Principles of Clinical Diagnosis
Susan Bayliss Mallory, Alanna Bree, Peggy Chern in Illustrated Manual of Pediatric Dermatology, 2005
See Table 13.4 Multisystemic idiosyncratic drug reactionFever, rash, lymphadenopathy, hepatitis, eosinophilia, leukocytosisFemale/male ratio = 1Begins 7–60 days (mean 17 days) after starting suspected drugRash (Figures 13.6 and 13.7)Begins as morbilliform on face, upper trunkCan progress to erythroderma or chronic exfoliative dermatitisCan have vesicles, bullae, petechiae, purpura, edema
Myelodysplastic Syndromes
Wojciech Gorczyca in Atlas of Differential Diagnosis in Neoplastic Hematopathology, 2014
The acute neutropenia is most often related to infections (viral) or drugs. The causes of chronic neutropenia include T-LGL leukemia, vitamin B12/folate deficiency, hypersplenism, chronic infections (e.g., typhoid fever), certain medications (idiosyncratic drug reaction), damage of the BM by toxins or drugs, splenomegaly, collagen vascular diseases (including SLE and Felty syndrome), immune-mediated reactions (autoimmune in SLE, alloimmune after allogeneic stem cell transplantation, or rarely drug-related), radiation therapy, cyclic neutropenia, acquired idiopathic neutropenia, immunodeficiency, and some metabolic disorders.
Unilateral Idiopathic Choroidal Effusion in a Patient Who Takes Sulfonamides
Published in Ocular Immunology and Inflammation, 2021
All in all, malignances presenting with choroidal effusion are rare. However, in the case of choroidal effusion, neoplasm has to be one of the top listed differentials, especially if it is unilateral and patient has not had any previous eye surgery. Nowadays, we have options for multimodal imaging which may be quite helpful in making suspicion on malignant process, although clinical picture or history are not in favor of that. As soon as a definite diagnosis is made, treatment may be started. Eventually, our case did not show the presence of malignant process and we were able to diagnose it as idiopathic unilateral choroidal effusion which should be diagnosed only if all other options are excluded. At the same time, the suprachoroid drainage was a diagnostic and treatment procedure. The only other thing to consider is whether the choroidal effusion was conceivably caused by an idiosyncratic drug reaction. We do know that Topiramate can cause a secondary angle closure glaucoma, presumably as a result of choroidal effusions arising as a result of disruption of the blood-retinal barrier.4 A similar drug-related mechanism is conceivable in our patient, but the finding against this is the unilateral nature of the disease.
Dapsone for the treatment of acne vulgaris: do the risks outweigh the benefits?
Published in Cutaneous and Ocular Toxicology, 2022
Selami Aykut Temiz, Munise Daye
Drug hypersensitivity syndrome is a serious idiosyncratic drug reaction determined by the clinical triad of fever, rash, and visceral involvement (most commonly the liver and the hematological system). Dapsone ranks high among drugs that reason drug hypersensitivity syndrome. Dapsone hypersensitivity syndrome (DHS) is the most serious and potentially fatal complication of dapsone. The fatal course is observed in approximately 10% of DHS cases. The severity of hepatocellular damage and previous drug sensitivity can be considered as poor prognostic signs for the outcome of the condition. For the treatment of dapsone hypersensitivity syndrome, early diagnosis, immediate discontinuation of dapsone and minimal use of other drugs should be emphasized. It usually appears on average 4 weeks (1–6 weeks) after the initiation of therapy1,42.
Uveitis and Papillitis in the Setting of Dabrafenib and Trametinib Therapy for Metastatic Melanoma: A Case Report
Published in Ocular Immunology and Inflammation, 2018
Jennifer Lim, Anna J. Lomax, Catriona McNeil, Brian Harrisberg
Visual acuity was 6/24 bilaterally with mutton-fat keratic precipitates and some cells, suggesting bilateral granulomatous uveitis with no vitreous cellular infiltrate suggestive of vitritis. Iris structure was normal. Fundoscopy showed bilateral hyperemic discs with swelling consistent with papillitis (Figure 1, right eye) and optical coherence tomography (OCT) showed a small amount of subretinal fluid in both maculae (Figures 2 and 3). He was commenced on prednisolone 1% topical drops hourly and his oral prednisone was reduced to 10 mg in case this was contributing to subretinal fluid. However, within 2 days his vision deteriorated substantially to 6/30 on the right and count fingers on the left. A fluorescein angiogram (Figure 4) showed ongoing profound bilateral disc swelling with no leakage suggestive of central serous retinopathy and no evidence of retinal vasculitis. Serum ACE levels and screening autoantibodies were all negative. His dabrafenib was ceased and we commenced pulsed methylprednisolone 1 g daily for 3 days for VKH-like syndrome (panuveitis with subretinal fluid and papillitis) secondary to a presumed idiosyncratic drug reaction. He responded to methylprednisolone with improvement of his visual acuity to 6/15 and 6/21 within 3 days.
Related Knowledge Centers
- Adverse Drug Reaction
- Drug Intolerance
- Idiopathic Disease
- Immune Response
- Idiosyncrasy