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Zhang Y, Liu L, Duan X, Pi H, Jiang L, Li J, Wang G, Shu X. Longitudinal study of patients with anti-SAE antibody positive dermatomyositis: a multicenter cohort study in China. Rheumatology (Oxford) 2024:keae232. [PMID: 38648758 DOI: 10.1093/rheumatology/keae232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES To describe the longitudinal study and long-term prognosis of multicentre large inception cohort of patients with anti-SAE positive DM. METHODS We retrospectively recruited patients with anti-SAE+DM in four tertiary referral centers from China between March 2005 and December 2022. Long-term survival analysis was performed in the enrolled patients. The Myositis Damage Index (MDI) and Cutaneous Disease Area and Severity Index (CDASI) were used to evaluate the degree of different organ damage and the extent of skin rashes. Longitudinal computed tomographic (CT) patterns were analyzed. Phenotypes were characterized using unsupervised cluster analysis. RESULTS All-cause death occurred in 10.5% (4/38) of all patients, in which three patients succumbed to malignancies at 13, 18, and 36 months. Most patients had favorable long-term outcomes, 35.3% of them were in drug-free remission. Skin rashes showed significant improvement evaluated by CDASI with time. However, damage to different systems was observed in 70.6% of the surviving patients using the MDI, which mainly consisted in skin damage, accounting for 47.1%. Nine patients with anti-SAE+DM associated interstitial lung disease (ILD) underwent repeat CT showed marked radiological improvement at 6 months or being stable after 12 months. In further, different characteristics and outcomes were also showed in three clusters identified by unsupervised analysis. CONCLUSIONS Anti-SAE+DM is characterized with lower mortality rate and the development of malignancies being the primary cause of death. Patients who survived showed notable cutaneous damage, while the ILD tends to stabilize. Clusters identified with unsupervised analysis could assist physicians in identifying higher risk of mortality.
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Affiliation(s)
- Yingfang Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, China
| | - Lei Liu
- Department of Rheumatology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang, China
| | - Xinwang Duan
- Department of Rheumatology and Immunology, the Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Hui Pi
- Department of Rheumatology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Jiangxi, China
| | - Lili Jiang
- Department of Rheumatology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Jiangxi, China
| | - Jiang Li
- Department of Laboratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, China
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Shu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Rheumatology, Key Lab of Myositis, China-Japan Friendship Hospital, Beijing, China
- Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
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Yang Z, Shao Y, Huang H, Liu Y, Wang Z, Wang Y. Real-world analysis of apalutamide-associated skin rash in Chinese patients with prostate cancer. World J Urol 2024; 42:171. [PMID: 38506974 DOI: 10.1007/s00345-024-04880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE This study aimed to explore the clinical characteristics of apalutamide-associated skin rash and management of skin rash in real-world Chinese patients with prostate cancer. METHODS We investigated 138 patients with prostate cancer who received apalutamide in the Second Hospital of Tianjin Medical University from January 2022 to March 2023. The primary end points were the incidence of skin rash and the time to skin rash. The second end points were the grade of skin rash, the time to remission, the rate of recurrence of skin rash, clinical risk factors and management of skin rash. RESULTS One hundred patients were analyzed. Patients were a median of 73 years old (IQR 68-77.75). Thirty-two patients (32%) developed apalutamide‑associated skin rash. The median time to incidence and remission of skin rash were 57.5 and 11.5 days, respectively. Of 32 skin rash, 27 patients had apalutamide therapy maintained after rash remission. There were seven patients having recurrence of skin rash. By multivariable logistic regression analysis, we revealed that hypertension history (OR 3.22, 95% CI 1.09-9.53, p = 0.035), bad life-styles (OR 3.29, 95% CI 1.11-9.8, p = 0.032), ECOG ≥ 1 (OR 3.92, 95% CI 1.33-11.55, p = 0.013), and high tumor burden (OR 3.13, 95% CI 1.07-9.14, p = 0.037) were independently associated with higher incidence of skin rash. CONCLUSION Nearly one-third of Chinese patients experienced skin rash after taking apalutamide in our study. The poor health patients might have a higher incidence of apalutamide-associated skin rash.
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Affiliation(s)
- Zhen Yang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuan Shao
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hua Huang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yang Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zeyuan Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yong Wang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
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Ogoina D, Damon I, Nakoune E. Clinical review of human mpox. Clin Microbiol Infect 2023; 29:1493-1501. [PMID: 37704017 DOI: 10.1016/j.cmi.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Historically, human mpox was predominantly a zoonotic disease occurring more frequently in rural children in Africa and characterized by a largely self-limiting febrile centrifugal monomorphic rash illness. However, the 2022 mpox global outbreak has shown that the disease is changing in many ways, including sustained human-to-human transmission via sexual contact, novel clinical presentations, and adverse associations between mpox and advanced HIV. OBJECTIVES The aim of this paper is to review the traditional and emerging clinical aspects of human mpox and provide updated information on the clinical course and outcome of the disease. SOURCES We searched electronic databases including PubMed and Google Scholar and identified relevant published literature on mpox. CONTENT The clinical presentation of human mpox is influenced by the route of infectious exposure, the strain and dose of the infecting virus, and the host immune system. Exposure to the virus can result in sub-clinical or clinical diseases of variable severity. Infections caused by clade I viral strains are more severe than class IIa and IIb strains, which are associated with a milder febrile rash illness, and with anogenital skin lesions in clade IIb infections. Most cases of mpox recover entirely within 2-4 weeks after onset of illness and a few develop skin-related sequelae. Overall, people with advanced HIV infection, children <5 years of age, and pregnant women may present with more severe disease and higher case fatalities. IMPLICATIONS The continued endemicity of the classical mpox in Africa, the emergence of a new clinical form of the disease during the 2022 global outbreak, and the adverse associations between advanced HIV and mpox have implications for the surveillance, clinical diagnosis, and management of human mpox.
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Affiliation(s)
- Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University/Niger Delta University Teaching Hospital, Bayelsa, Nigeria.
| | - Inger Damon
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Emmanuel Nakoune
- Department of Viral Haemorrhagic Fevers, Institut Pasteur de Bangui, Bangui, Central African Republic
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Farhani S, Hayaatul Najaa M, Hu SE. An eight-year old girl with fever and rash: What is the possible diagnosis? Malays Fam Physician 2023; 18:55. [PMID: 38026578 PMCID: PMC10664757 DOI: 10.51866/tyk.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
In this clinical challenge, we describe the case of a previously healthy 8-year-old girl who presented to a primary care clinic with fever, reduced oral intake and malaise on day 3 of her illness. Clinical examination revealed that she was tachypnoeic and tachycardic. An erythematous rash was found across the bridge of her nose and cheeks, and several painless ulcers were noted in the oral cavity. Blood investigation showed thrombocytopenia, while urinalysis revealed microscopic haematuria and proteinuria. Useful initial diagnostic imaging studies were discussed, including bedside ultrasound in the ambulatory care setting. It is imperative that primary care providers be vigilant when encountering cases like this.
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Affiliation(s)
- Samat Farhani
- MD, MMed, Tanjung Karang Health Clinic, Kuala Selangor, Selangor, Malaysia.
| | - Miptah Hayaatul Najaa
- MBBCh BAO, MMed, Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Jalan Prima Selayang 7, Batu Caves, Selangor, Malaysia
| | - Su Eng Hu
- MBBS, Lanang Health Clinic, Lor Lanang Barat 7, Pekan Sibu, Sibu, Sarawak, Malaysia
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Tamura T, Hata S, Baba T, Koyanagi T, Umeno T, Nishii K, Kuyama S. A case of successful desensitization treatment with tepotinib after tepotinib-induced rash. Respir Med Case Rep 2023; 45:101911. [PMID: 37706029 PMCID: PMC10495622 DOI: 10.1016/j.rmcr.2023.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/06/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
Tepotinib is one of the key drugs for MET exon 14-skipping mutation-positive non-small cell lung cancer (NSCLC). The main adverse event of tepotinib treatment is edema. Rash is a rare adverse event, affecting only 0.7% of patients. We report a case of successful desensitization after skin rash caused by tepotinib. A 61-year-old male was treated with tepotinib 500 mg as second-line therapy for NSCLC with MET exon 14-skipping mutation. Treatment was discontinued on day 12 due to grade 3 erythema throughout the body. After improvement of the skin rash, he was started on 250 mg tepotinib with an oral antihistamine and topical steroid. Treatment was discontinued on day 11 due to skin rash exacerbation. One month of treatment-free follow-up showed skin rash improvement but lung carcinoma growth. Tepotinib desensitization therapy was started at a dose of 12.5 mg and gradually increased to 250 mg/day. The patient has since continued tepotinib treatment without skin rashes. Desensitization therapy may be effective for managing skin rash due to tepotinib.
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Affiliation(s)
- Tomoki Tamura
- Department of Respiratory Medicine, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
| | - Sakura Hata
- Department of Respiratory Medicine, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
| | - Takahiro Baba
- Department of Respiratory Medicine, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
- Department of Internal Medicine, National Hospital Organization, Otake Medical Center, Otake, Japan
| | - Taisaku Koyanagi
- Department of Respiratory Medicine, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
| | - Takahiro Umeno
- Department of Respiratory Medicine, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
| | - Kazuya Nishii
- Department of Respiratory Medicine, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization, Iwakuni Clinical Center, Iwakuni, Japan
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De Moor R, Koroki Y, Wu DBC, Yu DY, Tohyama M, Ohyama C. A retrospective study on the incidence, management and risk factors of skin rash in patients with advanced prostate cancer in Japan. BMC Urol 2023; 23:73. [PMID: 37118710 PMCID: PMC10148545 DOI: 10.1186/s12894-023-01246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/13/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Worldwide, prostate cancer (PC) is the second most diagnosed cancer and the fifth leading cause of cancer death in men. Hormonal therapies, commonly used for PC, are associated with a range of treatment-emergent adverse events (TEAEs). The population from Japan seems to be at higher risk of developing TEAEs of skin rash compared to the overall global population. This study was conducted to get a better insight into the incidence, management, and risk factors for skin rash during active treatment for advanced PC in Japan. METHODS A retrospective cohort of PC patients was identified and subsequently categorized, into non-metastatic and metastatic castration-resistant prostate cancer patients (nmCRPC and mCRPC), and metastatic castration-naïve prostate cancer patients (mCNPC). The analysis was based on a dataset from the Medical Data Vision (MDV) database. Descriptive statistics were determined, and a multivariate Cox proportional hazards model was used to the associated risk factors for the onset of rash. RESULTS Overall, 1,738 nmCRPC patients, 630 mCRPC patients, and 454 mCNPC patients were included in this analysis. The median age was 78 years old and similar across the three cohorts. The skin rash incidence was 19.97% for nmCRPC cohort, 28.89% for mCRPC cohort, and 28.85% for mCNPC cohort. The median duration of skin rash ranged from 29 to 42 days. Statistically significant risk factors for developing skin rash included a history of allergy or hypersensitivity (all cohorts), increased age (nmCRPC and mCRPC), a body mass index (BMI) of < 18.5 (nmCRPC and mCRPC), and a PSA level higher than the median (nmCRPC). Skin rash was commonly managed with systemic and topical corticosteroids which ranged from 41.76% to 67.03% for all cohorts. Antihistamines were infrequently used. CONCLUSION This study provides a better understanding of the real-world incidence, onset, duration, management and risk factors of skin rash in patients on active PC treatment in Japan. It was observed that approximately 20-30% of PC patients experience skin rash. Development of skin rash was associated with previous allergy or hypersensitivity, BMI of < 18.5, increased age and higher PSA levels, and was usually treated with corticosteroids.
