Michiko Aihara

Predictive Factors Associated With Acute Ocular Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

PURPOSEnTo suggest an objective score for grading the acute ocular severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to determine predictive factors for severe acute ocular involvement such as ocular surface epithelial defect and/or pseudomembrane formation.nnnDESIGNnRetrospective cohort study.nnnMETHODSnThe medical records of SJS (n = 87) and TEN (n = 48) patients between 2005 and 2007 were reviewed. An acute ocular severity score was determined on a scale from 0 to 3 (none, mild, severe, and very severe) according to the existence of hyperemia, corneal or conjunctival epithelial defect, and pseudomembrane formation. The associations between the severe acute ocular involvement and factors such as patient age, exposed drugs, systemic severity, and the prevalence of ocular sequelae were examined.nnnRESULTSnThe number of cases with score grade 0, 1, 2, and 3 was 19 (21.8%), 31 (35.6%), 22 (25.3%), and 15 (17.2%) in 87 SJS cases and 12 (25.0%), 11 (22.9%), 17 (35.4%), and 8 (16.7%) in 48 TEN cases. Multivariate logistic regression analysis revealed that patient age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P = .007) and nonsteroidal anti-inflammatory drugs NSAIDs or cold remedies (OR, 2.58; 95% CI, 1.26-5.29; P = .010) were predictive factors for severe acute ocular involvement. The prevalence of visual disturbance and eye dryness increased according to the increase of acute ocular severity (P = .001 and P = .007 in SJS; P = .007 and P = .014 in TEN, respectively).nnnCONCLUSIONSnAt the onset of SJS/TEN, strict attention should be paid to ocular involvement in young patients and in patients exposed to NSAIDs or cold remedies.

Toxic epidermal necrolysis in a child successfully treated with cyclosporin A and methylprednisolone

© 2007 Japan Pediatric Society Toxic epidermal necrolysis (TEN) is an acute and life-threatening disease that is characterized by severe necrosis of the skin. It also involves visceral organs and manifests systemic symptoms. 1,2 Some medicines and infections are known to be major precipitating factors of the disease. 3 TEN and Stevens – Johnson syndrome (SJS) are now categorized into the same type of disorder. 4 The mortality rate of TEN is 30 – 35% and prompt management including withdrawal of causative drugs with long half-lives is essential for a favorable outcome. 5 Many drugs such as corticosteroids, i.v. immunoglobulin, 3 and thalidomide 6 are used as treatment for TEN, but these drugs are unsatisfactory in effi cacy. In the current report we present a pediatric case of TEN associated with leukopenia successfully treated with i.v. cyclosporin A (CsA), methylprednisolone and granulocyte-colony stimulating factor (G-CSF).

Different patterns of cytokines, ECP and immunoglobulin profiles at two adverse drug reactions in a patient

Abstract Objectives :u2002Drug‐induced hypersensitivity syndrome (HS) is a rare but life‐threatening disease. We experienced carbamazepine‐induced HS in a 14‐year‐old boy, who had cefaclor‐induced cutaneous eruptions 15 months later. To clarify the mechanisms of HS and the differences between two diseases we studied this case in detail.

Toxic epidermal necrolysis in a 4-year-old boy successfully treated with plasma exchange in combination with methylprednisolone and i.v. immunoglobulin.

and ⁄ or dorsal hand involvement. Sweet syndrome affect adults in their third to fifth decades. However, the mean age at onset in the reviewed NDDH cases was 61 years, which is similar to the mean age reported in previous studies. The mean age of the reviewed NDP cases was 75.5 years, which is statistically much greater than that of the NDDH cases (P < 0.01, Mann–Whitney U-test). The difference in the age of onset between NDDH and NDP probably reflects a difference in their pathogenesis. Furthermore, in our review, the NDDH cases were strongly associated with malignant disorders, whereas the NDP cases were not. The latter showed a typical dermal neutrophilic infiltrate with neither vasculitis nor fibrinoid necrosis, whereas vascular damage was frequently observed in the NDDH cases. Some researchers recently suggested that vasculitis in SS is not a primary process but occurs secondary to the release of noxious products by neutrophils. However, the presence of vasculitis apparently differs between NDP and NDDH, and is very likely to be associated with the difference in their pathogenesis. We consider that more cases are necessary to confirm these points presented in this article. Kaoru IMAOKA, Sakae KANEKO, Yuji HARADA, Masataka OTA, Minao FURUMURA, Eishin MORITA Departments of Dermatology and Pathology, Shimane University Faculty of Medicine, Izumo, Japan

Pustulosis palmaris et plantaris successfully treated with leukotriene antagonist

Abstract