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Gaudin O, Milpied B, Papouin B, Hüe S, Ortonne N, Régnier E, Wolkenstein P, Chosidow O, de Prost N, Ingen-Housz-Oro S. Lupus erythematosus and epidermal necrolysis: a case series of 16 patients. Br J Dermatol 2021; 186:372-374. [PMID: 34597413 DOI: 10.1111/bjd.20775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 01/18/2023]
Affiliation(s)
- O Gaudin
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - B Milpied
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Dermatology Department, Saint André Hospital, Bordeaux, France
| | - B Papouin
- Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S Hüe
- Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France.,INSERM U955, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France.,Immunology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - N Ortonne
- Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France
| | - E Régnier
- Dermatology Department, AP-HP, Cochin Hospital, Paris, France
| | - P Wolkenstein
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France
| | - O Chosidow
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France.,Groupe de Recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - N de Prost
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris-Est Créteil Val de Marne, UPEC, Créteil, France.,Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France
| | - S Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,EpiDermE, Université Paris-Est Créteil, Créteil, France
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2
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Monnet P, Rodriguez C, Gaudin O, Cirotteau P, Papouin B, Dereure O, Tetart F, Lalevee S, Colin A, Lebrun-Vignes B, Abe E, Alvarez JC, Demontant V, Gricourt G, de Prost N, Barau C, Chosidow O, Wolkenstein P, Hue S, Ortonne N, Milpied B, Ingen-Housz-Oro S. Towards a better understanding of adult idiopathic epidermal necrolysis: a retrospective study of 19 cases. J Eur Acad Dermatol Venereol 2021; 35:1569-1576. [PMID: 33834541 DOI: 10.1111/jdv.17274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/24/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Most cases of Stevens-Johnson syndrome and toxic epidermal necrolysis are drug-induced. A small subset of cases remain with unknown aetiology (idiopathic epidermal necrolysis [IEN]). OBJECTIVE We sought to better describe adult IEN and understand the aetiology. METHODS This retrospective study was conducted in 4 centres of the French national reference centre for epidermal necrolysis. Clinical data were collected for the 19 adults hospitalized for IEN between January 2015 and December 2019. Wide toxicology analysis of blood samples was performed. Histology of IEN cases was compared with blinding to skin biopsies of drug-induced EN (DIEN, 'controls'). Available baseline skin biopsies were analysed by shotgun metagenomics and transcriptomics and compared to controls. RESULTS IEN cases represented 15.6% of all EN cases in these centres. The median age of patients was 38 (range 16-51) years; 68.4% were women. Overall, 63.2% (n = 12) of cases required intensive care unit admission and 15.8% (n = 3) died at the acute phase. Histology showed the same patterns of early- to late-stage EN with no difference between DIEN and IEN cases. One toxicology analysis showed unexpected traces of carbamazepine; results for other cases were negative. Metagenomics analysis revealed no unexpected pathological microorganism. Transcriptomic analysis highlighted a different pro-apoptotic pathway in IEN compared to DIEN, with an overexpression of apoptosis effectors TWEAK/TRAIL. CONCLUSIONS IEN affects young people and is a severe form of EN. A large toxicologic investigation is warranted. Different pathways seem involved in IEN and DIEN, leading to the same apoptotic effect, but the primary trigger remains unknown.
