Stevens-Johnson syndrome (SJS) manifests with severe cutaneous reactions, most commonly triggered by medications, which are characterized by fever and mucocutaneous lesions leading to necrosis and sloughing of the epidermis. To our knowledge, pravastatin-induced SJS has not yet been reported. Here, we describe a case of SJS due to pravastatin, which was diagnosed by a patch test. A 70-year-old woman presented with maculopapular skin rashes, which developed 2 weeks after medication of bisoprolol, amlodipine, pravastatin, spironolactone, and indobufene for cardiac problems. Various bullous-erosive mucocutaneous lesions occupied less than 10% of the total body surface area. Painful oropharyngeal mucous membrane lesions were observed. The vermilion border of the lips became denuded and developed serosanguinous crusts. With the drug withdrawal and the use of systemic corticosteroids, her manifestations resolved. Drug patch tests with bisoprolol, amlodipine, pravastatin, spironolactone, and indobufene were performed, resulting in a positive reaction to pravastatin, but not to the other drugs. To the best of our knowledge, this is the first case of pravastatin-induced SJS.
Adrenal Cortex Hormones ; Aged ; Amlodipine ; Bisoprolol ; Body Surface Area ; Epidermis ; Exanthema ; Female ; Fever ; Humans ; Lip ; Mucous Membrane ; Necrosis ; Patch Tests ; Pravastatin ; Spironolactone ; Stevens-Johnson Syndrome*

PURPOSE: Fractional exhaled nitric oxide (FeNO) is useful for the diagnosis of allergic rhinitis (AR) as well as bronchial asthma (BA). However, FeNO may differ according to race, age, and other determinants. There have been few studies about FeNO in Korean children with AR. The aims of this study were to evaluate the value of FeNO in AR and to compare FeNO, and determinants of FeNO levels between AR, BA, and combined AR and BA. METHODS: This study included 647 children aged 5 to 17. The children were classified into 5 groups after performing the skin test, FeNO measurement, the pulmonary function test, and the methacholine challenge test: those with nonallergic rhinitis (NAR), those with AR, those with BA, and those with combined AR and BA, and healthy controls,. RESULTS: The values of FEV1 (forced expiratory volume in one second) %predicted were 94.4%+/-12.6%, 93.8%+/-20.7%, 90.0%+/-17.4% in AR, BA, and combined AR and BA, respectively. The values of FeNO in AR (32.3+/-25.0 ppb), BA (31.1+/-20.5 ppb), and combined AR and BA (34.5+/-30.4 ppb) were significantly higher compared to those of NAR (16.8+/-13.5 ppb) and controls (15.9+/-12.5 ppb). There was no significant difference in FeNO among AR, BA, and combined AR and BA. FeNO was significantly higher in patients with > or =4 positive results (36.6+/-29.2 ppb) than in those with <4 positive skin test results (27.6+/-20.7 ppb). When the receiver operating characteristic curve analysis for prediction of AR showed 0.756 of area under the curve, the cutoff level of FeNO was 16 ppb. CONCLUSION: In this study, children with AR had increased levels of FeNO. It is suggested that AR may have eosinophilic bronchial inflammation without BHR or clinical asthma.
Asthma ; Child* ; Continental Population Groups ; Diagnosis ; Eosinophils ; Humans ; Inflammation ; Methacholine Chloride ; Nitric Oxide* ; Respiratory Function Tests ; Rhinitis* ; ROC Curve ; Skin Tests

