Generalized pustules in a healthy woman

A healthy 47-year-old woman developed diffuse pustules and edema of the skin after exposure to diltiazem and cephalexin. Bacterial, fungal and viral cultures were sterile suggesting a noninfectious etiology. A skin biopsy showed spongiosis, subcorneal collections of neutrophils, papillary dermal edema and a superficial perivascular mixed cell infiltrate. The clinical and histopathologic findings were consistent with acute generalized exanthematous pustulosis (AGEP). The patient was treated with supportive care and the pustular dermatitis cleared. AGEP is a rare complication of drug therapy and should be considered in the differential diagnosis of patients presenting with acute onset pustular dermatitis. Drug reactions are an uncommon and unpredictable complication of medical therapy. Cutaneous drug reaction rates occur with a frequency of 1% to 8% and can be higher for certain classes of drugs. They can range from mild morbilliform eruptions to more severe forms such as drug-hypersensitivity syndrome, toxic epidermal necrolysis or anaphylaxis. Acute generalized exanthermatous pustulosis (AGEP) is a rare presentation of a drug reaction and can be difficult to distinguish from other pustular dermatoses. Herein we review a case of AGEP and include a discussion of salient clinical and histological features of AGEP.     

Acute generalized exanthematous pustulosis induced by iodixanol (Visipaque): a serious reaction to a commonly used drug

Acute generalized exanthematous pustulosis (AGEP) is an acute sterile pustular eruption most commonly induced by medications. Although antibiotics are the most commonly accused drugs in AGEP, non-antibiotic agents may also cause this disease. We present a case of AGEP following use of iodixanol for coronary angiography in a 61-year-old woman. Given the wide use of this substance in cardiology, clinicians should be aware of this potential complication.     

Acute generalized exanthematous pustulosis induced by piroxicam: A case report

Acute generalized exanthematous pustulosis (AGEP) is a severe adverse cutaneous reaction characterized by an acute episode of sterile pustules over erythematous-edematous skin. The main triggering drugs are antibiotics, mainly beta-lactam and macrolides. Non-steroid anti-inflammatory drugs may rarely be responsible. We describe a case of a woman with AGEP, who presented with generalized pustulosis lesions after the use of piroxicam for renal colic. The diagnosis was confirmed by the clinical and histological correlations and the dermatosis resolved after withdrawal of the drug.KEY WORDS: Acute generalized exanthematous pustulosis, adverse drug reactions, piroxicam, pustulosis     

他汀类药物的不良反应

他汀类药物是临床广泛应用的降脂药,在多种心血管疾病的治疗中发挥重要作用。随着使用范围和使用人数的增加,其不良反应报道逐渐增多,包括他汀类药物相关性肌病、肝损害、过敏反应、眼外肌麻痹、性功能障碍、多尿、消化系统反应、关节痛、下肢不宁综合征等。本文对他汀类药物的不良反应和防治措施进行简要综述,以促进其合理应用。     

Adverse effects of neuromuscular blocking agents based on yellow card reporting in the U.K.: are there differences between males and females?

BACKGROUND: Adverse drug reactions (ADRs) are known to occur during anaesthesia; in the U.K. such ADRs may be reported through the Yellow Card Scheme (YCS). Our aim was to determine the demographics of ADRs to neuromuscular blocking drugs without formal causality assessment. METHODS: A retrospective analysis of ADRs to seven neuromuscular blocking drugs reported via the YCS during a greater than 30-year period was performed. Sex and age were analysed in order to identify at risk groups. RESULTS: Of 998 reports, 969 included gender. Non-allergic suspected reactions occurred with almost the same frequency as those with an allergic component. The majority occurred in females 676 (70%), and significant sex differences were measured between drugs. Males were more likely to have suffered an ADR to atracurium (p = 0.01) whilst females experienced more ADRs to suxamethonium (p = 0.01). ADRs proved fatal in 81 (9%) of the 950 reports for single drugs. Mortality following suxamethonium was significantly higher in males at 22% compared with 9% females (p < 0.001). More women than men were reported to have allergic reactions, 73% (362/499) compared with 27% (137/499) respectively. The female:male ratio for ADRs was reversed for subjects < 10 years compared with peak ADR reports during the decade from 31-40 years. CONCLUSIONS: Sex differences in mortality exist in this analysis. The unexpected high frequency of non-allergic ADRs suggests that morbidity and mortality from reactions to established drugs is twice that expected from allergic reactions alone. Standards and guidance for the reporting of ADRs warrant urgent development.     