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Affiliation(s)
- Raf De Moor
- Integrated Market Access, Janssen Pharmaceutical K.K., 3 Chome-5-2 Nishikanda, Tokyo, 101-0065, Japan.
| | - Yosuke Koroki
- Medical Affairs, Janssen Pharmaceutical K.K., Tokyo, Japan
| | - David Bin-Chia Wu
- Janssen Pharmaceutical Companies of Johnson and Johnson, Asia Pacific Regional Office, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- School of Pharmacy, Monash University Malaysia, Bandar Suwnay, Malaysia
| | - Dae Young Yu
- Janssen Pharmaceutical Companies of Johnson and Johnson, Asia Pacific Regional Office, Singapore, Singapore
| | - Mikiko Tohyama
- Department of Dermatology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Agustin M, Trifitriana M, Danarti R. COVID arm as a common cutaneous manifestation after mRNA-1273 vaccination: a systematic review. BMC Infect Dis 2023; 23:7. [PMID: 36609222 PMCID: PMC9817307 DOI: 10.1186/s12879-022-07973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND By August 2022, CoronaVirus Disease-2019 (COVID-19) had caused 600 million illnesses and 6.5 million fatalities globally. A massive vaccination program is being implemented worldwide to suppress this condition. Several works of literature stated that mRNA COVID-19 vaccination, specifically with the mRNA-1273 vaccine, is followed by clear evidence of the COVID arm effects associated with this vaccine. OBJECTIVE To analyze the latest evidence of COVID arm as a common effect of mRNA-1273 vaccination with the ultimate goal of improving vaccine counseling to help healthcare professionals and reassure patients. METHODS A comprehensive search was performed on topics that assess the COVID arm as a cutaneous manifestation following mRNA-1273 vaccination from inception up until July 2022. RESULTS Eighteen studies with a total of 1129 participants after the first and second dose of mRNA-1273 vaccination reported that most participants had COVID arm following the first dose administration. The characteristics of the patients were a mean age of 43.8 years old, and females represented ≥ 50% in most studies, with a mean onset of 6.9 days after the first dose administration. Symptoms resolved within seven days following the treatment and were harmless. CONCLUSIONS This study found that the COVID arm condition is most common following the first mRNA-1273 vaccination in the female and middle-aged group. The correlation between demographic variables and COVID arm risk elucidates that the reaction is a type IV allergic skin reaction.
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Affiliation(s)
- Maulidina Agustin
- grid.8570.a0000 0001 2152 4506Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Monica Trifitriana
- grid.108126.c0000 0001 0557 0975Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Retno Danarti
- grid.8570.a0000 0001 2152 4506Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia ,grid.8570.a0000 0001 2152 4506Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Gedung Radiopoetro Lantai 3, Jalan Farmako, Sekip, Yogyakarta, 55281 Indonesia
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Kandra NV, Varghese AM, Uppala PK, Uttaravelli U, Lavanya B, Shabana SKM, Somarouthu VS, Balijepalli MK. Monkeypox outbreak in the post-eradication era of smallpox. Egypt J Intern Med 2023; 35:10. [PMID: 36777901 PMCID: PMC9897877 DOI: 10.1186/s43162-023-00196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Human monkeypox (MPOX) which recently hit the headlines is a rare, emerging zoonotic disease, only next to smallpox yet never attended adequately to halt the epidemic outbreak threat. MPOX is caused by Orthopox virus, which is a double-stranded, linear DNA virus, transmitted from infected animals, commonly rodents to humans. Monkeypox is endemic to the tropical jungles in Central-West Africa; occasional cases reported in other nations could be due to people traveling from endemic regions of MPOX. Transmission may occur via direct contact with human body secretions, cutaneous or mucosal lesions in the mouth or throat or respiratory droplets, and contaminated objects. Typical MPOX symptoms are fever, lymphadenopathy, skin rashes, intense headache, muscle, back pain, etc. Lesions can range from a few to numerous and may be filled with clear or yellowish fluid that later dries up or crusts, eventually falling off. MPOX is often considered as infrequent and self-limiting; nonetheless, the latest sporadic reports call for urgent vigilance, precautionary preparedness, and immediate response. Paucity of the data available about MPOX virus diversity and incomplete information on validated management protocols instigate a sense of impending danger and loom large as a global health emergency. MPOX is a completely preventable infection, and this article will cater to the need for creating general awareness and developing cutting-edge surveillance measures to curtail the spread of the disease. Genomic investigations of new cases of MPOX must be undertaken to check for mutations which can lead to higher human susceptibility. Local health stakeholders and clinicians should emphasize early identification and give out appropriate treatment as per the existing protocol.
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Affiliation(s)
- Naga Vishnu Kandra
- Department of Pharmacology, Santhiram Medical College & General Hospital, Nandyal, Kurnool, Andhra Pradesh India
| | - Anjaly Mary Varghese
- Department of Pharmacology, Santhiram Medical College & General Hospital, Nandyal, Kurnool, Andhra Pradesh India
| | - Praveen Kumar Uppala
- Employment ID (IPC-291), NCC-PvPI, Indian Pharmacopeia Commission, Ghaziabad, India
| | - Upendrarao Uttaravelli
- Department of Pharmaceutical Analysis, Sri Sivani College of Pharmacy, Srikakulam, Andhra Pradesh India
| | - Butti Lavanya
- Department of Pharmacology, Santhiram Medical College & General Hospital, Nandyal, Kurnool, Andhra Pradesh India
| | - S. K. M. Shabana
- Department of Hospital & Clinical Pharmacy, K V K College of Pharmacy, Surmaiguda, Hyderabad, India
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Alshurafa A, Abu-Tineh M, Ibrahim FA, Petkar M, Yassin MA. Delayed Diagnosis of Indolent Systemic Mastocytosis as the Cause of Unexplained Skin Rash: A Case Report. Case Rep Oncol 2023; 16:62-68. [PMID: 36785740 PMCID: PMC9918867 DOI: 10.1159/000529347] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/29/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023] Open
Abstract
Mastocytosis is a heterogeneous group of disorders in which mast cells exhibit clonal proliferation that infiltrates one or more organs. In cutaneous mastocytosis, the mast cells infiltrate the skin only, whereas systemic mastocytosis is diagnosed when at least one extra-cutaneous site is involved, with or without the skin being affected. Given the rarity of mastocytosis and the fact that skin rash can be a manifestation of different conditions and many clinicians are not familiar with this disorder, an accurate diagnosis may be delayed. We report a delayed diagnosis of indolent systemic mastocytosis in a 40-year-old gentleman who had been complaining of an unexplained skin rash for 6 years.
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Affiliation(s)
- Awni Alshurafa
- Hematology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Feryal A. Ibrahim
- Department of Laboratory Medicine and Pathology/Haematopathology, Hamad Medical Corporation, Doha, Qatar
| | - Mahir Petkar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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Jellouli M, Boussetta A, Hajji M, Falfoul Y, Kacem LH, Abderrahim E, Gargah T. Rhabdomyolysis-associated acute kidney injury in a teenager: Questions. Pediatr Nephrol 2022:10.1007/s00467-022-05766-0. [PMID: 36214886 DOI: 10.1007/s00467-022-05766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Manel Jellouli
- Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Research Laboratory of Immunopathology and Immunology of Renal Transplantation (LR03SP01), Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Abir Boussetta
- Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia. .,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia. .,Research Laboratory of Immunopathology and Immunology of Renal Transplantation (LR03SP01), Charles Nicolle Hospital of Tunis, Tunis, Tunisia.
| | - Meriem Hajji
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Yosra Falfoul
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of Ophthalmology, Hedi Raies Institute, Tunis, Tunisia
| | - Linda Hadj Kacem
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of Anatomic Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ezzeddine Abderrahim
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Tahar Gargah
- Pediatric Nephrology Department, Charles Nicolle Hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Research Laboratory of Immunopathology and Immunology of Renal Transplantation (LR03SP01), Charles Nicolle Hospital of Tunis, Tunis, Tunisia
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Affiliation(s)
- Yuya Ando
- Department of Internal Medicine, Self-Defense Forces Central Hospital, Tokyo, Japan; Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satoko Senda
- Department of Dermatology, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Yosuke Ono
- Department of General Medicine, National Defense Medical College, Saitama, Japan.
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12
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Onodera M, Saito T, Fukui A, Nitta M, Tsuzuki S, Koriyama S, Masamune K, Kawamata T, Muragaki Y. The high incidence and risk factors of levetiracetam and lacosamide-related skin rashes in glioma patients. Clin Neurol Neurosurg 2022; 220:107366. [PMID: 35878560 DOI: 10.1016/j.clineuro.2022.107366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Antiseizure drug (ASD)-induced skin rash remains the main side effect of seizure management in patients with glioma. New generations of ASDs, such as levetiracetam (LEV) and lacosamide (LCM) are associated with less frequent skin rashes than conventional ASDs. However, there are few reports regarding the incidence of skin rashes by LEV and LCM in patients with glioma. Therefore, the aim of this study was to investigate the incidence and risk factors of LEV- and LCM-associated skin rashes in patients with glioma. METHODS We compared the incidence of ASD-associated skin rash between 353 patients with glioma and 125 patients with meningioma, who received LEV or LCM and underwent surgery between 2017 and 2019 at our institution. Furthermore, to evaluate the association between potential risk factors and ASD-associated skin rashes, univariate and multivariate analyses were performed. RESULTS The incidence of ASD-associated skin rash in patients with glioma was higher (11 %) than in those with meningiomas (1.6 %). The multivariate regression analysis showed that adjuvant treatment with radiotherapy (p = 0.023) and a history of drug allergy (p = 0.023) were significant risk factors for ASD-associated skin rash. The rate of ASD-related skin rashes in patients with glioma was also higher than the previously reported rates of 1-3 % in patients with epilepsy. CONCLUSION Our results indicate that adjuvant treatment with radiotherapy and a history of drug allergy correlated with a high incidence of ASD-related skin rashes in patients with glioma who receive LEV and LCM. Patients with these two factors should be carefully checked for skin rashes.
