Hypersensibilté drug
This rare toxiderma combines a skin
reaction, eosinophilia, lymphocytosis (up to 20,000 items per mm3) and one or
more visceral.
Facial swelling and lymphadenopathy
poly often accompany the rash and sometimes a significant fever.
This drug eruption began later than
usual drug allergies, has a longer duration of illness and is often associated
with viral reactivation.
The drugs most often involved are
anti-epileptics, sulfonamides, allopurinol, nonsteroidal anti-inflammatory
drugs, anti retrovirals.
This immune response is linked to
the activation of T lymphocytes directed against the drug.
It is common to found an HLA B.
The rash is a maculopapular rash
that can sometimes be associated with purpura, with vesicles or pustules,
especially on the face.
Visceral injuries are variables can
affect the kidney, liver, lung and heart.
- When the liver is affected it is
sometimes associated with anicteric cholestasis (without jaundice).
- When the kidney is reached there
is a tubulointerstitial nephropathy.
Creatinine is then raised with
microscopic hematuria and pyuria (white blood cells in the urine).
- When the lung is reached it is
pneumonia with radiological manifestations.
- The rare cardiac involvement,
manifested by myocarditis or pericarditis.
- Exceptional meningoencephalitis
has been described most often caused by a virus (HHV-6)
EVOLUTION
Usually favorable after immediate
discontinuation of drug.
An unfavorable prognosis is possible
in case of severe liver injury.
The evolution can be long and
relapses are possible even without taking the new drug.
TREATMENT
It is to stop the medication.
Sometimes corticosteroids is
essential in case of severe visceral involvement at a dose of 1 mmg / kg for
about a month.
The lifetime exclusion of offending
drug and its derivatives possible is essential.
A new access can be very harmful.
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