A recent update of pharmacogenomics in drug-induced severe skin reactions

In some adverse drug reactions (ADRs), genetic predisposition plays a significant role in pathogenesis, and the skin is the most frequently reported target. These severe cutaneous ADRs include bullous fixed drug eruptions (FDE), acute generalized exanthematous pustulosis (AGEP), drug-induced hypersensitivity syndrome (HSS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). The putative contribution of individual effector cells in drug hypersensitivity is briefly mentioned. To trigger these drug hypersensitivities, certain class I HLA alleles (e.g., HLA-A and HLA-B alleles) and certain class II HLA alleles (e.g., HLA-DR alleles) have been recently found to be the genetic determinants. One of the best characterized examples mentioned in this article is HLA-B*1502 to determine the incidence of carbamazepine-induced SJS. How drugs are processed and presented by these HLA alleles to activate immune responses has been explained by several hypotheses. Further implication of pharmagenomic findings to prevent drug-induced severe skin reactions can be achieved by pre-screening putative risk HLA alleles before using drugs.     

天津市第一中心医院蛇毒血凝酶的临床应用合理性分析

目的 调查并分析天津市第一中心医院蛇毒血凝酶的临床真实应用情况及规律,为指导临床安全、合理用药提供参考。方法 回顾性分析2022年1～8月天津市第一中心医院使用蛇毒血凝酶的住院患者病历信息,统计患者性别、年龄、临床诊断、用药情况、疗程＞5 d、是否监测纤维蛋白原（FIB）水平及药物不良反应（ADRs）等相关信息,依据药品说明书及相关共识,评价用药合理性。结果 22个临床科室共1 170例患者使用了蛇毒血凝酶,使用量前3位的科室为神经外科、肝胆外科及耳鼻喉科;622例患者（占53.16%）为预防性用药,548例（占46.84%）为治疗性用药;给药途径以iv为主;共有578例次不合理用药,存在的主要问题为未监测FIB、疗程过长以及给药途径不合理等;总ADRs发生率为1.54%,发生FIB降低的ADRs共有18例,无过敏反应的ADRs。结论 天津市第一中心医院临床使用蛇毒血凝酶的比例高,但仍存在较多不合理用药情况,临床应严格按照药品说明书或共识使用并监测凝血指标,避免疗程过长,以减少ADR,并增加用药安全性。     

2008～2012年我院严重药品不良反应报告分析

目的：分析我院严重药品不良反应（ADR）的药品、发生机制、高危因素、防治措施,为临床安全用药提供参考。方法：收集2008年1月-2012年12月我院上报北京市药品不良反应监测中心的药品不良反应,根据《常见严重药品不良反应技术规范及评价标准》确定严重药品不良反应,并对怀疑药品、ADR类型、发生时间、住院费用及转归进行回顾性分析。结果：2008年1月-2012年12月上报的药品不良反应共545例,其中42例为严重不良反应,包括过敏性休克、再生障碍性贫血、粒细胞缺乏症、血小板减少症、全血细胞减少症、急性肝衰竭、急性胰腺炎、急性肾衰竭、中毒性表皮坏死松解症等。引起严重ADR前3位的药品分别是对比剂、抗菌药物和抗肿瘤药物。涉及男22例,女20例,平均年龄46岁,住院时间平均41 d,住院费用平均273 015.39元,住院药物费用平均80 135.69元。5例既往有食物或药物过敏史,3例死亡,39例患者停药或对症治疗后均好转出院。结论：医院应不定期开展医疗安全案例警示培训,重点关注药品不良反应,尤其是新的和严重的不良反应。     

183例头孢菌素类不良反应报告分析

目的:探讨某院头孢菌素类抗菌药物致不良反应(ADR)的情况及发生规律,为临床合理用药提供参考。方法:采用回顾性方法收集某院2008—2013年上报的183例头孢菌素类抗菌药物ADR报告,按患者性别、年龄、给药途径、ADR涉及的药品品种、累及器官或系统及临床表现、ADR转归等方面进行统计、分析。结果:183例头孢菌素类ADR共涉及13种头孢菌素类药品,在10岁以内的儿童中发生的ADR最多(52例,28.41%);静脉滴注(179例,97.81%)是引发ADR主要的给药途径;过敏反应最常见(92例,50.27%);头孢曲松引发的ADR最多(90例,49.18%);新的和严重的ADR共11例(6.01%)。结论:临床应加强头孢菌素类抗菌药物的合理应用,高度重视头孢菌素类药物引发的ADR,以避免和减少ADR的发生,确保用药安全。     