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Affiliation(s)
- Mikoto Onodera
- Department of Pharmacy, Tokyo Women's Medical University, Tokyo, Japan; Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Taiichi Saito
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunichi Koriyama
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Masamune
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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13
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Tohi Y, Kato T, Fukuhara H, Kobayashi K, Ohira S, Ikeda K, Daizumoto K, Katayama S, Shimizu R, Nishimura K, Nagami T, Hayashida Y, Hirama H, Takamoto A, Dainichi T, Sugimoto M; Chu-shikoku Japan Urological Consortium. Real-world analysis of apalutamide-associated skin adverse events in Japanese patients with advanced prostate cancer: a multi-institutional study in the Chu-shikoku Japan Urological Consortium. Int J Clin Oncol 2022. [PMID: 35596089 DOI: 10.1007/s10147-022-02183-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Apalutamide-associated skin adverse events are more common in the Japanese than in the global population. However, limited clinical data have hampered further understanding. This real-world study investigated the clinical characteristics of skin adverse events in patients with advanced prostate cancer. METHODS We retrospectively reviewed 119 patient records from 16 institutions in Japan. Skin adverse events were graded according to the Common Terminology Criteria for Adverse Events (v5.0). The incidence and characteristics of skin adverse events (along with the clinical risk factors for their incidence, worsening, and recurrence) were evaluated. RESULTS Fifty-five patients (46.2%) experienced skin adverse events. The median times to the incidence and remission of skin adverse events were 62 and 30 days, respectively. Grade 3 skin adverse events were observed in 15 patients (12.6%). The median time from the first incidence to apalutamide interruption was significantly longer in patients with progression to grade 3 skin adverse events than in those without such a progression (8 vs. 0 days, p = 0.005). Skin adverse events were observed in 45.2% of patients who resumed apalutamide treatment (median treatment interruption time: 31.5 days). Sixteen patients (13.4%) permanently discontinued apalutamide due to skin adverse events. No significant clinical risk factors for the incidence, worsening and recurrence of apalutamide-associated skin adverse events were observed. CONCLUSIONS Nearly half of the Japanese patients in this study experienced skin adverse events following apalutamide administration. The time to apalutamide discontinuation after the incidence of skin adverse events was positively correlated with the worsening of these events.
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14
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Bopp L, Kreuter A, von Stebut E, Fabri M. [Virus-induced exanthems in returning travellers]. Hautarzt 2022; 73:462-474. [PMID: 35554622 PMCID: PMC9100320 DOI: 10.1007/s00105-022-05001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 04/07/2022] [Indexed: 10/25/2022]
Abstract
Dermatological diseases are among the most common travel-associated diseases. In particular, viral infections not only with tropical and subtropical pathogens, but also with viruses common in Germany, which are often accompanied by skin rashes and general symptoms, are of great importance. In addition to an accurate travel history and possible risk exposures, epidemiological information on country-specific risks in combination with molecular and serological analyses is helpful in making the correct diagnosis. This article provides an overview of important virus-induced exanthems in returned travellers.
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Affiliation(s)
- Luisa Bopp
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland
| | - Esther von Stebut
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Mario Fabri
- Medizinische Fakultät und Uniklinik Köln, Klinik für Dermatologie und Venerologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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15
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Gianfranco C, Maurizio C, Eustachio N, Luigi M, Caterina F, Angelo V. Hypersensitivity to febuxostat in a patient with a previous allopurinol-induced Steven-Johnson syndrome: a case report of treatment with a slow desensitization protocol. Endocr Metab Immune Disord Drug Targets 2022; 22:895-899. [PMID: 35379143 DOI: 10.2174/1871530322666220404200918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/04/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We report thea case of a 43-year-old Chinese male with tophaceous gout who had been living in our country for some years. CASE PRESENTATION Previous treatments with allopurinol had induced Steven Johnson syndrome, dictating a switch to febuxostat 80 mg daily. After two years of treatment with febuxostat, he developed a diffuse maculopapular rash with severe itching. Rheumatologists stopped the febuxostat but the gout worsened over the following years despite of treatment with kalnicitrate and colchicine. Therefore, an allergy consultation was called for. A slow desensitization protocol with febuxostat was started, with a low oral dosage scheme to be increased up to 80mg/day. Febuxostat was prepared in a solid formulation by the pharmacist as pills, instead of the more frequently used liquid suspension. CONCLUSION The patient is currently receivinges febuxostat 80 mg, shows no side effects and his gout has improved. This is the first reported example of a successful desensitization protocol using a solid preparation of diluted febuxostat given as pills.
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Affiliation(s)
- Calogiuri Gianfranco
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, Bari University "Aldo Moro" - Bari, Italy
| | | | - Nettis Eustachio
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, Bari University "Aldo Moro" - Bari, Italy
| | - Macchia Luigi
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, Bari University "Aldo Moro" - Bari, Italy
| | - Foti Caterina
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Bari University "Aldo Moro", Piazza Giulio Cesare, Bari - Italy
| | - Vacca Angelo
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine and Clinical Oncology, Bari University \'Aldo Moro\' - Bari, Italy
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16
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Calpena Martínez S, Carrillo Acosta I, Álvarez Álvarez B, Górgolas Hernández-Mora M. A case report. Rediscovering tuberculostatics drugs: skin rash and pyrazinamide. Rev Esp Quimioter 2022; 35:295-298. [PMID: 35229590 PMCID: PMC9134886 DOI: 10.37201/req/157.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/23/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Affiliation(s)
- S Calpena Martínez
- Silvia Calpena Martínez, Infectious Diseases Department, Fundación Jiménez Díaz, Universidad Autónoma de Madrid. Av/ Reyes Católicos nº2, 28040, Madrid. Spain.
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17
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Salih AF, Hamasalih K, Rahman HS, Mohammed GA. Pediatric COVID-19 infection in Sulaimaniyah Governorate, Iraq. Am J Otolaryngol 2022; 43:103199. [PMID: 34560597 PMCID: PMC8413489 DOI: 10.1016/j.amjoto.2021.103199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND COVID-19 is a severe acute respiratory syndrome caused by SARS-CoV-2. OBJECTIVE To study the demographic and clinical presentations of COVID-19 with their types including MIS-C and Kawasaki among children who were admitted to Doctor Jamal Ahmad Rashid Pediatric Teaching Hospital (DJARPTH) at Sulaimaniyah city, Iraq. PATIENTS AND METHODS A prospective cohort study was conducted from June to December 2020 in which 50 cases suspected of COVID-19 were enrolled in the study that was admitted at the first visit to the emergency department of DJARPTH and their age ranged between 3 months to 14 years. Then, the collected data were divided into 3 groups: COVID-19, Kawasaki disease (KD), and MIS-C. RESULTS The fever was the most common presented symptom in all cases with COVID-19 regardless of the severity. COVID-19 may be presented as KD as well as MIS-C. There is an increase in the number of Kawasaki cases since 2019 by 6.7 fold due to the increased number of COVID-19 cases in children. Death was more related to MIS-C and primary COVID-19 diseases. Most COVID-19 cases presented with pericardial effusion; although coronary involvement and LV dysfunction mostly seen with MIS-C cases. CONCLUSION COVID-19 is not uncommon in pediatric patients and it presents as either primary, MIS-C, and KD. Most of the deaths and ICU outcomes were related to MIS-C presentations.
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18
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Akiyama Y, Ishikane M, Ohmagari N. Epstein-Barr virus induced skin rash in infectious mononucleosis. IDCases 2021; 26:e01298. [PMID: 34631423 PMCID: PMC8493569 DOI: 10.1016/j.idcr.2021.e01298] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 11/19/2022] Open
Abstract
Epstein-Barr virus (EBV) causes infectious mononucleosis (IM) with skin rash. EBV skin rash in IM is known to appear after exposure to antimicrobials. However, skin rash sometimes occur even in the absence of antimicrobial exposure. Clinicians must consider EBV skin rash in IM regardless of antimicrobial exposure.
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Affiliation(s)
| | - Masahiro Ishikane
- Correspondence to: Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
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19
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Tandon P, Govardhanam V, Gallinger Z, Weizman AV. Risk Factors for Developing Hidradenitis Suppurativa in Patients With Inflammatory Bowel Disease: A Retrospective Case-Control Study. J Can Assoc Gastroenterol 2021; 4:165-172. [PMID: 34337316 PMCID: PMC8320283 DOI: 10.1093/jcag/gwaa024] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Hidradenitis suppurativa (HS) is associated with inflammatory bowel disease (IBD), though risk factors remain to be determined. Aim To characterize HS among a cohort of IBD patients and identify risk factors for its development. Methods This was a retrospective case–control study at the ambulatory IBD centre at Mount Sinai Hospital from inception to May 2019. Patients with IBD who developed HS were included. Cases were matched 5:1 by age, gender (male versus female) and IBD type (ulcerative colitis [UC] or Crohn’s disease [CD]) to controls who had IBD without HS. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs). Results Twenty-nine cases of HS (19 CD and 10 UC) and 145 controls were included. Of the 29 patients with HS, 11 (37.9%) were male and 18 (62.1%) were female. The severity of HS was mild in 10 (34.5%), moderate in 16 (55.2%) and severe in 3 (10.3%) patients. Patients with HS and IBD were more likely to be active (OR 10.3, 95% CI 2.0 to 54.0, P = 0.006) or past (OR 8.4, 95% CI 2.7 to 25.8, P < 0.005) smokers. Patients with HS and IBD were also more likely to have active endoscopic disease (OR 3.8, 95% CI 1.2 to 12.2, P = 0.022). Furthermore, those with HS and CD were more likely to have active perianal disease (OR 21.1, 95% CI 6.2 to 71.9, P < 0.005). Conclusions Active IBD, perianal disease and smoking may be associated with HS in IBD. Larger studies are needed to better characterize this morbid condition.
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Affiliation(s)
- Parul Tandon
- Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Govardhanam
- Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zane Gallinger
- Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adam V Weizman
- Division of Gastroenterology, Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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De Luca R, Lo Coco G, Addeo R, Fattoruso SIS, Auriemma A, Paci R, Mistretta O, Epifanio MS, Salvato A, D'Agostino A, Cicero G. Quality of Life in Patients With Severe Skin Reactions in Course of First-Generation Epidermal Growth Factor Receptor Inhibitors Monoclonal Antibodies (Our Experience With Cetuximab). World J Oncol 2021; 12:104-110. [PMID: 34349854 PMCID: PMC8297050 DOI: 10.14740/wjon1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/20/2021] [Indexed: 11/11/2022] Open
Abstract
Background Metastatic colorectal cancer (mCRC) with wild type expression of RAS and RAF genes can be treated with anti-epidermal growth factor receptor (EGFR) monoclonal antibodies, such as cetuximab, in combination with chemotherapy. Skin toxicity represents the most serious and frequent side effect in these patients. Skin manifestations occur in approximately 80% of patients. In this study, we investigated the consequences on body image and quality of life (QoL) of patients with severe skin toxicity. Methods One hundred patients were enrolled with mCRC. All patients signed informed consent and completed questionnaires to assess QoL and body discomfort. Toxicity was assessed on Common Terminology Criteria for Adverse Events (CTCAEs). Results The greatest impact on QoL was represented by difficulties in managing skin rash-related side effects. Data showed a significant impact in psychological sphere and social relationships. Conclusions Skin side effects, particularly rash, influence QoL and social relationships, compromising therapeutic compliance.
