Aged ; Diagnosis, Differential ; Exanthema/etiology* ; Female ; Humans

A girl, aged 22 months, attended the hospital due to recurrent vulvar rashes for more than half a year. Skin biopsy showed Langerhans cell histiocytosis, and evaluation of systemic conditions showed no systemic involvement. Therefore, the girl was diagnosed with Langerhans cell histiocytosis (skin type). In conclusion, for rashes on the vulva alone, if there are no specific clinical manifestations, the possibility of Langerhans cell histiocytosis should be considered after molluscum contagiosum, sexually transmitted diseases, and Fordyce disease are excluded.
Developmental Disabilities ; Exanthema/etiology* ; Female ; Histiocytosis, Langerhans-Cell ; Humans ; Infant ; Vulvar Diseases/diagnosis*

BACKGROUNDDrug reaction with eosinophilia and systemic symptoms (DRESS) is a severe, life-threatening disorder caused by drugs. In the present study, we tried to explore the types of DRESS-inducing drugs, incubation period, features of skin rashes, accompanying visceral damage, and effectiveness of glucocorticoid therapy so as to inform clinical practice.

METHODSPatients diagnosed with a drug-induced rash, dermatitis, and DRESS admitted to our hospital from January 2006 to December 2015 were included in the study. The diagnosis followed the criteria and scoring system set by the European Registry of Severe Cutaneous Adverse Reactions. Statistical analyses were carried out using SPSS version 17.0 (IBM, Armonk, NY, USA), and a value of P < 0.05 was considered statistically significant.

RESULTSAmong 104 patients, 38 were male and 66 female (aged 18-83 years). The latent period was 13 (interquartile range [IQR]: 10-17) days. The most common allergy-inducing drugs were antibiotics (n = 37, 35.6%), followed by antiepileptic drugs and traditional Chinese medicines (TCMs). Eighty-two cases (78.8%) had rash with area >50% body surface area (BSA). Liver damage occurred in 90% of cases. Patients were divided into oral antihistamine group and glucocorticoid/immunosuppressive agent/intravenous immunoglobulin (IVIG) group. Sex, age, incubation period, duration of hospital stay, and the number of patients with body temperature ≥38.5°C were not significantly different between the two groups. However, the number of patients meeting the criteria of "definite" and "probable" (χ2 = 5.852, P = 0.016), with an eosinophilic granulocyte count of ≥1.5 × 109/L (χ2 = 7.129, P = 0.008), and with rash area of >50% BSA (χ2 = 4.750, P = 0.029), was significantly different.

CONCLUSIONSAntibiotics were associated with allergic reactions, but TCMs also had an important role. Allergy resulting from repeat use of the same drug was more severe with a shorter incubation period. The most typical rash was widespread erythematous papules. Liver damage accounted for >90% of cases.

Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; adverse effects ; Dermatitis ; diagnosis ; etiology ; Drug Hypersensitivity Syndrome ; diagnosis ; etiology ; Eosinophilia ; diagnosis ; etiology ; Exanthema ; diagnosis ; etiology ; Female ; Glucocorticoids ; adverse effects ; Humans ; Immunosuppressive Agents ; adverse effects ; Liver ; drug effects ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Imatinib mesylate is recommended as adjuvant therapy for GIST after surgical resection. However, drug-related adverse events are common. A 74-year-old female with metastatic GIST who was managed with imatinib experienced severe adverse events, including skin rashes, tremor, and alopecia, etc. The imatinib dose was reduced and the size of the metastatic GIST continued to decrease and adverse events showed significant improvement.
Aged ; Antineoplastic Agents/adverse effects/*therapeutic use ; Exanthema/etiology ; Female ; Gastrointestinal Neoplasms/diagnosis/*drug therapy/pathology ; Gastrointestinal Stromal Tumors/diagnosis/*drug therapy/pathology ; Humans ; Imatinib Mesylate/adverse effects/*therapeutic use ; Immunohistochemistry ; Proto-Oncogene Proteins c-kit/metabolism ; Tomography, X-Ray Computed

