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A survey of Hematological and Biological abnormalities in dress Syndrome
Poster Presentations The anti-inflammatory effect of pelargonium graveolens methanolic extract in acetic acid-induced ulcerative colitis in Rat model B. Ghanizadeh1; H. Shafaroodi1; J. Asgarpanah2; and Z.N. Sharifi3 Department of Pharmacology & Toxicology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran - Iran (IAUPS); 2Department of Pharmacognosy, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran - Iran (IAUPS); and 3 Department of Anatomy, Tehran Medical Branch, Islamic Azad University, Tehran, Iran Background: IBD refers to two different, inflammatory conditions, Crohn’s disease and ulcerative colitis. There are limited drug classes for Treatments of IBD. As regards, more effective and less harmful compound for treatment appears to be essential, we investigate the efficacy of Pelargonium graveolens on colitis, which has antiinflammatory ingredients. Methods: After P. graveolens was extracted, rats were divided into groups Such as: the normal group (N.G) and the negative control group (NCG.), that received only normal saline; EXT100, EXT200 and EXT400 groups, which received 100, 200 and400 mg/kg/day of extract (p.o); the vehicle group (VG), which received vehicle orally; the Positive control group (SULF.G), which received Sulfasalazine (500 mg/kg/day, orally). Rats were given compounds for 72, 48, 24 and 2 hours before colitis induction as well as 24h thereafter. For induce colitis, 1ml of acetic acid 4.5% were instilled intra-colonially to each group. NS (1 mL) was administered to normal group. Twentyfour hours after the last gavage, colons were removed for assessed its macroscopic and microscopic changes and myeloperoxidase activities. Results: Forty-eight hours after colitis was induced, the macroscopic scores and DAI show inflammation in NCG and VG and the results of two groups weren’t significant difference together but other groups were significantly different with these two groups. Whereas, among other groups, there was no significant difference (P < 0.05). Microscopic examination shows Degradation rate in the CG compared to NCG, VG and EXT400 was significant (P < 0.05). This difference between the other groups wasn’t significantly from each other. MPO activity assessments show there are no significant differences between the extract groups with NG and SULFG, but there are significantly with VG and NGV (P < 0.05). Conclusions: The anti-inflammatory effect of P. graveolens is significant on colitis specially the dose of 100 mg/kg is recommended due to provide better effects than the others, so the results are encouraging and warrant clinical trials for further confirmation. 1
A survey of Hematological and Biological abnormalities in dress Syndrome N. Fathallah1; R. Slim1; S. Larif1; H. Ben romdhane1; A. Aounallah2; N. Ghariani2; and C. Ben Salem1 1 Faculty of Medicine of Sousse, Tunisia; and 2Farhat Hached University Hospital of Sousse, Tunisia Background: DRESS syndrome is a rare hypersensitivity syndrome associated with high variability on its hematological and biological test findings. The aim of this study was to detail, from a patient serial, the hematological abnormalities as well as the biological disturbances that may occur with DRESS. Materials and Methods: All cases of DRESS reported to our pharmacovigilance center from January 2009 to December 2014 were retained. Hemograms, liver level tests, LDH and CPK were detailed.
August 2015
Results: Twenty-four cases concerned 7 women and 17 men. Median of age was 46.75 years old. The most involved drugs were: anticonvulsivants in 30% of cases, salazopyrine in 20% and allopurinol in 16%. Seventy-five percent had eosinophilia exceeding 0.5 g/L and 33% had eosinophilia exceeding 1 g/L. Leukocytosis was present in 54% of cases. Lymphocytopenia in 16% and lymphocytosis in 33% of patients. Neutropenia was found in 12 % of cases. Fifty percent had cytolysis and 50% of them were exceeding 4 folds normal range whereas cholestasis was present in only 12% of cases. LDH and CPK values > 2 folds upper normal range limit was present in 29% of cases. Almost 50% of them had values upper of 10 folds normal range. Conclusions: Eosinophilia was the most frequently occurring hematological abnormality in our survey. Other hematological abnormalities observed were leukocytosis and neutropenia. Hepatic involvement in the form of hepatocellular injury was the most common visceral abnormality and it was present in 4 cases with sulfasalazine and in 3 cases with allopurinol. Liver injury may be a pro-drome of DRESS and patients with hepatocellular injury are relatively young in our survey (mean age of 36.3). Elevated LDH and CPK was observed most often with sulfasalazine. There is an evidence of great frequency of haematological abnormalities that occur during DRESS.