PURPOSE: Asthma is a global health concern involving 300 million people, and mortality due to asthma still accounts for a significant proportion of deaths. The purpose of this study was to define risk factors for the mortality of patients admitted to the intensive care unit because of asthma exacerbation. METHODS: A retrospective analysis of 163 severe asthma patients, who were admitted to Ewha Womans University Mokdong Hospital from January 1997 to December 2011 with the need for intensive medical care, was performed. The medical history and laboratory workup at initial visit to hospital were collected by reviewing medical records. To identify risk factors for mortality, data was compared between the survivors (survivor group) and the dead (death group). RESULTS: As a result, mortality rate was 30.7%. The number of patients 65 years or older was larger in the death group. The number of patients on mechanical ventilation was larger in the death group compared to the survivor group. In arterial blood gas analysis, the levels of pH and PaO2 were higher and the PCO2 levels were lower in the death group. In multivariate analysis, the risk of death was higher in patients on mechanical ventilation (odds ratio [OR], 5.327). PCO2 and O2 saturation were protective factors for mortality (OR, 0.90 and 0.915, respectively). CONCLUSION: Use of mechanical ventilator, low PCO2, and O2 saturation are the most important factors for mortality while admitted to the intensive care unit in severe asthma patients. We should pay attention to patients who are on mechanical ventilation and have low PCO2 and O2 saturation levels.
Asthma* ; Blood Gas Analysis ; Female ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units* ; Critical Care* ; Medical Records ; Mortality* ; Multivariate Analysis ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Survivors ; Tertiary Care Centers* ; Ventilators, Mechanical

PURPOSE: Children with asthma frequently have allergic rhinitis (AR) as a comorbidity. Asthmatic children with AR have a higher exhaled nitric oxide (eNO) level and bronchial hyperresponsiveness (BHR) than those without. The purpose of this study is to investigate the difference in lung function, eNO, and BHR between atopic asthma with and without AR, and the association of eNO and BHR with atopic intensity in total asthmatics. METHODS: We recruited 69 atopic asthmatic children with AR, 19 atopic asthmatic children without AR, 38 children with AR, and 43 nonatopic controls. We measured forced expiratory volume in one second (FEV1) and forced expiratory flow at 25% to 75% of forced vital capacity (FEF(25%-75%)), dose response slope (DRS) of bronchial challenge with methacholine and adenosine 5'-monophosphate (AMP), the levels of eNO, and the ratio of sum of allergen wheal diameter to histamine using skin prick tests. RESULTS: Atopic asthmatic children with AR had a higher eNO level compared to those without AR (P<0.05). However, there was no difference in FEV1 %predicted, FEF(25%-75%) %predicted, methacholine DRS, and AMP DRS between asthmatic children with and without AR. In total asthmatics, methacholine DRS and AMP DRS significantly correlated with eNO levels (r=0.338, P<0.001; r=0.365, P<0.001), but not with total IgE levels. However, eNO significantly correlated with total IgE levels (r=0.479, P<0.001). CONCLUSION: These results suggest that AR may enhance airway inflammation but may not lead to enhanced BHR in children with asthma.
Adenosine ; Asthma ; Bronchial Hyperreactivity ; Child* ; Comorbidity ; Forced Expiratory Volume ; Histamine ; Humans ; Immunoglobulin E ; Inflammation ; Lung ; Methacholine Chloride ; Nitric Oxide* ; Rhinitis* ; Skin ; Vital Capacity

PURPOSE: Vascular endothelial growth factor (VEGF), transforming growth factor beta1 (TGF-beta1), and platelet derived growth factor (PDGF) are known to be involved in the pathogenesis of inflammation and remodeling in asthmatic airways. YKL-40, a chitinase-like protein, and clusterin have been reported to be biomarkers for severe asthma. We examined the serum levels of growth factors, YKL-40, and clusterin in children with acute asthma or stable asthma, and investigated their correlation with clinical findings and lung function parameters. METHODS: Forty-one children (> or =6 years of age) with asthma were enrolled, and 2 groups were defined: 23 patients admitted with acute asthma (acute asthma group) and 18 patients with stable asthma (stable asthma group). The serum levels of VEGF, TGF-beta1, PDGF-BB, YKL-40, and clusterin were measured using enzyme-linked immunosorbent assay and assessed in relation to clinical manifestations and spirometric parameters. Fifteen age-matched controls were also studied. RESULTS: The serum levels of VEGF, TGF-beta1, and YKL-40 were significantly elevated in children with acute asthma compared to controls. The serum levels of VEGF and YKL-40 were higher in the stable asthma group than in controls. The serum levels of VEGF, TGF-beta1, and YKL-40 were not different between the acute asthma and stable asthma groups. The serum VEGF levels in the acute asthma group correlated significantly with asthma severity. The serum TGF-beta1 levels in stable asthma group showed a significant inverse correlation with (FEV1) forced expiratory volume in one second and FEF(25%-75%) (forced expiratory flow between 25 and 75 percent of expired vital capacity). Serum YKL-40 had no significant relationship with clinical manifestations and spirometric parameters. CONCLUSION: Our study suggests that increased serum levels of VEGF and YKL-40 might affect asthmatic airways not only during acute exacerbation but also in stable state and that serum TGF-beta1 might be a biomarker for airway obstruction in children with asthma.
Airway Obstruction ; Asthma* ; Biomarkers ; Child* ; Clusterin ; Enzyme-Linked Immunosorbent Assay ; Forced Expiratory Volume ; Humans ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Lung ; Platelet-Derived Growth Factor ; Transforming Growth Factor beta1 ; Vascular Endothelial Growth Factor A*

