Acute generalized exanthematous pustulosis induced by ingestion of bamifylline.
ABSTRACT We report a case of acute generalized exanthematous pustulosis (AGEP) in a 64-year-old woman, associated with the use of bamifylline. To the best of our knowledge there have been no previous reports of AGEP induced by the ingestion of bamifylline in the medical literature. We, therefore, add this drug to the list of causes for AGEP.
Full-textDOI: · Available from: Paulo Ricardo Criado, May 30, 2015
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ABSTRACT: Drug-induced exanthems are the most common manifestations of drug hypersensitivity and are observed in as much as 2-3% of hospitalized patients. Here we summarize new concepts of the immune mechanisms underlying various forms of drug-induced exanthems. Alpha-betaTCR+, CD4 and CD8+ T cells are involved in different drug hypersensitivity reactions. Their function determines the clinical picture. In maculopapular, bullous and pustular exanthems cytotoxic T cells are involved, while a high IL-5 and eotaxin production by tissue cells is frequently found in maculopapular and occasionally in bullous and in pustular exanthems. High IL-8 (CXCL-8) and granulocyte-macrophage colony stimulating factor production by T cells is a hallmark of pustular drug exanthems. In the most severe and potentially life-threatening forms of exanthems (Stevens-Johnson syndrome/toxic epidermal necrolysis) cytotoxic CD8+ T cells with natural killer cell markers can be found in the blister fluid. These findings are the basis for a new subclassification of delayed, type IV hypersensitivity reactions into type IVa (T helper type 1 cells, e.g. tuberculin reaction and contact dermatitis), IVb (T helper type 2 cells, maculopapular exanthem with eosinophilia), IVc (cytotoxic T cells, contact dermatitis, maculopapular and bullous exanthem), and IVd reactions (CXCL-8/granulocyte-macrophage colony stimulating factor-producing T cells and neutrophil attraction, pustular exanthems), by which, in most reactions, various mechanisms occur together but one reaction dominates the clinical picture.Current Opinion in Allergy and Clinical Immunology 11/2004; 4(5):411-9. DOI:10.1097/00130832-200410000-00013 · 3.66 Impact Factor