Fenofibrate-induced photosensitivity associated with lingual and oral Mucosa Hyperpigmentation N. Fathallah1; S. Larif1; R. Slim1; L. Boussffara2; N. Ghariani2; R. Nouira2; and C. Ben Salem1 1 Faculty of Medicine of Sousse, Tunisia; and 2Farhat Hached University Hospital of Sousse, Tunisia Introduction: Fenofibrate is a lipid regulating agent approved in the treatment of hyperlipidemia. Cutaneous adverse reactions attributed to the drug are rare including acute hypersensitivity reactions, pruritus and skin ulcer. Although photosensitivity induced by fenofibrate was reported in rare cases in the literature, there are no reports of fenofibrate-induced photosensitivity associated with lingual and oral mucosa pigmentation. Herein, we report the first case, to the best of our knowledge, of a patient who developed gingival, labial, lingual pigmentation associated with photosensitivity after fenofibrate therapy. Case report: A 43-year-old woman presented with skin eruption affecting the sun-exposed areas. Her medical history was unremarkable except for hyperlipidemia treated with fenofibrate (200 mg daily) started three months earlier. Physical examination revealed numerous variously sized hyperpigmentated plaques over the sun exposed areas. Inspection of the oral mucosa revealed hyperpigmentated macules. Laboratory investigation was in normal ranges except for triglycerides. Serum levels of adrenocorticotropic hormone and cortisol were also in normal ranges. Histologic examination revealed a non-specific lymphoplasmacytic infiltrate. Discussion: Diagnosis of drug-induced photosensitivity is often challenging. It is based primarily on the history of drug intake and the clinical appearance of the eruption, primarily affecting sun-exposed areas of the skin. Among the class of fenofibric acid, this photosensitizing capacity of fenofibrate is mainly determined by the photo excited chemical structure, the benzophenone moiety. Our revue of literature did not reveal any case of fibric acid-induced mucosal pigmentation and our patient is the first case of fenofibrate-induced oral pigmentation. The suggested mechanism of fenofibrate-induced oral pigmentation in our patient can be related to a direct effect of the drug in melanin secretion.
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A survey of Hematological and Biological abnormalities in dress Syndrome N. Fathallah1; R. Slim1; S. Larif1; H. Ben romdhane1; A. Aounallah2; N. Ghariani2; and C. Ben Salem1 1 Faculty of Medicine of Sousse, Tunisia; and 2Farhat Hached University Hospital of Sousse, Tunisia Background: DRESS syndrome is a rare hypersensitivity syndrome associated with high variability on its hematological and biological test findings. The aim of this study was to detail, from a patient serial, the hematological abnormalities as well as the biological disturbances that may occur with DRESS. Materials and Methods: All cases of DRESS reported to our pharmacovigilance center from January 2009 to December 2014 were retained. Hemograms, liver level tests, LDH and CPK were detailed.
August 2015
Results: Twenty-four cases concerned 7 women and 17 men. Median of age was 46.75 years old. The most involved drugs were: anticonvulsivants in 30% of cases, salazopyrine in 20% and allopurinol in 16%. Seventy-five percent had eosinophilia exceeding 0.5 g/L and 33% had eosinophilia exceeding 1 g/L. Leukocytosis was present in 54% of cases. Lymphocytopenia in 16% and lymphocytosis in 33% of patients. Neutropenia was found in 12 % of cases. Fifty percent had cytolysis and 50% of them were exceeding 4 folds normal range whereas cholestasis was present in only 12% of cases. LDH and CPK values > 2 folds upper normal range limit was present in 29% of cases. Almost 50% of them had values upper of 10 folds normal range. Conclusions: Eosinophilia was the most frequently occurring hematological abnormality in our survey. Other hematological abnormalities observed were leukocytosis and neutropenia. Hepatic involvement in the form of hepatocellular injury was the most common visceral abnormality and it was present in 4 cases with sulfasalazine and in 3 cases with allopurinol. Liver injury may be a pro-drome of DRESS and patients with hepatocellular injury are relatively young in our survey (mean age of 36.3). Elevated LDH and CPK was observed most often with sulfasalazine. There is an evidence of great frequency of haematological abnormalities that occur during DRESS.
Fenofibrate-induced photosensitivity associated with lingual and oral Mucosa Hyperpigmentation N. Fathallah1; S. Larif1; R. Slim1; L. Boussffara2; N. Ghariani2; R. Nouira2; and C. Ben Salem1 1 Faculty of Medicine of Sousse, Tunisia; and 2Farhat Hached University Hospital of Sousse, Tunisia Introduction: Fenofibrate is a lipid regulating agent approved in the treatment of hyperlipidemia. Cutaneous adverse reactions attributed to the drug are rare including acute hypersensitivity reactions, pruritus and skin ulcer. Although photosensitivity induced by fenofibrate was reported in rare cases in the literature, there are no reports of fenofibrate-induced photosensitivity associated with lingual and oral mucosa pigmentation. Herein, we report the first case, to the best of our knowledge, of a patient who developed gingival, labial, lingual pigmentation associated with photosensitivity after fenofibrate therapy. Case report: A 43-year-old woman presented with skin eruption affecting the sun-exposed areas. Her medical history was unremarkable except for hyperlipidemia treated with fenofibrate (200 mg daily) started three months earlier. Physical examination revealed numerous variously sized hyperpigmentated plaques over the sun exposed areas. Inspection of the oral mucosa revealed hyperpigmentated macules. Laboratory investigation was in normal ranges except for triglycerides. Serum levels of adrenocorticotropic hormone and cortisol were also in normal ranges. Histologic examination revealed a non-specific lymphoplasmacytic infiltrate. Discussion: Diagnosis of drug-induced photosensitivity is often challenging. It is based primarily on the history of drug intake and the clinical appearance of the eruption, primarily affecting sun-exposed areas of the skin. Among the class of fenofibric acid, this photosensitizing capacity of fenofibrate is mainly determined by the photo excited chemical structure, the benzophenone moiety. Our revue of literature did not reveal any case of fibric acid-induced mucosal pigmentation and our patient is the first case of fenofibrate-induced oral pigmentation. The suggested mechanism of fenofibrate-induced oral pigmentation in our patient can be related to a direct effect of the drug in melanin secretion.
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