article-391092024-04-15T16:14:45Z Consideration of the spectrum of erythema multiforme in the polymedication era Consideración del espectro de eritema multiforme en la era de la polimedicación Ferro, AA Palacio, C Mazzotta, MM Zalazar, EV Cabalier, ME erythema multiforme stevens-johnson carbamazepine polymedication eritema multiforme stevens-johnson carbamazepina polimedicación Erythema multiforme (EM) is an acute, self-limited, immune-mediated disease characterized by a pleomorphic rash with erythematous macules, papules, urticarial plaques, vesicles, and blisters. EM includes EM minor, EM major, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). Factors related to its development involve infections, medications, neoplasms, autoimmune diseases. Associated drugs can be nonsteroidal anti-inflammatory drugs, sulfonamides, antiepileptics, and antibiotics. SJS is applied to severe cases with oral involvement. The lesions are disseminated or limited to the trunk, are usually associated with drugs and present systemic symptoms. EM major presents localized lesions on the extremities and/or face and usually occurs secondary to herpes. TEN is considered the most severe form and presents as a generalized erythema that rapidly progresses to a bullous phase with extensive skin detachment. Mortality approaches 35%. The objective is to present a clinical case of SJS associated with polypharmacy with its clinical and pathological findings. CLINICAL CASE: A 23-year-old woman with polypharmacy. She initially took minocycline 200 mg/day due to acne, reporting headache and fine tremor after 7 days, for which she was derived to neurology service, and phenobarbital was indicated. A few days later, she presented urticarial lesions that were treated with desloratadine, and after that she presented erythema and facial edema, painful and bleeding blisters on the lips, lesions on the buccal mucosa and meliceric crusts with intense odynophagia. On palms and soles, she presented target lesions and edema and painful erythema in extremities. Also, she presented tachycardia, fever and hypertension. Skin biopsy: interface dermatitis with prominent epidermal apoptosis and mild perivascular inflammation with some eosinophils and bullous detachment. These findings were consistent with major EM/SSJ spectrum. Directed treatment was performed in the intensive care unit with excellent clinical evolution. This case is related to avoidable polypharmacy with adequate interdisciplinary management and knowledge of adverse drug reactions. In this context, it is important to maintain an agile relationship between different services to avoid potentially fatal drug reactions; or once produced the same, to be able to act with the efficiency required to avoid mortality El eritema multiforme (EM) es una enfermedad aguda, autolimitada e inmunomediada que se caracteriza por presentar una erupción pleomórfica con máculas eritematosas, pápulas, placas urticariales, vesículas y ampollas. El EM incluye el EM menor, el EM mayor, el síndrome de Stevens-Johnson (SJS) y la necrólisis epidérmica tóxica (NET). Los factores relacionados al desarrollo involucran infecciones, medicamentos, neoplasias, enfermedades autoinmunes. Los fármacos asociados pueden ser antiinflamatorios no esteroideos, sulfonamidas, antiepilépticos y antibióticos. El SJS se aplica a casos graves con afectación oral. Las lesiones son diseminadas o limitadas al tronco, suele asociarse a fármacos y presenta síntomas sistémicos. El EM mayor presenta lesiones localizadas en las extremidades y/o cara y suele ocurrir secundario a herpes. La NET se considera la forma más severa y se presenta como un eritema generalizado que progresa rápidamente hacia una fase ampollosa con extenso despegamiento de la piel. La mortalidad se acerca al 35%. El objetivo es presentar un caso clínico de EM asociado a polimedicación con sus hallazgos clínicos y anatomopatológicos. CASO CLÍNICO: Mujer de 23 años con polimedicación. Inicialmente minociclina 200 mg/día por acné, refiriendo a los 7 días cefalea y temblor fino, por lo cual se deriva a neurología indicando fenobarbital. A los pocos días presenta lesiones urticariales tratadas con desloratadina, y posteriormente eritema y edema facial, vésico-ampollas dolorosas y sangrantes en labios, lesiones en mucosa yugal y costras melicéricas con odinofagia intensa. En palmas y en plantas lesiones en dianas y en las extremidades edema, eritema doloroso con taquicardia, fiebre e hipertensión. Biopsia de piel: dermatitis de interfaz con apoptosis epidérmica prominente e inflamación perivascular leve con algunos eosinófilos y despegamiento ampolloso. Hallazgos compatibles con el espectro EM mayor/ SSJ. Se realiza tratamiento dirigido en unidad de terapia intensiva con excelente evolución clínica. Este caso se relaciona con polimedicación evitable con un adecuado manejo interdisciplinario y el conocimiento de reacciones adversas medicamentosas. Es importante, en este contexto, mantener una relación ágil entre diferentes servicios para evitar farmacodermias potencialmente fatales; o una vez producidas las mismas, poder actuar con la eficacia requerida para evitar la mortalidad. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2022-10-26 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion txt https://revistas.unc.edu.ar/index.php/med/article/view/39109 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 79 No. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 79 Núm. Suplemento JIC XXIII (2022): Suplemento JIC XXIII Revista da Faculdade de Ciências Médicas de Córdoba; v. 79 n. Suplemento JIC XXIII (2022): Suplemento JIC XXIII 1853-0605 0014-6722 http://creativecommons.org/licenses/by-nc/4.0 |