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Affiliation(s)
- Rossella De Luca
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Raffaele Addeo
- Oncology Operative Unit, Hospital of Frattamaggiore (NA), ASLNA2NORD, Italy
| | | | | | - Roberta Paci
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Ornella Mistretta
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Maria Stella Epifanio
- Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
| | - Angela Salvato
- Oncology Operative Unit, Hospital of Frattamaggiore (NA), ASLNA2NORD, Italy
| | - Alberto D'Agostino
- Surgery Unit and Trauma Center, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | - Giuseppe Cicero
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
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21
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Chawla S, Hill A, Fearfield L, Johnston S, Parton M, Heelan K. Cutaneous toxicities occurring during palbociclib (CDK4/6 inhibitor) and endocrine therapy in patients with advanced breast cancer: a single-centre experience. Breast Cancer Res Treat 2021; 188:535-545. [PMID: 33683521 DOI: 10.1007/s10549-021-06169-9] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/24/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Treatment with Palbociclib, a cyclin-dependent kinase 4/6 inhibitor, has demonstrated significantly improved progression-free survival in patients with hormone receptor-positive, HER2-negative, advanced breast cancer, when used in combination with letrozole or fulvestrant endocrine therapies. However, limited information exists on its cutaneous adverse effects (AE). Hence, we conducted a retrospective cohort study to investigate the prevalence and management of cutaneous AE during palbociclib and endocrine therapy. METHOD We included 324 adult patients with advanced breast cancer who received palbociclib between March 2016 and August 2020 within a tertiary comprehensive cancer centre. Patient demographics, details of previous and concurrent treatments, as well as treatment-related cutaneous AE were recorded from electronic records. RESULTS The incidence of treatment-related cutaneous AE was 14.2% (46 from a total of 324 patients). The most frequent cutaneous reactions included maculopapular rash (41%), asteatosis (37%), pruritus and urticaria (20%), and bullous dermatitis reactions (9%). We identified two patients with treatment-induced subacute cutaneous lupus erythematosus, one case of bullous pemphigoid, and a single erythema multiforme. Patients received an average of 9 cycles of treatment, completing an average of 6 cycles before developing cutaneous AE, which persisted for a median of 43 days. Only 15% (n = 7) of affected patients required temporary suspension, and 4% (n = 2) required discontinuation. The majority were managed with potent topical steroids, with oral corticosteroids being required in 3 patients, and one patient required hydroxychloroquine. CONCLUSION Our study describes both the spectrum of cutaneous AE of palbociclib and endocrine therapy, and approaches to management. Prompt management may limit the negative impact on patients, facilitating beneficial continuation of palbociclib and endocrine therapy.
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Affiliation(s)
- Sumir Chawla
- Dermatology Department, Skin Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Alison Hill
- Dermatology Department, Skin Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Louise Fearfield
- Dermatology Department, Skin Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Stephen Johnston
- Breast Unit, The Royal Marsden NHS FoundationTrust, Fulham Road, London, SW3 6JJ, UK
| | - Marina Parton
- Breast Unit, The Royal Marsden NHS FoundationTrust, Fulham Road, London, SW3 6JJ, UK
| | - Kara Heelan
- Dermatology Department, Skin Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
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22
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Raimondi A, Corallo S, Lonardi S, Antoniotti C, Rimassa L, Amatu A, Tampellini M, Racca P, Murialdo R, Clavarezza M, Zaniboni A, Toscano G, Tomasello G, Petrelli F, Antonuzzo L, Giordano M, Cinieri S, Longarini R, Niger M, Antista M, Ambrosini M, Pagani F, Prisciandaro M, Randon G, de Braud F, Di Bartolomeo M, Pietrantonio F, Morano F. Systemic doxycycline for pre-emptive treatment of anti-EGFR-related skin toxicity in patients with metastatic colorectal cancer receiving first-line panitumumab-based therapy: a post hoc analysis of the Valentino study. Support Care Cancer 2021; 29:3971-3980. [PMID: 33392769 DOI: 10.1007/s00520-020-05972-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/22/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The combination of anti-EGFRs and doublet chemotherapy is considered the optimal upfront option for patients with RAS/BRAF wild-type left-sided metastatic colorectal cancer (mCRC). The prophylactic or reactive treatment with tetracyclines for EGFR inhibitor-induced skin toxicity is currently clinical practice, though non-conclusive results are available. METHODS We performed a post hoc analysis of the Valentino study that randomized RAS wild-type mCRC patients to two panitumumab-based maintenance regimens after the first-line induction, aimed at assessing the safety and efficacy of the administration of a pre-emptive doxycycline prophylaxis for anti-EGFR-related skin toxicity. We assessed the rate of treatment-related and panitumumab-related adverse events (AEs), treatment intensity, progression-free survival (PFS), and overall survival (OS). RESULTS A total of 226 patients, out of the 229 enrolled in the Valentino study, were eligible for the analysis. Overall, 143 (63%) and 83 (37%) patients received or not the antibiotic prophylaxis for skin toxicity. Any grade and G3/4 panitumumab-related AEs were reported in 89% versus 92% (p = 0.650) and 27% versus 27% (p = 1.000) patients who received or not the pre-emptive prophylaxis, respectively. Any grade and G3/4 skin rash occurred in 81% versus 90% (p = 0.085) and 27% versus 25% (p = 0.876) patients receiving or not the prophylaxis, respectively. No significant differences in terms of treatment duration, treatment delays or dose reductions, PFS, and OS were observed in the two sub-populations. CONCLUSION The adequate management of anti-EGFR-related skin toxicity is fundamental to optimize the outcome of mCRC patients, balancing the survival benefit with patients' quality of life, especially in the first-line setting.
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Affiliation(s)
- Alessandra Raimondi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Salvatore Corallo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Carlotta Antoniotti
- Unit of Medical Oncology, Department of Translational Research and New Technologies in Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alessio Amatu
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Tampellini
- Department of Oncology, AOU San Luigi di Orbassano, University of Torino, Orbassano, Italy
| | - Patrizia Racca
- Colorectal Cancer Unit, Medical Oncology Division 1, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Roberto Murialdo
- Department of Internal Medicine, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Matteo Clavarezza
- Medical Oncology Unit, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | | | - Giuseppe Toscano
- Medical Oncology Unit A.O. Papardo & Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Fausto Petrelli
- Medical Oncology Unit, Oncology Department, ASST Bergamo Ovest, Treviglio, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, AOU Careggi, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Monica Giordano
- Medical Oncology Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale Antonio Perrino, Brindisi, Italy
| | | | - Monica Niger
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Maria Antista
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Margherita Ambrosini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Filippo Pagani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Michele Prisciandaro
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
- Oncology and Hemato-oncology Department, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
- Oncology and Hemato-oncology Department, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy.
- Oncology and Hemato-oncology Department, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy.
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, via Giacomo Venezian 1, 20133, Milan, Italy
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Amanati A, Badiee P, Lotfi M, Monabati A, Faghihi MA, Yavarian M, Hatami Mazinani N. Generalized exfoliative skin rash as an early predictor of supratherapeutic voriconazole trough levels in a leukemic child: A case report. Curr Med Mycol 2020; 6:73-78. [PMID: 33834148 PMCID: PMC8018824 DOI: 10.18502/cmm.6.3.4500] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose: Skin rashes, mostly seen in children and adolescents, are considered among the most common side effects of azole antifungals. Although therapeutic concentrations of voriconazole (VCZ) have been documented for infected skin, there is no evidence specifying whether specific dermatologic side effects could predict high VCZ serum concentration, especially in high-risk leukemic children. Case report: Herein, we report a unique skin side effect of VCZ in a 5-year-old boy with T-cell acute lymphoblastic leukemia (ALL) referred to Amir Medical Oncology Center in Shiraz, Iran. The patient experienced erythroderma and macular rashes shortly after VCZ consumption, leading to generalized exfoliative skin rashes. Concurrent to these skin manifestations, VCZ serum concentration reached the supratherapeutic levels despite the recommended VCZ doses. As a result, VCZ was withheld, and the patient was treated with caspofungin. The lesions were resolved gradually within 2 weeks, and the patient successfully completed his treatment course with caspofungin. Conclusion: The unique case presented in this study emphasizes the need for a high index of suspicion for VCZ toxicity in any patient with atypical dermatologic manifestations, especially generalized exfoliative skin rashes. Based on this report, VCZ supratherapeutic concentration could be predicted early in the course of treatment. Additional therapeutic dose monitoring should be considered to establish a confirmatory diagnosis. It is required to further investigate the toxic effect of high VCZ concentration on the skin epithelium.
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Affiliation(s)
- Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Badiee
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Monabati
- Department of Hematopathology, Molecular Pathology and Cytogenetics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Faghihi
- Center for Therapeutic Innovation, Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, USA.,Persian Bayan Gene Research and Training Center, Shiraz, Iran
| | - Majid Yavarian
- Persian Bayan Gene Research and Training Center, Shiraz, Iran.,Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazafarin Hatami Mazinani
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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24
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Affiliation(s)
| | - Ajay Gogia
- All India Institute of Medical Sciences, Medical Oncology, New Delhi, India
| | - Ritu Gupta
- Laboratory Oncology Unit, New Delhi, India
| | - Saumyaranjan Mallick
- All India Institute of Medical Sciences, Department of Pathology, New Delhi, India
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25
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Weber T, Schmidberger A, Ligeti K, Bauer M, Rosenwald A, Müller LP. Presence of Parvovirus B19 but Not Herpesvirus Genome in Acute Skin Rash after Allogeneic Stem Cell Transplantation Correlates with Outcome. Acta Haematol 2020; 144:202-211. [PMID: 32906131 DOI: 10.1159/000509739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Skin rash is a first symptom of acute graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (ASCT) but can also be caused by viruses. The relevance of virus DNA analyses in skin rash for diagnosis and clinical outcome is unknown. OBJECTIVES To record the frequencies of detection of herpes and parvovirus B19 (ParvoB19) DNA in skin rash within 100 days after ASCT and to analyze their relevance for diagnosis, clinical course, and non-relapse mortality (NRM). METHODS We retrospectively identified 55 patients with virus DNA analysis for CMV, EBV, HHV6, HHV8, HSV, VZV, or ParvoB19. We assessed the rate of virus DNA detection and studied associations with histological diagnosis, virus DNA from concomitantly analyzed blood, clinical presentation, exanthema treatment, and NRM. RESULTS CMV, EBV, HHV6, HHV8, HSV, VZV and ParvoB19 DNA were detected in 12.5, 11.8, 10, 0, 0, 2.9, and 26.7% of exanthemas. Histopathological diagnosis was not associated with virus polymerase chain reaction (PCR) results. Detection of CMV, EBV, or HHV6 DNA but not ParvoB19 in skin and blood was associated with PCR results (p = 0.016; p < 0.001; p = 0.067; p = n.a.). Detection of CMV, EBV, HHV6, or ParvoB19 DNA in the skin was not significantly associated with patient, ASCT, or GvHD characteristics. Detection of ParvoB19 but not herpes virus DNA was associated with less immunosuppressive treatment (p = 0.015) and lower NRM (p = 0.041). In multivariate analyses, detection of ParvoB19 was associated with a lower NRM. CONCLUSIONS Detection of ParvoB19 DNA in exanthema after ASCT might be associated with lower NRM.