There have been a number of studies about correlations between HLA genotypes in various ethnic groups and occurrence of various cutaneous adverse drug reactions, ranging in intensity from mild to severe, caused by antiepileptic drugs (AEDs). This is the first report analyzing the HLA genotypes of 9 Korean patients with skin rashes induced by various AEDs. The AEDs that induced skin rash were lamotrigine (n=3), carbamazepine (n=3), oxcarbazepine (n=1), phenobarbital (n=1), and phenytoin (n=1). None of the patients' HLA genotypes was either HLA-B*1502 or HLA-A*3101. Based on these series of cases, AED-induced skin rash can occur independently of HLA-B*1502 or HLA-A*3101 genotypes in the Korean patients.
Adolescent ; Adult ; Aged ; Alleles ; Anticonvulsants/*adverse effects ; Asian Continental Ancestry Group/*genetics ; Exanthema/*diagnosis/etiology ; Female ; Gene Frequency ; Genotype ; HLA-A Antigens/*genetics ; HLA-B Antigens/*genetics ; Humans ; Male ; Republic of Korea ; Young Adult

Aged, 80 and over ; Exanthema ; etiology ; Female ; Humans ; Leukemia, Monocytic, Acute ; pathology ; Leukemic Infiltration ; complications ; diagnosis ; Skin ; pathology

The triad of rash, arthritis, and uveitis seems to be characteristic for early-onset childhood sarcoidosis. We describe an interesting case of early-onset childhood sarcoidosis coexisting enchondromatosis, which clinically masquerade as Langerhans cell histiocytosis. A 33 months old girl presented with skin rash, subcutaneous nodules with polyarthritis, and revealed the involvement of lymph nodes as well as spleen during work-up. She also presented with multiple osteolytic lesions which pathologically proven enchondromatosis. Oral prednisone was prescribed at 2 mg/kg/day for 2 months until when subcutaneous nodules and joint swellings almost disappeared, and then slowly tapered over a period of 5 months. We report an unusual case of early-onset childhood sarcoidosis presented with osteolytic bone lesions which were irrelevant to sarcoidosis.
Administration, Oral ; Anti-Inflammatory Agents/therapeutic use ; Arthritis/complications ; Child, Preschool ; Diagnosis, Differential ; Enchondromatosis/*complications/*diagnosis/drug therapy/radiography ; Exanthema/etiology ; Female ; Humans ; Positron-Emission Tomography and Computed Tomography ; Prednisone/therapeutic use ; Sarcoidosis/*complications/*diagnosis/drug therapy/radiography ; Whole Body Imaging

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.
Acute Kidney Injury/diagnosis ; Anti-Bacterial Agents/*adverse effects/therapeutic use ; Cefotaxime/adverse effects/therapeutic use ; Cholestasis/complications/*diagnosis ; Cytomegalovirus/genetics ; Cytomegalovirus Infections/drug therapy/virology ; DNA, Viral/analysis ; Eosinophilia/etiology ; Exanthema/*chemically induced/pathology ; Ganciclovir/therapeutic use ; Hepatitis A/complications/*diagnosis/drug therapy ; Humans ; Hydrocortisone/therapeutic use ; Immunoglobulins/therapeutic use ; Male ; Syndrome ; Young Adult

Adult ; Exanthema ; diagnosis ; drug therapy ; etiology ; physiopathology ; Humans ; Male ; Pruritus ; physiopathology ; Steroids ; administration & dosage ; Treatment Outcome

OBJECTIVETo study the Chinese medicine (CM) syndrome laws of patients with pruritic papular eruption (PPE), thus providing reference for its classification and standard diagnosis.

METHODSUsing multicenter, prospective trials in 346 PPE patients,the correlations between sex, age, infection route, and CD4 levels and CM syndrome patterns were analyzed. The syndrome laws correlated with PPE was studied from the macroscopic and microscopic aspects.

RESULTSThere was no statistical difference in sex, age, or CD4 level among various CM syndrome patterns. There was statistical difference in the infection route among various CM syndrome patterns. Pi-deficiency dampness-accumulation syndrome occurred more in patients infected by blood. Wind production induced by heat in blood syndrome occurred more in those infected by sexual contact. Blood deficiency wind dryness syndrome occurred in those infected by intravenous drug abuse.

CONCLUSIONSWind production induced by heat in blood syndrome, blood deficiency wind dryness syndrome, and Pi-deficiency dampness-accumulation syndrome exist in CM syndrome types of AIDS. There was statistical difference in different infection routes of the distribution of each syndrome type.

Acquired Immunodeficiency Syndrome ; complications ; diagnosis ; Adolescent ; Adult ; Exanthema ; diagnosis ; etiology ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Prospective Studies ; Pruritus ; diagnosis ; etiology ; Young Adult