PURPOSE: We evaluated the clinical characteristics of respiratory viruses that were frequently found in children during spring/summer, namely, human bocavirus (hBoV), human metapneumovirus (hMPV), parainfluenza virus (PIV), and human rhinovirus (hRV). METHODS: This study enrolled patients with acute lower respiratory infection in whom respiratory virus reverse transcriptase polymerase chain reaction was performed between March 2013 and August of 2013. We retrospectively reviewed the medical records to collect the patients' data. RESULTS: A total of 96 patients were enrolled and divided into 5 categories: hBoV in 19 patients (19.8%), hMPV in 18 patients (18.8%), PIV in 16 patients (16.7%), hRV in 20 patients (20.8%), and negative result in 23 patients (24.0%). The mean age of the patients was 8.2+/-5.9 months (median, 7.5 months; range, 1-24 months), and the male-to-female ratio was 1.1:1. The most common diagnoses were acute bronchiolitis (62.5%) and pneumonia (30.2%). Compared to other patients, those with hBoV were older (12.3+/-4.9 months, P=0.001) and more frequently diagnosed with acute bronchiolitis (P=0.005). In addition, they showed higher incidences of tachypnea and rales (P=0.039 and P=0.035, respectively), and were more frequently treated with oxygen and systemic steroids (P=0.044 and P=0.001, respectively) than the other patients. CONCLUSION: We compared respiratory viruses in children during spring/summer and found that hBoV may have more severe clinical manifestations than other viruses.
Bronchiolitis ; Child* ; Diagnosis ; Human bocavirus* ; Humans ; Humans* ; Incidence ; Medical Records ; Metapneumovirus ; Oxygen ; Paramyxoviridae Infections ; Pneumonia ; Respiratory Sounds ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Rhinovirus ; Steroids ; Tachypnea

PURPOSE: The purpose of this study is to identify the epidemiologic and clinical characteristics of respiratory adenovirus infections in children, and to investigate the difference in the clinical features between single adenovirus infection and coinfection with adenovirus and other respiratory viruses. METHODS: A retrospective study was performed in 470 children hospitalized with respiratory adenovirus infections in Gwangmyeong Sungae Hospital between January 2013 and December 2013. RESULTS: The mean age of the patients was 46.2 months and the peak incidence was in the 12- to 24-month age group. The mean duration of hospitalization and fever were 4.5+/-1.1 and 4.5+/-9.2 days, respectively. Seasonally it had occurred throughout the year, but showed the highest prevalence in August and high prevalence in July, September, and October. The frequency of viral coinfection with other respiratory viruses was 39.6%. The age was significantly younger in coinfection group than in the single adenovirus infection group (P<0.001). The prevalence rates of bronchiolitis (P<0.001) and pneumonia (P=0.042) were significantly higher in the respiratory syncytial virus coinfection group. The coinfection rate was significantly higher in children aged less than 2 years (P<0.001), and the prevalence rates of bronchiolitis (P<0.001) and pneumonia (P<0.001) were also higher in the group aged less than 2 years than other age groups. CONCLUSION: Adenovirus is an important viral agent in hospitalized children with acute respiratory tract infection. Lower respiratory tract infections, such as bronchiolitis and pneumonia, and coinfection with other respiratory viruses were more frequently occurred in patients under 2 years of age. Further studies are needed to clarify whether coinfection with other respiratory viruses would increase the rate of lower respiratory tract infections in patients with respiratory adenoviral infections.
Adenoviridae Infections* ; Adenoviridae* ; Bronchiolitis ; Child ; Child, Hospitalized ; Coinfection ; Fever ; Hospitalization ; Humans ; Incidence ; Inpatients* ; Pneumonia ; Prevalence ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Retrospective Studies ; Seasons