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Affiliation(s)
- Thomas Weber
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany,
| | - Andreas Schmidberger
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kinga Ligeti
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Bauer
- Institute of Pathology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Rosenwald
- Institute of Pathology, University Hospital Würzburg, Würzburg, Germany
| | - Lutz P Müller
- Department of Hematology and Oncology, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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26
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Uemura H, Koroki Y, Iwaki Y, Imanaka K, Kambara T, Lopez-Gitlitz A, Smith A, Uemura H. Skin rash following Administration of Apalutamide in Japanese patients with Advanced Prostate Cancer: an integrated analysis of the phase 3 SPARTAN and TITAN studies and a phase 1 open-label study. BMC Urol 2020; 20:139. [PMID: 32878613 PMCID: PMC7465330 DOI: 10.1186/s12894-020-00689-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/29/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A higher incidence of apalutamide-related skin rash has been observed in Japanese patients with prostate cancer (PC). METHODS This integrated analysis of data of Japanese patients from 2 global Phase 3 studies, SPARTAN ( NCT01946204 ; patients with non-metastatic castration-resistant PC [nmCRPC]) and TITAN ( NCT02489318 ; patients with metastatic castration-sensitive PC [mCSPC]), and the Phase 1 study 56021927PCR1008 ( NCT02162836 ; patients with metastatic CRPC [mCRPC]), assessed clinical risk factors of apalutamide-related skin rash as well as the potential correlation with plasma exposure to apalutamide. Kaplan-Meier method was used for time-to-event analyses. Clinical risk factors for skin rash were assessed using odds ratio. RESULTS Data from 68 patients (SPARTAN: n = 34, TITAN: n = 28, 56021927PCR1008: n = 6) receiving apalutamide 240 mg orally once-daily were analyzed. Rash (13 [19.1%]) and maculo-papular rash (11 [16.2%]) were the most frequently reported skin rash. All Grade and Grade 3 skin rash occurred in 35 (51.5%) and 10 (14.7%) patients, respectively. Most (85.7%) skin rash occurred within 4 months of apalutamide initiation and resolved in a median time of 1 month following the use of antihistamines, topical or systemic corticosteroids, with/without apalutamide dose interruptions/reductions. Median time-to-remission of first incidence of rash and maximum grade incidence of rash were 1.0 month (IQR: 0.36-1.81) and 1.0 month (IQR: 0.30-2.43), respectively. No significant clinical risk factors for the incidence of skin rash were observed. Areas under the curve (0-24 h) (AUC0-24, ss) at steady-state of plasma apalutamide concentration were numerically slightly higher in patients with skin rash than those without. CONCLUSIONS No clinical risk factors for rash could be detected. There is a potential correlation between incidence of skin rash and plasma exposure to apalutamide. In general, apalutamide-related skin rash is easily managed, with appropriate treatment with or without dose adjustment. TRIAL REGISTRATION Retrospective pooled analysis of NCT01946204 , NCT02489318 , and NCT02162836 .
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Affiliation(s)
- Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yosuke Koroki
- Medical Affairs, Janssen Pharmaceutical K.K., Tokyo, Japan.
| | - Yuki Iwaki
- Clinical Pharmacology, Janssen Pharmaceutical K.K, Tokyo, Japan
| | | | - Takeshi Kambara
- Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Andressa Smith
- Janssen Global Research & Development, Spring House, PA, USA
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
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27
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Choi J, Anderson R, Blidner A, Cooksley T, Dougan M, Glezerman I, Ginex P, Girotra M, Gupta D, Johnson D, Shannon VR, Suarez-Almazor M, Rapoport BL, Lacouture ME. Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe dermatological toxicities from checkpoint inhibitors. Support Care Cancer 2020; 28:6119-6128. [PMID: 32856211 DOI: 10.1007/s00520-020-05706-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
Immune checkpoint inhibitors (ICIs) frequently result in cutaneous immune-related adverse events (IrAEs). Although the majority of these events are mild-to-moderate in severity, up to 5% are severe, which may lead to morbidity and dose interruption or discontinuation of ICI therapy. In addition, up to 25% of dermatologic IrAEs are corticosteroid-refractory or corticosteroid-dependent. These 2020 MASCC recommendations cover the diagnosis and management of cutaneous IrAEs with a focus on moderate-to-severe and corticosteroid-resistant events. Although the usage of immune-suppressive therapy has been advocated in this setting, there is a lack of randomized clinical trial data to provide a compelling level of evidence of its therapeutic benefit.
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Affiliation(s)
- Jennifer Choi
- Division of Oncodermatology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ronald Anderson
- Faculty of Health Sciences, Department of Immunology, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, PO Box 667, Pretoria, 0002, South Africa
| | - Ada Blidner
- Laboratory of Immunopathology, Institute of Biology and Experimental Medicine-CONICET, Buenos Aires, Argentina
| | - Tim Cooksley
- Manchester University Foundation Trust, Manchester, UK.,The Christie, University of Manchester, Manchester, UK
| | - Michael Dougan
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ilya Glezerman
- Renal Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Monica Girotra
- Endocrine Division, Department of Medicine, Weill Cornell Medical College (MG, AF), New York, NY, USA.,Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Douglas Johnson
- Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, TN, USA
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bernardo L Rapoport
- Faculty of Health Sciences, Department of Immunology, University or Pretoria, Corner Doctor Savage Road and Bophelo Road, PO Box 667, Pretoria, 0002, South Africa. .,The Medical Oncology Centre of Rosebank, 129 Oxford Road, Saxonwold, 2196, Johannesburg, South Africa.
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Outpatient Center, New York, NY, USA
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28
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Westphalen CB, Kukiolka T, Garlipp B, Hahn L, Fuchs M, Malfertheiner P, Reiser M, Kütting F, Heinemann V, Beringer A, Waldschmidt DT. Correlation of skin rash and overall survival in patients with pancreatic cancer treated with gemcitabine and erlotinib - results from a non-interventional multi-center study. BMC Cancer 2020; 20:155. [PMID: 32093649 PMCID: PMC7041266 DOI: 10.1186/s12885-020-6636-7] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 02/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Gemcitabine/erlotinib treatment offers limited benefit in unselected patients with pancreatic ductal adenocarcinoma (PDAC). Development of skin rash has been associated with favorable outcomes in patients treated with gemcitabine/erlotinib. This study aimed to extend knowledge on the effectiveness of gemcitabine/erlotinib in metastatic PDAC in the context of clinical practice and with focus on skin rash. Methods This multicenter, non-interventional study enrolled 376 patients with metastatic PDAC receiving gemcitabine/erlotinib. The primary endpoint was overall survival (OS) in patients with skin rash versus no skin rash. Secondary endpoints included progression-free survival (PFS), treatment satisfaction and safety. All data were analyzed using descriptive statistics. Survival time and time to disease progression were estimated using the Kaplan-Meier method. Effectiveness endpoints were analyzed for subgroups by skin rash grade (no rash, rash grade 1, rash grade ≥ 2), duration of erlotinib treatment (≤8 weeks, > 8 weeks), Eastern Cooperative Oncology Group (ECOG) performance status at baseline (0–1, 2) and age (≤65 years, > 65 years). Results Within the full analysis set (FAS; N = 270), 48 patients (17.8%) developed grade 1 rash, 51 patients (18.9%) grade ≥ 2 rash, while 171 patients (63.3%) did not develop a rash. Median OS of all patients was 9.11 months with an OS of 9.93 months in rash-positive and 8.68 months in rash-negative patients. Median PFS was 5.06 months for rash-positive and 4.11 months for rash-negative patients. PFS was longer in patients with rash grade ≥ 2 and in older patients (> 65 years). Examination using a multivariate Cox proportional model revealed that an age > 65 years was associated with longer OS (hazard ratio 0.640; p = 0.0327) and PFS (hazard ratio 0.642; p = 0.0026). Out of the 338 patients in the SAF, 310 patients (91.7%) experienced at least one AE, and 176 patients (52.1%) experienced skin-related side effects, all of which were CTC grade 1 to 3. Conclusions Comparing rash-positive with rash-negative patients showed no significant difference in survival. While patients with rash grade ≥ 2 and older patients (independent of skin reactions) showed longer PFS, this did not translate into prolonged OS. The study did not reveal new safety signals. Trial registration ClinicalTrials.gov Identifier: NCT01782690, retrospectively registered on 4 February 2013.
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Affiliation(s)
- C Benedikt Westphalen
- Comprehensive Cancer Center Munich & Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Tobias Kukiolka
- Department of Medicine I, University Hospital, Ulmenweg 18, 91054, Erlangen, Germany
| | - Benjamin Garlipp
- Department of Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Lars Hahn
- DOKUSAN GmbH & CO. KG, Herne, Germany
| | - Martin Fuchs
- Munich Municipal Hospital Group GmbH, Englschalkinger Str. 77, 81925, Munich, Germany
| | | | - Marcel Reiser
- PIOH Praxis Internistischer Onkologie und Hämatologie, Richard-Wagner-Str. 13-17, 50674, Cologne, Germany
| | - Fabian Kütting
- Department of Gastroenterology and Hepatology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center Munich & Department of Medicine III, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | | | - Dirk T Waldschmidt
- Department of Gastroenterology and Hepatology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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Chen ZQ, Li ZY, Yang CZ, Lin RT, Lin LZ, Sun LL. Chinese herbal medicine for epidermal growth factor receptor inhibitor-induced skin rash in patients with malignancy: An updated meta-analysis of 23 randomized controlled trials. Complement Ther Med 2019; 47:102167. [PMID: 31780021 DOI: 10.1016/j.ctim.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 06/03/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To systematically review and evaluate the effectiveness of Chinese herbal medicine (CHM) therapy for epidermal growth factor receptor inhibitor (EGFRI)-induced skin rash in patients with malignancy. METHODS The electronic databases of Medline, PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, VIP Chinese Sci-tech Journal, Wan Fang, and Chinese Biomedicine were searched from their inception to 31 st September 2018. Randomized controlled trials (RCTs) investigating the effectiveness of CHM in improving EGFRI-induced skin rash were analyzed by Review Manager 5.3. RESULTS Twenty-three eligible RCTs with 1392 participants were identified and divided into four subgroups according to different treatment rules of Traditional Chinese Medicine (TCM) and different controls. CHM (dispel wind, clear heat, and eliminate dampness), the representative formula Xiao Feng San, is more effective than western medicine in improving and curing skin rash(RR,95%CI: 1.46,1.26-1.70 and 1.65,1.24-2.20); CHM (nourish yin, clear heat, and remove toxin for eliminating blood stasis), the representative formula Yang Fei Xiao Zhen Tang, is more effective than western medicine in improving skin rash(RR,95%CI: 1.45,1.10-1.92). CHM (clear lung and purge heat, cool blood, and remove toxic substance) is more effective in improving and curing skin rash, compared with the western medicine group (RR,95%CI: 1.42,1.21-1.67 and 2.43,1.23-4.81) or the blank control group(RR,95%CI:2.37,1.21-4.63 and 2.98,1.20-7.41). The side effects of CHM are all mild and tolerable. Sensitivity analysis indicates that the results of the study are stable. The asymmetry funnel plots described that publication bias of this research may exist. CONCLUSION The limited evidence suggests that CHM exhibits clinical effectiveness and good safety on the treatment of EGFRI-induced skin rash. Large-sample RCTs are required to further determine the effectiveness of CHM.
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Affiliation(s)
- Zhi-Qiang Chen
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Ze-Yun Li
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Cai-Zhi Yang
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Rui-Ting Lin
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Li-Zhu Lin
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
| | - Ling-Ling Sun
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
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30
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Thinn MM, Hsueh CT, Hsueh CT. Sustained complete response to erlotinib in squamous cell carcinoma of the head and neck: A case report. World J Clin Cases 2019; 7:616-622. [PMID: 30863760 PMCID: PMC6406195 DOI: 10.12998/wjcc.v7.i5.616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/12/2019] [Accepted: 01/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Squamous cell carcinoma of head and neck (SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib. CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes (levels 2 and 3). Imaging studies including (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx, oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment. He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib. CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.
