Limits...
Acute generalized exanthematous pustulosis secondary to azathioprine.

Basak P, Dong Z, Jesmajian S - Indian J Dermatol (2015 Jan-Feb)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Montefiore New Rochelle Hospital and Albert Einstein College of Medicine, 16 Guion Place, New Rochelle, and New York Medical College, New York, USA. E-mail: pbasak@sshsw.org.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

It is used alone or in combination with other immunosuppressive agents to prevent rejection following organ transplantation and to treat an array of autoimmune diseases and vasculitis... Its steroid-sparing and immunomodulatory effects have been useful for treating Wegener's granulomatosis in remission... The most common cutaneous manifestation of AZA hypersensitivity is a neutrophilic dermatosis, and biopsy could be consistent with Sweet's syndrome, erythema nodosum, small-vessel vasculitis, and acute generalized exanthematous pustulosis (AGEP)... Laboratory results showed 90% neutrophils with leukocytosis 14.5 × 10/L, elevated blood urea nitrogen (BUN) 20.3 mmol/L, creatinine 710 mcmol/L, erythrocyte sedimentation rate (ESR) 108 mm/hour, and C-reactive protein (CRP) 307 mg/dL... Chest X-ray did not show any infiltrates... Punch biopsy of a skin lesion showed intracorneal neutrophils and intraepidermal neutrophilic pustules, with prominent subepidermal and dermal neutrophils with lymphocytes, consistent with AGEP [Figures 3 and 4]... Gram and silver stains were negative for any bacteria or fungi... Blood and urine culture results proved negative, and antibiotics were discontinued... His fever and rash improved dramatically within 48 hours of admission along with improvement of his renal functions... He was diagnosed as AZA-induced AGEP... The Naranjo Adverse Drug Reaction Probability Scale (Naranjo algorithm) was used to assess the probability whether the adverse drug reaction was due to AZA rather than the result of other factors... The typical histopathology of AGEP is characterized by spongiform subcorneal or intraepidermal pustules or both, marked papillary edema (occasionally with the formation of a subepidermal blister), and polymorphous perivascular infiltrates with neutrophils and exocytosis of some eosinophils. be appropriate instead of the comma... Confirming hypersensitivity with rechallenge can produce more severe symptoms... In up to 60% of AZA-hypersensitive patients, 6-MP may be a safe alternative, suggesting that in these individuals, immunological sensitivity is directed against the imidazole rather than the thiopurine moiety of the AZA molecule... Our patient had a latent interval of 8 days, which was close to the mean of 11 days for the development of AGEP.

No MeSH data available.


Related in: MedlinePlus

Subepidermal and dermal neutrophils with lymphocytes (H and E, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4318078&req=5

Figure 3: Subepidermal and dermal neutrophils with lymphocytes (H and E, ×40)

Mentions: A 55-year-old man presented at the emergency room with rash, fever, and generalized body ache since 3 days. He had been diagnosed with Wegener's granulomatosis 1 year ago, and was in remission on oral prednisone. He was started on AZA 8 days prior to presentation as a steroid-sparing alternative. Physical examination was significant for temperature of 40.4°C, and tachycardia at 121 beats per minute. There was diffuse nonblanching, erythematous 2-4 mm papulopustules present on his trunk and extremities, most prominently on his hands and distal forearms [Figures 1 and 2]. No mucosal or scalp lesions were noted. Laboratory results showed 90% neutrophils with leukocytosis 14.5 × 109/L, elevated blood urea nitrogen (BUN) 20.3 mmol/L, creatinine 710 mcmol/L, erythrocyte sedimentation rate (ESR) 108 mm/hour, and C-reactive protein (CRP) 307 mg/dL. Chest X-ray did not show any infiltrates. Diagnoses considered on admission were systemic infection with sepsis, flare-up of his underlying vasculitis, and AZA hypersensitivity. He was started on intravenous (IV) methylprednisolone sodium succinate 125 mg every 6 hours, and IV cefepime and vancomycin were added, pending pan culture results. Punch biopsy of a skin lesion showed intracorneal neutrophils and intraepidermal neutrophilic pustules, with prominent subepidermal and dermal neutrophils with lymphocytes, consistent with AGEP [Figures 3 and 4]. Gram and silver stains were negative for any bacteria or fungi. Blood and urine culture results proved negative, and antibiotics were discontinued. His fever and rash improved dramatically within 48 hours of admission along with improvement of his renal functions. He was diagnosed as AZA-induced AGEP. On the Hartwig's Severity Assessment Scale, the patient scored level 4, indicating moderate severity of the drug reaction. The Naranjo Adverse Drug Reaction Probability Scale (Naranjo algorithm) was used to assess the probability whether the adverse drug reaction was due to AZA rather than the result of other factors. As determined by this scale, AZA was the “probable” cause of the adverse drug reaction. The patient was discharged from hospital on oral prednisone.


