Prospective, noncomparative open study from Kuwait of the role of intravenous immunoglobulin in the treatment of toxic epidermal necrolysis

BACKGROUND: High-dose intravenous immunoglobulin (IVIG) is emerging as a promising new therapy for treating the rare but potentially fatal drug reaction toxic epidermal necrolysis (TEN). Experimental in vitro studies support that IVIG can block the Fas-FasL-mediated apoptosis in TEN. METHODS: Twelve consecutive patients (7M, 5F) with TEN admitted over a 5-year period from January 1998 to December 2002 were treated with a dose of 0.5-1.0 g/kg/d of IVIG for 4-5 days along with standard care protocol. Clinical outcome in terms of average duration to arrest the progression, complete healing, hospital stay, side-effects and complications were determined to find the efficacy of IVIG treatment. RESULTS: Average age was 27.16 years (7-50 years). There were four children (2M, 2F) aged 7-12 years. One patient had an underlying malignancy. No patient had HIV infection. The average total body surface area involvement was 57.5% (30-90%). An IVIG infusion was started, on average, 1.58 days (1-3 days) after admission. All patients responded well to the treatment. There was no mortality. The disease progression was arrested in a mean of 2.83 days (1-5 days). Time taken for complete healing (re-epithelialization) was 7.33 days (5-13 days). The average duration of hospital stay was 12.5 days (7-21 days). No side-effects of the IVIG treatment were observed in these patients. The drugs triggering TEN in these patients were phenytoin (four patients), followed by penicillin (three), cotrimoxazole (two), phenobarbital and furosemide (one patient each), respectively. In one patient, the offending drug could not be ascertained. CONCLUSION: Our experience of treating 12 patients with TEN using IVIG, in Kuwait, confirms that it is a safe and effective treatment for these patients.     

Fixed Drug Eruption Due to Influenza Vaccine

Two females, one 28 years old and the other 32 years old, developed dusky red macules with pain and a burning sensation within 24 hours of receiving influenza vaccine. One patient had blisters within the lesion. A clinical diagnosis of fixed drug eruption (FDE) due to influenza vaccine was made. Histopathology was consistent with the diagnosis of FDE. The lesions subsided within 2 weeks of topical corticosteroid treatment. The diagnosis was confirmed by topical provocation test with influenza vaccine. A Medline search revealed these cases to be the second report of this kind of reaction due to influenza vaccine.

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Deux femmes âgées respectivement de 28 et de 32 ans ont développé des macules rouges, accompagnées de douleurs et de brûlures, dans un intervalle de 24 heures suivant une vaccination antigrippale. Une des patientes a présenté des vésicules à lintérieur des lésions. Un diagnostic clinique a révélé un érythème pigmenté fixe dû au vaccin antigrippal. Lhistopathologie a confirmé le diagnostic. Les lésions ont disparu après deux semaines de traitement aux corticostéroïdes topiques. Le diagnostic a été confirmé par un test de provocation au vaccin antigrippal par voie topique. Une recherche dans la base de données Medline a révélé quil sagit du second rapport de cas de réactions au vaccin antigrippal.

     

Tinea capitis among children and adolescents in the Farwaniya region of Kuwait

Analysis of 325 patients (182 males, 143 females) of mycologically proven tinea capitis (TC) seen over a period of two years from January 2001--December 2002 in the Farwaniya region of Kuwait is presented in this study. The age range was 8 months to 17 years. Peak incidence was observed in the 3-14 year age group (79.6%). Positive family history and contact with pets were noted in 22% and 36.7% of the cases, respectively. The non-inflammatory 'gray patch' variety was the most common clinical type, seen in 163 (50.2%) children, followed by the black-dot variant in 100 (30.2%) patients. A significant proportion of the cases (16.6%) had the uncommonly reported seborrheic dermatitis or dandruff like pattern. Highly inflammatory kerion was encountered infrequently (2.5%). Seven species of dermatophytes were isolated; Trichophyton violaceum in 135 (41.5%), followed by Microsporum canis in 89 (27.4%), Microsporum audouinii in 48 (14.8%), Trichophyton mentagrophytes var. mentagrophytes in 31 (9.5%), Trichophyton verrucosum in 15 (4.6%), Trichophyton tonsurans in 6 (1.9%) and Microsporum gypseum in 1 (0.3%) patient. T. violaceum was the most common fungus responsible for the black-dot variety (89/100) and kerion (4/8) patients. Three cases of kerion (33.3%) grew T. verrucosum. M. canis was the most common species isolated from the 'gray patch' cases (79/163; 48.5%) followed by almost equal prevalences of T. violaceum (16.6%), M. audouinii (15.3%), and T. mentagrophytes var. mentagrophytes (12.3%). Among the seborrheic type of cases, M. audouinii was the most common fungus isolated in 20/54 (37%) followed by T. violaceum in 15 (27.8%), T. mentagrophytes var. mentagrophytes in 9 (16.7%), M. canis in 8 (14.8%) and T. verrucosum and T. tonsurans in one (0.3%) patient each. The results are significantly different from those in earlier studies in Kuwait.     