25例急性泛发性发疹性脓疱病的临床分析

目的：探讨急性泛发性发疹性脓疱病（acute generalized exanthematous pustulosis,AGEP）的病因、临床特征及处理对策,为临床医师安全用药和药师药学服务提供参考。方法：采用Euro SCAR （the european study of severe cutaneous adverse reactions） 评分表和药物不良反应因果评价法对2011年7月-2018年7月某三级皮肤病医院收治的25例AGEP病例进行分析。结果：25例患者均由药物引起,可疑致敏药物以抗菌药物为主（16例,64%）,其次为非甾体类抗炎药（3例,12%）,中药及中成药（2例,8%）,苯二氮类镇静催眠药地西泮（1例,4%）,抗疟药羟氯喹（1例,4%）,多巴胺第2受体拮抗剂甲氧氯普胺（1例,4%）及选择性5-羟色胺₄受体激动药莫沙必利（1例,4%）。25例患者经治疗均好转出院。结论：药物,尤其是抗菌药物是诱发AGEP的主要原因,临床使用中应加强药学监护,发现异常应及时停药并给予对症处理,控制并发症的发生。     

β-内酰胺类抗生素不良反应133例报表分析

目的:分析β-内酰胺类抗生素不良反应的特点,促进合理用药。方法:对重庆市ADR监测中心收到的β-内酰胺类抗菌药物ADR病例报告进行分析。结果:133例β-内酰胺类抗生素ADR病例报告中涉及26种β-内酰胺类抗菌药物,主要为头孢曲松钠(37例),青霉素(20例)和头孢噻肟钠(12例)。A型不良反应18例,B型不良反应115例,不良反应以过敏反应居多(98例)。反应程度绝大多数为轻、中度反应,重度反应15例,其中死亡1例。结论:应合理使用β-内酰胺类抗生素,避免和减少不良反应的发生。     

Clopidogrel: A possible exacerbating factor for psoriasis

A 64-year-old man developed palmoplantar pustulosis eventuating into palmoplantar pustular psoriasis following treatment with diltiazem, atenolol, aspirin and atorvastatin for suspected coronary artery disease (CAD). Treatment for psoriasis, stopping atenolol and substituting aspirin with clopidogrel did not benefit. Subsequently, he stopped all his drugs and did not develop psoriasis or symptoms/signs of CAD. Re-challenge with oral clopidogrel precipitated his skin lesions. This case has implications for patients having psoriasis and cardiovascular comorbidity where clopidogrel/ticlopidine or aspirin may not be a useful alternative.KEY WORDS: Adverse drug reactions, antiplatelet therapy, clopidogrel, psoriasis triggers, pustular psoriasis     

1230例抗生素不良反应分析

目的 :探讨抗生素不良反应的规律及特点 ,指导合理用药。方法 :用文献计量学方法对近10年国内公开报道的1230例抗生素所致的不良反应进行分析。结果 :1230例抗生素不良反应占同期药物不良反应的46 19 % (1230/2663) ,品种以β-内酰胺类居首 (18种 ) ,例次数氨苄青霉素最多 (192例 ) ,其表现累计例次最多的是皮肤及其附件损害 (691例 ) ,最严重的是过敏性休克 (109例 ) ,其中 β-内酰胺类占76 15 % (83/109) ,氨基糖苷类的肾损害占本文全部肾损害的51 79 % (29/56) ,不容忽视。结论 :审慎用药 ,抗生素不良反应是可以大大减少的     

Drug eruptions: approaching the diagnosis of drug-induced skin diseases

Adverse drug reactions are a major problem in drug therapy, and cutaneous drug reactions account for a large proportion of all adverse drug reactions. Cutaneous drug reactions are also a challenging diagnostic problem since they can mimic a large variety of skin diseases, including viral exanthema, collagen vascular disease, neoplasia, bacterial infection, psoriasis, and autoimmune blistering disease, among others. Furthermore, determining that a particular medication caused an eruption is often difficult when the patient is taking multiple drugs. In this review, we will describe and illustrate a thoughtful, comprehensive, and clinical approach to the diagnosis and management of adverse cutaneous drug reactions. A morphologic approach to drug eruption includes those that are classified as maculopapular, urticarial, blistering or pustular with or without systemic manifestations. Exanthematous drug eruptions, drug hypersensitivity syndrome, urticaria and angioedema, serum sickness-like reactions, fixed drug eruptions, drug-induced autoimmune blistering diseases, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug-induced acne, acute generalized exanthematous pustulosis, lichenoid drug eruptions and photosensitivity eruptions will be discussed.     