Acute generalized exanthematous pustulosis secondary to azathioprine.

Basak P, Dong Z, Jesmajian S - Indian J Dermatol (2015 Jan-Feb)

Subepidermal and dermal neutrophils with lymphocytes (H and E, ×40)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318078&req=5

Figure 3: Subepidermal and dermal neutrophils with lymphocytes (H and E, ×40)
Mentions: A 55-year-old man presented at the emergency room with rash, fever, and generalized body ache since 3 days. He had been diagnosed with Wegener's granulomatosis 1 year ago, and was in remission on oral prednisone. He was started on AZA 8 days prior to presentation as a steroid-sparing alternative. Physical examination was significant for temperature of 40.4°C, and tachycardia at 121 beats per minute. There was diffuse nonblanching, erythematous 2-4 mm papulopustules present on his trunk and extremities, most prominently on his hands and distal forearms [Figures 1 and 2]. No mucosal or scalp lesions were noted. Laboratory results showed 90% neutrophils with leukocytosis 14.5 × 109/L, elevated blood urea nitrogen (BUN) 20.3 mmol/L, creatinine 710 mcmol/L, erythrocyte sedimentation rate (ESR) 108 mm/hour, and C-reactive protein (CRP) 307 mg/dL. Chest X-ray did not show any infiltrates. Diagnoses considered on admission were systemic infection with sepsis, flare-up of his underlying vasculitis, and AZA hypersensitivity. He was started on intravenous (IV) methylprednisolone sodium succinate 125 mg every 6 hours, and IV cefepime and vancomycin were added, pending pan culture results. Punch biopsy of a skin lesion showed intracorneal neutrophils and intraepidermal neutrophilic pustules, with prominent subepidermal and dermal neutrophils with lymphocytes, consistent with AGEP [Figures 3 and 4]. Gram and silver stains were negative for any bacteria or fungi. Blood and urine culture results proved negative, and antibiotics were discontinued. His fever and rash improved dramatically within 48 hours of admission along with improvement of his renal functions. He was diagnosed as AZA-induced AGEP. On the Hartwig's Severity Assessment Scale, the patient scored level 4, indicating moderate severity of the drug reaction. The Naranjo Adverse Drug Reaction Probability Scale (Naranjo algorithm) was used to assess the probability whether the adverse drug reaction was due to AZA rather than the result of other factors. As determined by this scale, AZA was the “probable” cause of the adverse drug reaction. The patient was discharged from hospital on oral prednisone.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Montefiore New Rochelle Hospital and Albert Einstein College of Medicine, 16 Guion Place, New Rochelle, and New York Medical College, New York, USA. E-mail: pbasak@sshsw.org.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

It is used alone or in combination with other immunosuppressive agents to prevent rejection following organ transplantation and to treat an array of autoimmune diseases and vasculitis... Its steroid-sparing and immunomodulatory effects have been useful for treating Wegener's granulomatosis in remission... The most common cutaneous manifestation of AZA hypersensitivity is a neutrophilic dermatosis, and biopsy could be consistent with Sweet's syndrome, erythema nodosum, small-vessel vasculitis, and acute generalized exanthematous pustulosis (AGEP)... Laboratory results showed 90% neutrophils with leukocytosis 14.5 × 10/L, elevated blood urea nitrogen (BUN) 20.3 mmol/L, creatinine 710 mcmol/L, erythrocyte sedimentation rate (ESR) 108 mm/hour, and C-reactive protein (CRP) 307 mg/dL... Chest X-ray did not show any infiltrates... Punch biopsy of a skin lesion showed intracorneal neutrophils and intraepidermal neutrophilic pustules, with prominent subepidermal and dermal neutrophils with lymphocytes, consistent with AGEP [Figures 3 and 4]... Gram and silver stains were negative for any bacteria or fungi... Blood and urine culture results proved negative, and antibiotics were discontinued... His fever and rash improved dramatically within 48 hours of admission along with improvement of his renal functions... He was diagnosed as AZA-induced AGEP... The Naranjo Adverse Drug Reaction Probability Scale (Naranjo algorithm) was used to assess the probability whether the adverse drug reaction was due to AZA rather than the result of other factors... The typical histopathology of AGEP is characterized by spongiform subcorneal or intraepidermal pustules or both, marked papillary edema (occasionally with the formation of a subepidermal blister), and polymorphous perivascular infiltrates with neutrophils and exocytosis of some eosinophils. be appropriate instead of the comma... Confirming hypersensitivity with rechallenge can produce more severe symptoms... In up to 60% of AZA-hypersensitive patients, 6-MP may be a safe alternative, suggesting that in these individuals, immunological sensitivity is directed against the imidazole rather than the thiopurine moiety of the AZA molecule... Our patient had a latent interval of 8 days, which was close to the mean of 11 days for the development of AGEP.

No MeSH data available.


Related in: MedlinePlus