PURPOSE: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Vitamin D and interleukin-31 (IL-31) are known to be related to the pathogenesis of AD with pruritus. The purpose of this study was to investigate the relationship between serum levels of 25-hydroxyvitamin D (25(OH)D) and IL-31 and the disease severity of AD in children with AD. METHODS: We recruited 160 children with AD and 42 controls. We used the SCORing Atopic Dermatitis (SCORAD) index to measure the severity of AD. Serum IL-31 and 25(OH)D levels were assayed using enzyme-linked immunosorbent assay and high-performance liquid chromatography, respectively. Serum levels of total IgE, specific IgE to common allergens and peripheral blood total eosinophil count were carried out in children with AD. RESULTS: Serum IL-31 level was significantly higher in AD group compared to control group and 25(OH)D level was significantly lower in AD group than control group. Serum IL-31 level showed the highest level in severe AD group followed by moderate and mild AD group, whilst serum 25(OH)D level was the lowest in severe AD group compared to moderate and mild AD group. There was no difference in serum IL-31 level between AD group and nonatopic dermatitis group. IL-31 level was positively correlated with subjective SCORAD index indicating pruritus in children with AD, and 25(OH)D was inversely correlated with SCORAD index. CONCLUSION: IL-31 and vitamin D may be related to the pathogenesis of AD, especially with regard to the pruritus.
Allergens ; Child* ; Chromatography, Liquid ; Dermatitis ; Dermatitis, Atopic* ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Humans ; Immunoglobulin E ; Pediatrics ; Pruritus ; Skin Diseases ; Vitamin D

Numerous disorders and etiologies may underlie increased eosinophil counts. Hypereosinophilia (HE) is defined as a peripheral blood eosinophil count greater than 1,500/mm3 and may be potentially harmful because of tissue damage. Hypereosinophilic syndrome (HES) also represents a heterogeneous disorder characterized by persistent HE with the evidence of organ dysfunction, clinical symptoms, or both caused by eosinophilia. The refining criteria and subclassification of HE and HES are currently being revised on cellular and molecular based diagnostic methods. Initial approaches focus on evaluating various underlying causes, including helminthic infections, adverse drug reactions, allergic diseases, and neoplastic diseases. When secondary causes of HE are excluded, the workup should proceed to the evaluation of primary/clonal bone marrow disease, including fip 1-like 1-platelet driven growth factor receptor alpha (FIP1L1-PDGFRA) mutation. Concurrently, if the patient has symptoms and signs, organ damage or dysfunction must be evaluated. Although, corticosteroids are the mainstay of therapy in confirmed HES, imatinib is considered a definitive treatment for FIP1L1-PDGFRA, platelet driven growth factor receptor beta rearranged HE and HES. In this article, we discuss recent advances in the classification of and practical approaches to HE and HES. In addition, we introduce several promising therapies for HE and HES.
Adrenal Cortex Hormones ; Blood Platelets ; Bone Marrow Diseases ; Classification* ; Drug-Related Side Effects and Adverse Reactions ; Eosinophilia ; Eosinophils ; Helminths ; Humans ; Hypereosinophilic Syndrome ; Molecular Targeted Therapy ; Imatinib Mesylate

No abstract available.
Nitric Oxide* ; Rhinitis*