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Affiliation(s)
- Mie Mie Thinn
- Division of Hematology and Medical Oncology, Loma Linda Veterans Administration Medical Center, Loma Linda, CA 92357, United States
| | - Chung-Tzu Hsueh
- Department of Dentistry, Cathay General Hospital, Taipei City 106, Taiwan
| | - Chung-Tsen Hsueh
- Division of Medical Oncology and Hematology, Department of Medicine, Loma Linda University, Loma Linda, CA 92357, United States
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Hagihara M, Ide S, Ohara S, Uchida T, Inoue M, Hua J. [Successful management of drug-induced skin rash in a relapsed multiple myeloma patient with pomalidomide desensitization]. Rinsho Ketsueki 2019; 60:137-139. [PMID: 30842382 DOI: 10.11406/rinketsu.60.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 71-year-old man diagnosed with IgG-κ type multiple myeloma 11 years ago was treated with low doses of pomalidomide (POM, 1 mg/daily) and dexamethasone (20 mg/week) as the third-line of salvage regimen. The treatment was terminated 4 days later owing to the appearance of a severe skin rash, which had also occurred after previous treatment with lenalidomide. After 2 months, POM was readministered via an outpatient desensitization protocol under prednisolone administration. During five cycles of POM-treatment, no severe skin rash appeared, and partial remission was obtained even though the final POM dose was as low as 1 mg/day.
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Affiliation(s)
| | - Shiro Ide
- Department of Hematology, Eiju General Hospital
| | - Shin Ohara
- Department of Hematology, Eiju General Hospital
| | | | | | - Jian Hua
- Department of Hematology, Eiju General Hospital
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Hung YC, Chin CY, Lee YC, Chen YH, Tsai MY. Clinical experience of chinese herbal medicine ameliorates dermatologic events from epidermal growth factor receptor inhibitors for lung cancer: A case series. Explore (NY) 2018; 15:363-370. [PMID: 30497918 DOI: 10.1016/j.explore.2018.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/01/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND To summarize the clinical efficacy and safety of Chinese herbal medicine (CHM) in the treatment of dermatologic events resulting from epidermal growth factor receptor (EGFR) inhibitors according to our experience of ten patients. METHODS Four males and six females, 35-73 years old, mainly with acneiform rash associated with EGFR inhibitors on the face, scalp, perineum, four limbs, and upper trunk, were treated at our traditional Chinese medicine (TCM) clinic in 2016 and 2017. CHM was prescribed thrice daily for 3.4 weeks, with clinical evaluation and photographic documentation performed during treatment. Size, severity, and quality of life (QoL) were documented. Therapeutic response was evaluated using the Skindex-16 dermatologic questionnaire and body surface area (BSA). RESULTS Our retrospective case series demonstrated significant improvement in QoL in 10 subjects with EGFR inhibitor-related skin toxicity treated with CHM. Mean overall scores of the Skindex-16 survey fell from 74.5% at baseline to 19.3% after treatment (p < 0.001). Improvements in BSA were consistent with an 82% reduction in the distribution of skin lesions after treatment (p < 0.05). CONCLUSION CHM is feasible, effective, and safe for the treatment of patients with mild to moderate dermatologic events caused by EGFR inhibitors, according to our preliminary clinical experience, and has distinct advantages, including a direct approach to the TCM syndrome, diverse compatibility, and reduced anaphylactic reaction to traditional acne treatment. However, future perspectives and the need for well-designed prospective studies on CHM and EGFR inhibitors are proposed.
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Affiliation(s)
- Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Chieh-Ying Chin
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 40402, Taiwan
| | - Yi-Chiao Lee
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Yen-Hao Chen
- Division of Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan
| | - Ming-Yen Tsai
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 40402, Taiwan.
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Zhang LN, Guo W, Zhu JH, Guo Y. Successful rescue of acute liver failure and hemophagocytic lymphohistiocytosis following varicella infection: A case report and review of literature. World J Clin Cases 2018; 6:659-665. [PMID: 30430121 PMCID: PMC6232574 DOI: 10.12998/wjcc.v6.i13.659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/10/2018] [Accepted: 10/09/2018] [Indexed: 02/05/2023] Open
Abstract
Herein we report a case of acute liver failure (ALF) and hemophagocytic lymphohistiocytosis (HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient’s condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction (PCR) amplifications of varicella-zoster virus (VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient’s symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life-threatening disorder.
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Affiliation(s)
- Li-Na Zhang
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
| | - Wei Guo
- Department of Emergency, Peking University People’s Hospital, Beijing 100044, China
| | - Ji-Hong Zhu
- Department of Emergency, Peking University People’s Hospital, Beijing 100044, China
| | - Yang Guo
- Department of Emergency, Peking University People’s Hospital, Beijing 100044, China
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Kure R, Uehara N, Inoue K, Kogiso T, Kodama K, Taniai M, Tokushige K, Nakano M, Egawa H, Yamamoto M. An intensive medical care network led to successful living-donor liver transplantation in late-onset hepatic failure with disseminated Staphylococcus aureus infection. Clin J Gastroenterol 2018; 12:112-119. [PMID: 30218430 DOI: 10.1007/s12328-018-0904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/05/2018] [Indexed: 11/29/2022]
Abstract
Here, we describe a 42-year-old male patient with late-onset hepatic failure (LOHF) due to acute-onset autoimmune hepatitis. At first, his response to steroid therapy was good, but hepatitis relapsed during steroid pulse therapy. Deterioration of liver function caused LOHF, and LOHF has a poor prognosis, particularly when it is complicated by infection. Systemic infection by Staphylococcus aureus resulted in a skin rash and septic pulmonary embolism, and is an absolute contraindication for liver transplantation (LT). In this treatment network, hepatologists and a transplant surgeon cooperated to overcome severe infection and their efforts led to successful transplantation. On-line hemodiafiltration is an indispensable treatment option for acute liver failure. Infection control is crucial for LT and an intensive medical care network led to successful living-donor LT.
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Affiliation(s)
- Rie Kure
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Natsumi Uehara
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Knagawa, 227-8501, Japan
| | - Kazuaki Inoue
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Knagawa, 227-8501, Japan.
| | - Tomomi Kogiso
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Kazuhisa Kodama
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Makiko Taniai
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Katsutoshi Tokushige
- Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masayuki Nakano
- Division of Diagnostic Pathology, Shonan Fujisawa Tokushuukai Hospital, 1-5-1 Kandai Tsujido, Fujisawa-shi, Kanagawa, 251-0041, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Tini ML, Rezza G. Morbilliform skin rash with prominent involvement of the palms in Chikungunya fever. IDCases 2018; 13:e00421. [PMID: 30101066 DOI: 10.1016/j.idcr.2018.e00421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 11/22/2022] Open
Abstract
An outbreak of chikungunya occurred in Central Italy in the summer of 2017. During the outbreak, two siblings with fever and joint pain developed a morbilliform skin rash with prominent involvement of the palms. Knowledge of the characteristics of chikungunya exanthem is important to adddress clinical diagnosis.
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Abstract
Background Acute fatty liver of pregnancy can be a very dramatic clinical event with significant risk of mortality to healthy women. The pathogenesis is still unknown. It usually occurs in the third trimester or in the immediate postpartum period. The clinical presentation is very variable. Medical staff have to be very cautious even regarding a minor complaint of feeling unwell. Skin rash has not been reported as one of the initial presentations of acute fatty liver of pregnancy. It is best treated in a center with a multidisciplinary approach. Admission to the intensive care unit is recommended. Case presentation We report a case of a 20-year-old Middle Eastern Arabic woman who developed an acute fatty liver of pregnancy. She was not known to have any medical disease. She had had two previous uncomplicated deliveries. She developed acute fatty liver of pregnancy on the first day after an uncomplicated normal vaginal delivery of a healthy male newborn. She started to have nonitchy skin rash over her abdomen and upper limbs. Then she started to feel unwell. Twelve hours later, she developed epigastric and right upper quadrant abdominal pain, followed by jaundice, nausea, and vomiting. She developed recurrent hypoglycemic attacks, hemolytic anemia, coagulopathy, and hepatorenal syndrome. Conclusions The clinical presentation of acute fatty liver of pregnancy is very variable and nonspecific. Skin rash can be a new presenting symptom of acute fatty liver of pregnancy. Immediate suspicion of the diagnosis, appropriate investigations, and urgent initiation of therapy in an intensive care unit and by a multidisciplinary team resulted in a good outcome with no adverse health consequences for our patient.
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Affiliation(s)
- Naser Al-Husban
- Obstetrics & Gynecology Department, Faculty of Medicine, University of Jordan and Jordan University Hospital, P.O. Box 2194, Amman, 11941, Jordan.
| | - Oqba Al-Kuran
- Obstetrics & Gynecology Department, Faculty of Medicine, University of Jordan and Jordan University Hospital, P.O. Box 2194, Amman, 11941, Jordan
| | - Amal Al Helou
- Obstetrics & Gynecology Department, Faculty of Medicine, University of Jordan and Jordan University Hospital, P.O. Box 2194, Amman, 11941, Jordan
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Leon de la Fuente R, Sanchez AP. Fatal spotted fever rickettsiosis in Argentina. IDCases 2018; 12:151-152. [PMID: 29942776 PMCID: PMC6011014 DOI: 10.1016/j.idcr.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/04/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/30/2022] Open
Abstract
We present a fatal case of a 17-year-old male patient who was hospitalized for febrile seizures and generalized skin rash.
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Haas M, Siveke JT, Schenk M, Lerch MM, Caca K, Freiberg-Richter J, Fischer von Weikersthal L, Kullmann F, Reinacher-Schick A, Fuchs M, Kanzler S, Kunzmann V, Ettrich TJ, Kruger S, Westphalen CB, Held S, Heinemann V, Boeck S. Efficacy of gemcitabine plus erlotinib in rash-positive patients with metastatic pancreatic cancer selected according to eligibility for FOLFIRINOX: A prospective phase II study of the 'Arbeitsgemeinschaft Internistische Onkologie'. Eur J Cancer 2018; 94:95-103. [PMID: 29549862 DOI: 10.1016/j.ejca.2018.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION In metastatic pancreatic ductal adenocarcinoma (mPDAC) treatment, erlotinib is known to be more effective in patients developing skin rash. Treatment with the FOLFIRINOX regimen is only performed in fit patients following defined inclusion criteria. The present study investigates the efficacy of gemcitabine plus erlotinib (gem/erlotinib) in rash-positive patients fit for FOLFIRINOX. PATIENTS AND METHODS For this prospective phase II study, 150 patients were recruited in 20 centres. All patients received gem/erlotinib for 4 weeks (run-in phase); the subsequent treatment was determined by the development of skin rash: patients with rash grades 1-4 continued with gem/erlotinib, rash-negative patients were switched to FOLFIRINOX. Primary study end-point was to achieve a 1-year survival rate in rash-positive patients ≥40%. RESULTS Ninety patients were deemed positive for skin rash by the end of the run-in phase, showing a 1-year survival rate of 40.0% (95% confidence interval [CI] 29.8-50.9). Median overall survival (OS) was 10.1 months, progression-free survival (PFS) was 3.8 months and overall response rate (ORR) was 23.3%. Patients switched to FOLFIRINOX (n = 27) had a 1-year survival rate of 48.1% (95% CI 28.7-68.1), a median OS of 10.9 months, a median PFS of 6.6 months and an ORR of 33.3%. Rash-negative patients had a lower quality of life at baseline but seemed to experience an improved control of pain during FOLFIRINOX. CONCLUSIONS First-line treatment with gem/erlotinib was effective in fit, rash-positive mPDAC patients achieving a 1-year survival rate comparable to previous reports for FOLFIRINOX. The study was registered at clinicaltrials.gov (NCT0172948) and Eudra-CT (2011-005471-17).