Ultrasonic purification of Bridge anticoagulant neutralizing agent (BANA) and a study on its effect on factor VIII inhibitor

Ether precipitation of globulins from the supernatant fraction of prothrombin complex concentrate, followed by adsorption on tricalcium phosphate and elution gives a beta2 fraction termed Bridge anticoagulant neutralizing agent (BANA). Although this is completely free of all known blood clotting factors, it improves recalcification time, PTT and thromboplastin generation of hemophilic plasma. It also counteracts the effect of factor VIII inhibitor. Ultrasonic elution produced more activity per mg N than did citrate elution. The possibility is discussed of incorporating BANA preparation in the routine fractionation of plasms without reduction in the yield of factor VIII or prothrombin comples concentrate.     

Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait

BACKGROUND: Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait. METHODS: All patients seen over a 1-year period (July 2003 to June 2004), who presented with signs and symptoms suggestive of STDs, were included. Sociodemographic details and clinical findings were recorded. The diagnosis of each STD was based mainly on standard World Health Organization (WHO) criteria and available data. Serologic tests for syphilis and human immunodeficiency virus (HIV) were offered to all patients. RESULTS: One thousand and ninety-six patients (1068 male, 28 female) with STDs constituted 2.84% of all new dermatology patients seen; most (866) were in the 21-40-year age group. The STDs were acquired from commercial sex workers in 844 patients (77%). Heterosexual encounter (99.3%) was the most common mode of acquiring STDs. Urethral discharge was noted in 54.1% of patients, followed by genital ulcers (17.8%), papules/growths (16.4%), and urethral/pubic pain without associated discharge/ulcers (5.9%); these were the four most common presenting complaints. Evaluation revealed gonorrhea in 31.5% of patients, nongonococcal urethritis in 23.6%, chlamydia in 4.1%, nonspecific urethritis in 19.5%, concomitant gonorrhea and chlamydia urethritis in 2.7%, genital warts in 13.7%, chancroid in 13.0%, genital herpes in 4.8%, molluscum contagiosum in 2.7%, and lymphogranuloma venereum in 1.4%. CONCLUSIONS: Urethral discharge, gonorrhea, and nonspecific urethritis (presenting with urethral discharge), followed by genital warts, chancroid, and genital herpes (ulcers), were the most common STDs among male patients in the Farwaniya region of Kuwait. Although no case of HIV or syphilis was detected, health authorities and physicians need to remain vigilant.     

Nail changes in childhood psoriasis: a study from Kuwait

Psoriasis is a widespread skin disorder in which nail involvement can be seen in up to two-thirds of those affected. Childhood psoriasis is a distinct entity and the literature focused on nail changes associated with childhood psoriasis is scant. Our objectives were to evaluate the frequency of nail involvement in childhood psoriatic patients, assess the types of nail changes in childhood psoriasis, and compare our clinical findings with the few reports available in the literature. Two hundred and one consecutive new patients with childhood (age < or = 16 years) psoriasis of both sexes were selected for the study of nail changes. The diagnosis of psoriasis was made on clinical grounds. Each patient underwent a thorough dermatologic examination with special attention paid to the nail changes. If a clinical suspicion of fungal infection of the nails existed, further mycologic investigations were performed. We found the prevalence of nail changes to be 37.81% (boys > girls) in children who had psoriasis. Nail pitting was found to be the most common manifestation (61.84%) followed by onycholysis (30.26%), subungual hyperkeratosis (13.16%), and discoloration of the nail plate (7.90%). Nail involvement had no relationship to the type of psoriasis, patient's sex, or duration or extent of disease.