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Affiliation(s)
- P Monnet
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - C Rodriguez
- Microbiology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,INSERM U955, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - O Gaudin
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - P Cirotteau
- Dermatology Department, Saint André Hospital, Bordeaux, France
| | - B Papouin
- Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France
| | - O Dereure
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Dermatology Department, Saint Eloi Hospital, Montpellier, France
| | - F Tetart
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Dermatology Department, Charles Nicole Hospital, Rouen, France
| | - S Lalevee
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Immunology Department, INSERM, Unité U955, Institut Mondor de Recherche Biomédicale, AP-HP, Henri Mondor Hospital, Créteil, France
| | - A Colin
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France
| | - B Lebrun-Vignes
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Pharmacovigilance Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - E Abe
- Pharmacology and Toxicology Department, AP-HP, Raymond Poincaré Hospital, Garches, France
| | - J-C Alvarez
- Pharmacology and Toxicology Department, AP-HP, Raymond Poincaré Hospital, Garches, France
| | - V Demontant
- Microbiology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,INSERM U955, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
| | - G Gricourt
- Microbiology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,INSERM U955, Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
| | - N de Prost
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Intensive Care Unit, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
| | - C Barau
- Clinical Investigation Center, Henri Mondor Hospital, Créteil, France
| | - O Chosidow
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
| | - P Wolkenstein
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
| | - S Hue
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Immunology Department, INSERM, Unité U955, Institut Mondor de Recherche Biomédicale, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
| | - N Ortonne
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
| | - B Milpied
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Dermatology Department, Saint André Hospital, Bordeaux, France
| | - S Ingen-Housz-Oro
- Dermatology Department, AP-HP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions TOXIBUL, Créteil, France.,Univ Paris Est Créteil EpidermE, Créteil, France
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Cheng L. Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Front Pharmacol 2021; 12:588063. [PMID: 33981213 PMCID: PMC8107822 DOI: 10.3389/fphar.2021.588063] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Adverse drug reactions are a public health issue that draws widespread attention, especially for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which have high mortality and lack of efficacious treatment. Though T-cell-mediated HLA-interacted immune response has been extensively studied, our understanding of the mechanism is far from satisfactory. This review summarizes infection (virus, bacterial, and mycoplasma infection), an environmental risk factor, as a trigger for SJS/TEN. The mutations or polymorphisms of drug metabolic enzymes, transporters, receptors, the immune system genes, and T-cell-mediated apoptosis signaling pathways that contribute to SJS/TEN are discussed and summarized. Epigenetics, metabolites, and mobilization of regulatory T cells and tolerogenic myeloid precursors are emerged directions to study SJS/TEN. Ex vivo lymphocyte transformation test has been exploited to aid in identifying the causative drugs. Critical questions on the pathogenesis of SJS/TEN underlying gene polymorphisms and T cell cytotoxicity remain: why some of the patients carrying the risky genes tolerate the drug and do not develop SJS/TEN? What makes the skin and mucous membrane so special to be targeted? Do they relate to skin/mucous expression of transporters? What is the common machinery underlying different HLA-B alleles associated with SJS/TEN and common metabolites?
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Affiliation(s)
- Lin Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Pacot L, Pouchot J, De Prost N, Senant M, Tartour E, Le Pimpec-Barthes F, Israel-Biet D, Dragon-Durey MA. Interstitial Lung Disease-Complicated Anti-MDA5 Antibody in Clinically Amyopathic Dermatomyositis Patients: Report of Two Cases With Distinct Clinical Features. Front Med (Lausanne) 2020; 7:77. [PMID: 32211415 PMCID: PMC7076087 DOI: 10.3389/fmed.2020.00077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 12/25/2022] Open
Abstract
Two patients presented simultaneously to our hospital with distinct clinical features associated with the presence of anti-MDA5 antibodies: the first one was admitted for a skin rash resembling to a toxic epidermal necrosis (Lyell syndrome) and the second one presented with pulmonary manifestations attributed to a diffuse fibrosing interstitial pneumonitis on chest CT-scan. In addition to the skin lesions involving 40% of the body surface area, the first patient developed a rapid diffuse interstitial pneumonitis with respiratory distress justifying the initiation of a systemic immunosuppressive treatment. However, she died 3 weeks after her admission from mesenteric thrombosis associated with septic shock. The second patient respiratory condition worsened despite an intensive immunosuppressive treatment with high doses of intravenous methylprednisolone and cyclophosphamide and plasmapheresis, and required lung transplantation. Anti-MDA5 antibody titer declined and disappeared on anti-rejection treatment. These two cases underline the diagnostic conundrum and the therapeutic difficulties in patients with anti-MDA5 antibodies and clinically amyopathic dermatomyositis (CADM) or interstitial lung disease (ILD), who may undergo rapidly-progressive and fatal outcome. Presence of anti-MDA5 antibodies should always be suspected when confronted to CADM patients with cutaneous ulcerations or ILD to allow a rapid and adapted treatment initiation.
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Affiliation(s)
- Laurence Pacot
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Paris, France
| | - Nicolas De Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France
| | - Marie Senant
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
| | - Eric Tartour
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
| | | | - Dominique Israel-Biet
- Université Paris-Descartes, Paris, France.,Service de Pneumologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie-Agnes Dragon-Durey
- Service d'Immunologie Biologique, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris-Descartes, Paris, France
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