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Affiliation(s)
- M Haas
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
| | - J T Siveke
- 2nd Medical Department, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Solid Tumor Translational Oncology (DKTK, Partner Site Essen), West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Schenk
- Department of Haematology and Oncology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - M M Lerch
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - K Caca
- Department of Internal Medicine I, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | | | - F Kullmann
- Department of Medicine I, Klinikum Weiden, Weiden, Germany
| | - A Reinacher-Schick
- Department of Haematology and Oncology, St. Josef-Hospital, Ruhr University, Bochum, Germany
| | - M Fuchs
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, Munich, Germany
| | - S Kanzler
- Department of Internal Medicine II, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - V Kunzmann
- Department of Medical Oncology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - T J Ettrich
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | - S Kruger
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - C B Westphalen
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - S Boeck
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
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Wei F, Shin D, Cai X. Incidence, risk and prognostic role of anti-epidermal growth factor receptor-induced skin rash in biliary cancer: a meta-analysis. Int J Clin Oncol 2017; 23:443-451. [PMID: 29289981 DOI: 10.1007/s10147-017-1231-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anti-epidermal growth factor receptor (EGFR)-induced skin rash is a common adverse event and is considered a prognostic factor of various cancers. However, the role of rash is rarely known in biliary cancer, possibly owing to the low incidence of this frequently fatal malignancy. We thus performed a meta-analysis to investigate the incidence, risk and prognostic significance of skin rash related to anti-EGFR treatment for biliary cancer. METHODS Eligible studies were enrolled after a systematic search of electronic databases. A fixed-effects or random-effects model was utilized according to the heterogeneity. RESULTS Fourteen clinical trials published between 2006 and 2017 comprising 1,106 patients with advanced biliary cancer were included. The overall incidence of all-grade and high-grade (grade ≥3) rash was 78.2% [95% confidence interval (CI) 70.4-84.3] and 11.3% (7.6-16.5), respectively. Anti-EGFR treatment correlates with a significantly increased risk of all-grade [risk ratio (RR) 7.37, 95% CI 5.11-10.64, p < 0.0001] and high-grade (RR 6.94, 95% CI 1.89-25.45, p = 0.0035) rash compared with control medication. Higher grades of skin rash correlate with a higher objective response rate (RR 3.50, 95% CI 1.47-8.33, p = 0.0048), and a longer overall [hazard ratio (HR) 0.47, 95% CI 0.31-0.71, p = 0.0003) and progression-free survival (HR 0.51, 95% CI 0.36-0.72, p = 0.0001) compared with lower grades or no rash in patients who received anti-EGFR treatment. CONCLUSIONS Anti-EGFR treatment correlates with an increased risk of skin rash in advanced biliary cancer. Stratifying patients by the severity of rash may have major implications for survival benefit regarding anti-EGFR treatment for biliary cancer.
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Affiliation(s)
- Fangqiang Wei
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Road, Hangzhou, 310016, Zhejiang, China.,Department of Developmental Biology, Pittsburgh Liver Research Center, McGowan Institute for Regenerative Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Donghun Shin
- Department of Developmental Biology, Pittsburgh Liver Research Center, McGowan Institute for Regenerative Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Xiujun Cai
- Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3, Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Rapoport BL, van Eeden R, Sibaud V, Epstein JB, Klastersky J, Aapro M, Moodley D. Supportive care for patients undergoing immunotherapy. Support Care Cancer 2017; 25:3017-30. [PMID: 28707167 DOI: 10.1007/s00520-017-3802-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/18/2017] [Indexed: 12/27/2022]
Abstract
Immune checkpoint inhibitors, a new class of cancer therapeutic agents, play an important role in the management of melanoma, NSCLC, and other malignancies. A workshop organized by three MASCC Study Groups: Oral Care, Skin Toxicities, and Neutropenia, Infection, and Myelosuppression during the MASCC Annual Meeting held in Adelaide, Australia on 23-25 June, 2016 focused on the new class of anti-cancer therapeutic agents. Topics in the workshop included the mechanism of action and clinical uses of immune anti-CTL4 and anti-PD1 antibodies, checkpoint inhibitor toxicities, including skin adverse events, gastrointestinal toxicities, oral complications, pulmonary toxicities, and endocrinological and immune-related infections. Checkpoint inhibitors have been approved for use in different malignancies including metastatic melanoma, advanced non-small cell lung cancer, metastatic renal cell carcinoma, refractory Hodgkin's lymphoma, metastatic bladder cancer, and advanced head and neck cancer, and the list continues to grow. In general, these agents seem to be better tolerated in most patients and less toxic compared to conventional chemotherapy. However, the toxicities here, termed immune-related adverse events (irAEs), are unique and different from what we have seen in the past. There is no prospective data on these toxicities, and guidelines or recommendations are currently based on symptomatic management from the ongoing clinical trials. Treating oncologists need to be aware and alert themselves to the subtleties in presentation and the big difference in the way we manage the irAEs. Although most irAEs are low-grade and manageable, they have the potential to be life-threatening and extremely severe if not promptly treated. Additionally, irAEs could even lead to death, if managed incorrectly. The MASCC workshop addressed the various irAEs, per organ system, clinical presentation, management recommendations, and individual toxicities.
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Kang DH, Kim SY, Kim HG, Park JH, Kim TK, Kim KH. Earlier treatment improves the chances of complete relief from postherpetic neuralgia. Korean J Pain 2017; 30:214-219. [PMID: 28757922 PMCID: PMC5532529 DOI: 10.3344/kjp.2017.30.3.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/14/2017] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background As herpes zoster progresses via postherpetic neuralgia (PHN) to well-established PHN, it presents its recalcitrant nature to the treatment. At this point, the well-established PHN is fixed as a non-treatable, but manageable chronic painful neuropathic disorder. This study evaluated the incidence of complete relief from PHN according to PHN duration at their first visit, and the other factors influencing it. Methods A retrospective chart review was performed on patients with PHN at a university-based pain clinic over 7 years. The responders were defined as patients who had complete relief from pain after 1 year of active treatment. Age, sex, PHN duration at their first visit, dermatomal distribution, and underlying disorders were compared in the responder and non-responder groups. Responders were also compared according to these factors. Results Among 117 PHN patients (M/F = 48/69), 35 patients (29.9%) had complete relief from PHN. Mean ages were 64.3 ± 10.6 and 66.9 ± 10.7 years, numbers of male to female patients were 11/24 and 37/45, and mean durations of PHN at their first visit were 8.5 ± 6.3 and 15.3 ± 10.7 months in the responder and non- responder groups, respectively. In addition, PHN patients who visited the clinic before 9 months showed a better result. Dermatomal distribution and underlying disorders did not show significant differences. Conclusions Almost 30% of PHN patients received complete relief. Those who sought treatment in a pain clinic before 9 months received a better result.
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Affiliation(s)
- Dong Hee Kang
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Su Young Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Hyuck Goo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Jung Hyun Park
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Tae Kyun Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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Wu XT, Hong PW, Suolang DJ, Zhou D, Stefan H. Drug-induced hypersensitivity syndrome caused by valproic acid as a monotherapy for epilepsy: First case report in Asian population. Epilepsy Behav Case Rep 2017; 8:108-110. [PMID: 29204346 PMCID: PMC5707210 DOI: 10.1016/j.ebcr.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/23/2017] [Accepted: 06/07/2017] [Indexed: 02/05/2023]
Abstract
Valproic acid (VPA) is a broad-spectrum antiseizure drug used for a variety of clinical conditions, such as epilepsy and mood disorders. Drug-induced hypersensitivity syndrome (DRESS) accompanied by hyponatremia, thrombocytopenia, hypoalbuminemia and elevated aminotransferase has never been reported as an adverse effect of VPA monotherapy during titration for epilepsy in Asian population. Hereby, we present the case of a 73-year-old Chinese male who suffered from DRESS and other complications two weeks after initiating VPA treatment for epilepsy. Understanding the risk associated with VPA-induced DRESS, and taking effective measures to avoid the severe side effects are necessary.
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Key Words
- AHS, acute hypersensitivity syndrome
- ASDs, antiseizure drugs
- Antiseizure drugs
- CBZ, carbamazepine
- Cutaneous adverse drug reactions
- DRESS, drug-induced hypersensitivity syndrome
- Drug-induced hypersensitivity syndrome (DRESS)
- ECG, electrocardiogram
- HLA, human leukocyte antigen
- LEV, levetiracetam
- LTG, lamotrigine
- MDH, multiple drug hypersensitivity
- PHT, phenytoin
- SCARs, severe cutaneous adverse drug reactions
- SJS/TEN, Stevens-Johnson syndrome/toxic epidermal necrolysis
- Skin rash
- VGB, vigabatrine
- VPA, valproic acid
- Valproate acid
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Affiliation(s)
- X T Wu
- Department of Neurology, West China Hospital, Sichuan University, China
| | - P W Hong
- Department of Neurology, West China Hospital, Sichuan University, China
| | - D J Suolang
- Department of Neurology, West China Hospital, Sichuan University, China
| | - D Zhou
- Department of Neurology, West China Hospital, Sichuan University, China
| | - H Stefan
- Department of Neurology - Biomagnetism, University Hospital Erlangen, Germany
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Wada Y, Koyama S, Kuraishi H, Miyahara T, Yoshiike F, Agatsuma T, Yamamoto R, Ono Y, Suzuki T, Hachiya T, Gomi D, Tateishi K, Hanaoka M, Koizumi T. Clinical analysis of patients treated with afatinib for advanced non-small cell lung cancer: A Nagano Lung Cancer Research Group observational study. Respir Investig 2016; 54:462-467. [PMID: 27886858 DOI: 10.1016/j.resinv.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Afatinib has been available in Japan for the treatment of epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) since May 2014. We conducted an observational study in patients treated with afatinib in Nagano prefecture, focusing on response and associated toxicities. METHODS We analyzed the clinical records of NSCLC patients treated with afatinib between May 2014 and February 2015. RESULTS The records of a total of 73 patients (27 men, 46 women) with a median age of 69 years (range: 42-85 years) were analyzed. Afatinib was administered to 11 patients as a first-line therapy, but it was predominantly administered as a fifth-line or beyond therapy (32 cases, 43.8%). The overall response rates for afatinib as a first-line therapy and beyond second-line therapy were 80% (95% confidence interval [CI]: 55.2-100.0%) and 27.1% (95% CI: 14.5-39.7%), respectively. The main toxicities grade >3 included diarrhea (8.2%), skin rash (6.8%), nausea (6.8%), and appetite loss (6.8%). A low body surface area (BSA) (<1.5m2) was significantly associated with a higher frequency of diarrhea grade >2, compared with a higher BSA (≥ 1.5m2). Forty-eight patients (63.0%) were treated without a dose reduction of afatinib. CONCLUSIONS Although the survival benefit with afatinib remains unclear, our observational analysis demonstrated the feasibility of using afatinib for EGFR-mutated NSCLC in clinical practice. In particular, a relatively high level of drug delivery is possible. In addition, a lower BSA may be a predictor of diarrhea in patients treated with afatinib.