某院45例新型冠状病毒肺炎患者药品不良反应分析

目的分析我院新型冠状病毒肺炎(COVID-19)患者治疗期间发生的药品不良反应(ADR)。方法临床药师通过问卷星调查、康网系统、查阅病程等方式收集ADR,对其性别、年龄、既往病史、过敏史、报告类型、怀疑药品、用法用量、不良反应临床表现等进行回顾性分析。结果收集ADR共45例,ADR发生率为12.4%,其中一般的44例(已知的39例、新的5例)、严重的1例。ADR发生较多的为抗病毒药物洛匹那韦/利托那韦片(LPV/r)、糖皮质激素甲泼尼龙(MP)、抗菌药物莫西沙星。结论临床使用多种药物治疗COVID-19时应严格掌握用药指征以及患者基本情况、药物相互作用、注意事项等。关注疗效同时对ADR也应积极宣教、及时发现与上报,进一步保障患者安全用药。     

169例药物不良反应报告分析

目的：了解我院药物不良反应（ADR）发生特点，促进临床合理用药。方法：对我院2005年上半年收集到的169例ADR报告分别从临床具体表现、严重程度、患者年龄、药物剂型、给药途径以及涉及药物种类等方面进行统计分析。结果：涉及97个药品品种的169例ADR中，抗微生物药物引起的ADRl04例，占总数的56．22％；严重ADR8例，死亡2例。ADR引起的皮肤及附件损伤较多，共80例，占总数的43．24％。结论：医院应重视ADR监测工作，为临床合理用药提供依据。     

Generalized pustular eruptions due to terbinafine

Terbinafine, a widely used antifungal agent, may rarely cause cutaneous side effects with an incidence of 2.7%. Generalized pustular eruptions are quite uncommon but severe adverse cutaneous reactions of terbinafine have been reported. The main pustular eruptions due to terbinafine include acute generalized exanthematous pustulosis and drug induced pustular psoriasis. In this report, two cases of acute generalized exanthematous pustulosis and one case of generalized pustular psoriasis triggered with terbinafine are presented.     

Allergic drug reactions: identification and management

Any attempt to distinguish allergic drug reactions from other adverse drug reactions (ADRs) can be complicated by the fact that terminology in this area has not been standardized. True allergic reactions are those resulting from immunologic causes, and their prevalence is only 6 to 10% of all ADRs. A number of factors predispose individuals to drug allergies--the recognition of which might aid the healthcare professional in diagnosing these reactions--and other criteria can be helpful in the process. In order to successfully separate pseudoallergic from allergic from other adverse drug reactions, the clinician must proceed with caution and suspicion. When foreseeable allergic reactions cannot be prevented, measures can be taken that might reduce their impact.     

莫西沙星不良反应文献分析

目的：探讨莫西沙星所致不良反应的类型及其特点,为临床安全用药提供参考。方法：在中国科技期刊数据库（维普资讯）和中国期刊全文数据库（中国知网）中,以＂莫西沙星＂和＂不良反应＂为关键词,搜索2005年～2011年11月莫西沙星所致不良反应文献,并进行统计分析。结果：收集到62例莫西沙星导致的不良反应,主要类型有神经系统反应（28.4%）、过敏反应（21.6%）、心血管系统反应（14.9%）、消化系统反应（10.8%）、呼吸系统反应（6.8%）等。70岁以上的患者占46.8%（29/62）,高于其他年龄段。静脉滴注给药者占59.7%（37/62）。结论：临床应高度重视莫西沙星的不良反应,加强用药监护。     

Generalized pustular eruptions due to terbinafine

Terbinafine, a widely used antifungal agent, may rarely cause cutaneous side effects with an incidence of 2.7%. Generalized pustular eruptions are quite uncommon but severe adverse cutaneous reactions of terbinafine have been reported. The main pustular eruptions due to terbinafine include acute generalized exanthematous pustulosis and drug induced pustular psoriasis. In this report, two cases of acute generalized exanthematous pustulosis and one case of generalized pustular psoriasis triggered with terbinafine are presented.