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Affiliation(s)
- Yosuke Wada
- Department of Pulmonary Diseases, Nagano Red Cross Hospital, Nagano City, Japan; First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Shigeru Koyama
- Department of Pulmonary Diseases, Nagano Red Cross Hospital, Nagano City, Japan.
| | - Hiroshi Kuraishi
- Department of Pulmonary Diseases, Nagano Red Cross Hospital, Nagano City, Japan.
| | - Takashige Miyahara
- Department of Pulmonary Diseases, Nagano Matsushiro General Hospital, Nagano City, Japan.
| | - Fumiaki Yoshiike
- Department of Pulmonary Diseases, Nagano Municipal Hospital, Nagano City, Japan.
| | - Toshihiko Agatsuma
- Department of Respiratory Medicine, National Hospital Organization Shinshu Ueda Medical Center, Ueda City, Japan.
| | - Ryouhei Yamamoto
- Division of Thoracic Surgery, Saku Central Hospital Advanced Care Center, Saku City, Japan.
| | - Yasushi Ono
- Treatment Center, Aizawa Hospital, Matsumoto City, Japan.
| | - Toshiro Suzuki
- Department of Pulmonary Diseases, Matsumoto Medical Center, Matsumoto City, Japan.
| | - Tsutomu Hachiya
- Department of Pulmonary Diseases, Suwa Red Cross Hospital, Suwa City, Japan.
| | - Daisuke Gomi
- Department of Medical Oncology, Iida Municipal Hospital, Iida City, Japan; Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto City, Japan.
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Tischer B, Huber R, Kraemer M, Lacouture ME. Dermatologic events from EGFR inhibitors: the issue of the missing patient voice. Support Care Cancer 2017; 25:651-60. [PMID: 27718067 DOI: 10.1007/s00520-016-3419-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/19/2016] [Indexed: 12/15/2022]
Abstract
Purpose As epidermal growth factor receptor (EGFR) inhibitors are associated with a variety of dermatologic adverse events (dAEs), the purpose of this study was to develop an overview of current knowledge of dAEs associated with EGFR inhibitors and to identify knowledge gaps regarding incidence, treatment, impact on quality of life (QOL), and patient acceptance. Method A structured literature search was conducted using MEDLINE/PubMed (January 1983 to January 2014). In total, 71 publications published from 2004 to 2014 were identified for consideration in the final evidence review. Results The majority of published articles concentrate on the incidence of skin reactions, duration, treatment, and prevention strategies. Different grading systems based on the symptoms of skin rash or on health-related QOL (HRQOL) are used. An additional topic is the possible correlation between acneiform rash and efficacy of EGFR inhibitors. Knowledge gaps identified in the literature were how dAEs impact QOL compared with other AEs from a patient’s perspective, patients’ acceptance of dAEs (willingness to tolerate), and the impact of physician-patient communication on treatment decisions. Conclusions Research is needed on the impact of dAEs on patients’ acceptance of cancer treatments. Systematic studies are missing that compare the impact of dAEs with other toxicities on therapy decisions from both physician’s and patient’s view, and that investigate the balance between efficacy and avoidance of acneiform rash in treatment decisions. Such studies could provide deeper insights into the acceptance of the risk of untoward dermatologic events by both physicians and patients when treating advanced cancers. Electronic supplementary material The online version of this article (doi:10.1007/s00520-016-3419-4) contains supplementary material, which is available to authorized users.
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Abstract
Very high frequency ultrasound (VHF-US) is new therapy method with a broad application spectrum in dermatology and aesthetic medicine. In this method, ultrasound waves with frequencies over 10 MHz, which were for a long time only used in ultrasound diagnostics, are applied for therapeutic purposes. Such US waves demonstrate specific biophysical efficiencies which warrant their application for the treatment of the skin efflorescences, chronic wounds and hypertrophic scars as well as in anti-aging and skin improvement procedures in aesthetic medicine. VHF-US can be applied not only for stand-alone treatments, but also as a supportive pre- and posttreatment method in combination with laser, radiofrequency currents, injection lipolysis, etc. as well as in aesthetic plastic surgery.
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Zaborowska-Szmit M, Kowalski DM, Piórek A, Krzakowski M, Szmit S. A decrease in D-dimer concentration and an occurrence of skin rash as iatrogenic events and complementary predictors of survival in lung cancer patients treated with EGFR tyrosine kinase inhibitors. Pharmacol Rep 2016; 68:1140-1148. [PMID: 27588390 DOI: 10.1016/j.pharep.2016.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Progression of lung cancer is associated with some abnormalities in coagulation. The aim of the study was to determine the predictive and prognostic value of changes in D-dimer concentration in non-small cell lung cancer (NSCLC) patients on anti-EGFR targeted therapy. METHODS The analysis included fifty two NSCLC patients treated with EGFR tyrosine kinase inhibitors (TKIs): erlotinib or gefitinib. All clinical data were collected before treatment and after 2 cycles (60days) of therapy and correlated with progression free and overall survival (PFS, OS). RESULTS Two iatrogenic events were noted within the first 60days of anti-EGFR treatment: typical skin rash in 38 (73.1%) and a decrease in D-dimer concentration in 26 (50%) patients. Multivariate analysis revealed a decrease of D-dimer concentration as the strongest factor associated with longer PFS (HR=0.39; 95%CI: 0.16-0.91; p=0.029) and OS (HR=0.33; 95%CI: 0.13-0.82, p=0.017) independently of skin rash, baseline level of D-dimer and other clinical characteristics. Coexisting a decrease in D-dimer concentration with an occurrence of skin rash correlated significantly with the positive objective response after 60days of anti-EGFR therapy (p=0.0175) and indicated the longest PFS (HR=0.31; 95%CI: 0.16-0.60, p=0.0005) as well as OS (HR=0.30; 95%CI: 0.15-0.59, p=0.0005). CONCLUSION Adverse events may predict the outcomes of cancer patients. Apart from skin rash, change in D-dimer concentration may be valuable parameter in creation of predictive and prognostic models in NSCLC patients receiving anti-EGFR targeted therapy.
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Affiliation(s)
- Magdalena Zaborowska-Szmit
- Lung & Thoracic Tumors Department, The Maria Sklodowska-Curie Memorial Cancer Centre & Institute of Oncology, Warszawa, Poland
| | - Dariusz M Kowalski
- Lung & Thoracic Tumors Department, The Maria Sklodowska-Curie Memorial Cancer Centre & Institute of Oncology, Warszawa, Poland
| | - Aleksandra Piórek
- Lung & Thoracic Tumors Department, The Maria Sklodowska-Curie Memorial Cancer Centre & Institute of Oncology, Warszawa, Poland
| | - Maciej Krzakowski
- Lung & Thoracic Tumors Department, The Maria Sklodowska-Curie Memorial Cancer Centre & Institute of Oncology, Warszawa, Poland
| | - Sebastian Szmit
- Department of Pulmonary Circulation and Thromboembolic Diseases, Centre of Postgraduate Medical Education, European Health Centre Otwock, Otwock, Poland.
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Abstract
Skin rashes that appear during febrile illnesses are in fact caused by various infectious diseases. Since infectious exanthematous diseases range from mild infections that disappear naturally to severe infectious diseases, focus on and basic knowledge of these diseases is very important. But, these include non-infectious diseases, so that comprehensive knowledge of these other diseases is required. Usually, early diagnostic testing for a febrile illness with a rash is inefficient. For clinical diagnosis of diseases accompanied by skin rash and fever, a complete history must be taken, including recent travel, contact with animals, medications, and exposure to forests and other natural environments. In addition, time of onset of symptoms and the characteristics of the rash itself (morphology, location, distribution) could be helpful in the clinical diagnosis. It is also critical to understand the patient's history of specific underlying diseases. However, diagnostic basic tests could be helpful in diagnosis if they are repeated and the clinical course is monitored. Generally, skin rashes are nonspecific and self-limited. Therefore, it could be clinically meaningful as a characteristic diagnostic finding in a very small subset of specific diseases.
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Affiliation(s)
- Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Affiliation(s)
- Kavita Paul
- Assistant Professor, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
| | - Geetika Paul
- Senior Resident, Department of Dermatology, SMS Medical College , Rajasthan, Jaipur, India
| | - Harbans Lal Kazal
- Professor, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
| | - Nariender Kumar Bairwa
- Resident, Department of Medicine, GGS Medical College & Hospital , Faridkot, Punjab, India
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Abstract
Legionella pneumophila is the most common cause of legionellosis and is one of the organisms causing atypical pneumonia. We report the presentation of disseminated intravascular coagulation (DIC) and skin rash in a single case of severe Legionella pneumonia. The unique clinical presentation of a diffuse rash diagnosed as purpura fulminans and the unpredictable variations encountered during the diagnostic work-up of the case make this write-up crucial. This article synthesizes all reported cases of L. pneumonia associated with cutaneous manifestations as well as cases presenting with DIC. Furthermore, this manuscript illustrates the correlation between cutaneous and coagulopathic manifestations, and morbidity and mortality from L. pneumonia.
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Affiliation(s)
- Prashanth M. Thalanayar
- Department of Internal Medicine, University of Pittsburgh Medical Center McKeesport, PA, USA
- Corresponding author. 1500 Fifth Avenue, McKeesport, PA 15132, USA. Tel.: +1 412 664 2618.
| | - Fernando Holguin
- Department of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
BACKGROUND We performed a systematic review and meta-analysis to determine the risk of mucocutaneous adverse events associated with lapatinib. PATIENTS AND METHODS Eligible studies included randomized phase II and III trials of patients with solid tumors on lapatinib; describing events of stomatitis, skin rash, hand foot syndrome, pruritus and alopecia. RESULTS Our search strategy yielded 380 potentially relevant citations on lapatinib from PubMed/Medline, CENTRAL Cochrane Registry and ASCO Meeting Library. After exclusion of ineligible studies, a total of 19 clinical trials were considered eligible for the meta-analysis. The RRs of all-grade skin rash, stomatitis, hand foot syndrome and pruritus were 3.04 (95% CI 2.33-3.96; p < 0.00001), 1.67 (95% CI 1.02-2.3; p < 0.04), 4.45 (95% CI 1.15-17.19; p = 0.03), and 2.02 (95% CI 1.46-2.8; p < 0.0001), respectively. Exploratory subgroup analysis showed no effect of treatment regimen on the RRs of the relevant adverse events. CONCLUSIONS Our meta-analysis has demonstrated that lapatinib is associated with a significantly increased risk of all-grade skin rash, hand foot skin reaction and pruritus. Clinicians should be aware of these risks and perform regular clinical monitoring.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University , Cairo , Egypt
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