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Skin necrosis from extravasation of vinorelbine
Posters -Adverse
IP28
Naproxen bullosis
sodium
induced
lichen
planus
A.$. bzkan’, F. izler’. E. Fetil’, N. Dorak*. A.T. Chines’. ‘Dokuz Eyliil Derttratolog)!
University Faculty izmir; 2Karg?vuka
of Medicine, Department of State Hospital, izmir; Turkey
Lichen ruber planus is a chronic, inflammatory mucocutaneous disorder of unknown etiology. It may represent as several distinctive eruptions such as erythematous, annular, follicular, erosive, atrophic, hypertrophic or vesiculobullous. Certain drugs have been reported to induce lichen ruber planus. We report here a 46 year-old-woman with breast carcinoma diagnosed as bullous lichen planus possibly induced by naproxen sodium administration. The patient presented with a two-month history of pruritic, violaceous maculopapular eruptions on her knees and elbows. Two weeks after the first examination tense blisters developed at the site of preexisting lesions. She had diagnosed as breast carcinoma in 1989 and had undergone total mastectomy, chemotherapy and radiotherapy. She has used naproxen sodium for osteoarthritis since one month before beginning of eruptions. In detailed investigations, there were no metastases or recurrence of carcinoma.
IP29
Skin necrosis vinorelbine
from extravasation
Uttiversitario
de la Pritrcesa,
Madrid,
Dertnatology; 2Departtnent of Ophthaltttology, Hospital
Spain
Skin necrosis from intravenous infiltration of soft tissue is a rare but potentially devastating complication of intravenous therapy. Intravenously induced skin injury can be produced by several different chemicals such as nutrients, electrolytes, chemotherapeutic agents and vasoconstrictors. A man aged 66 diagnosed of non small cell lung cancer was treated with cycles of cisplatin and vinorelbine. Accidentally intravenous extravasation of vinorelbine produced a central ulcerated area with surrounding swelling and erythema. A biopsy showed the separation of the dermis from a necrotic epidermis, associated with cytologic atypia and focal necrosis of eccrine glands. The patient was treated with local and systemic corticosteriods and analgesics, with a slow but favorable course. Vinorelbine is a semisynthetic analog of vinblastine. Like the other vinca alkaloids is a cell cycle specific agent that blocks cells in mitosis. Vinorelbine has activity against non small cell lung and breast cancer. Extravasation of vinorelbine produces lesions characterized by central ulcerated areas surrounded of erythema. These lesions are less severe than those with the same dose of any other vinca alkaloids. However, since the clinical dose of vinorelbine is higher than the other vincas, the likelihood of extravasating a toxic volume is probably similar. P30 El
Vasculitis and hepatitis of 2 cases
B vaccination:
Report
P Gmzard, E Berard, F. Wolf, B. Balme, H. Perrot. Hopital I’Atuiquaille,
Lyon,
de
France
We report 2 cases of cutaneous vasculitis occurring hepatitis B vaccination.
A case of toxic epidermal necrolysis with intravenous immunoglobulin
treated
S. Magina’, C. Lisboa’, E. Goncalves’, F. Concei@o?. V. LeaP, J. Mesquita-Guimarses’. ‘Department of
Mg.J. Moreno de Vega, B. Bartolome, J. Fraga’, E. Dauden, A. Garcia-Diez. Departtnetus of Dermatology; ‘Pathology, Hospital
Case 1: Sandra P., 7-year-old, received the first injection of Cienhevac B Pasteur@ on October 1995. She was examined 15 days after as she presented cutaneous infiltrated papule on both limbs in some area mimicking erythema multiforme. There was no pathogical medical history and no more clinical abnormality. Histopathologic findings showed an allergic vasculitis. Direct immunofluorescence of the skin wasn’t improved. Spontaneous remission was observed in February 1996. Case 2: Celine M., 16-year-old. received 2 injections at monthly intervals of hepatitis B vaccination (Genhevac B Pasteur’) during 1995 summer. She was examined 15 days after the last injection as she presented purpuric vascuiitis on both limbs confirmed by skin biopsy (leucocytoclastic vasculitis). Direct immunofluorescence was negative. Spontaneous revolving occurred rapidly. Discussion: In both cases, etiologic investigations were negative. A few cases of cutaneous vasculitis occurring after hepatitis B vaccination are reported in the literature, sometimes associated with auto-immune disorders. We herein conclude that hepatitis B vaccination could be an etiologic factor of cutaneous vasculitis.
IP31
of
s193
drug reactions
during
of Internal Medicine; ‘Department de S. Jocio, Porto, Portugal
A 16-year-old woman was treated with co-trimoxazole (960 mg b.i.d.) for a sinusitis. After two weeks she developed erythematous papules on the face and trunk. Two days later she presented with conjunctivitis, cheilitis, high grade fever, cutaneous pain, erythema of palms and soles and blisters on the trunk with Nikolsky’ sign. The patient was hospitalised and the drug intake was stopped. Hepatic dysfunction and leukopenia were present on admission. The maximal skin involvement was reached on hospital day 7, with 90% of mucocutaneous detachment and 95% of skin erythema. Several complications arose in the course of disease, namely rhabdomyolysis, anaemia and pneumonia, that led to systemic antibiotic therapy. On day 10 she started i.v. immunoglobulin (Sandoglobulina@). 0.4 g/Kg/day for 5 days, without any significant side effect. Re-epithelialization started 1 day later and, apart from post-inflammatory pigmentary changes, the skin had healed completely on day 18. She was discharged on day 30.
IP32
Cushing steroids
syndrome
induced
by topical
J.R. Santamaria, EA. Mulinari-Brenner, A.S. Dal Pizzol, L.C. Manfrinato. Hospital de Clinicas de Curitiba, Federal University
of Pat-an&,
Paratui,
Brazil
The objective of this study is to show the side effects of topical corticoterapy, and the necessity to avoid their abusive use. A retrospective study was performed in 4 patients with Cushing Syndrome induced by topical use of lobetasol and Betametasone. The patients’ age ranged from 1.s \to 37 years. Three patients were female and one male. The basic derma-
IP28
Naproxen bullosis
sodium
induced
lichen
planus
A.$. bzkan’, F. izler’. E. Fetil’, N. Dorak*. A.T. Chines’. ‘Dokuz Eyliil Derttratolog)!
University Faculty izmir; 2Karg?vuka
of Medicine, Department of State Hospital, izmir; Turkey
Lichen ruber planus is a chronic, inflammatory mucocutaneous disorder of unknown etiology. It may represent as several distinctive eruptions such as erythematous, annular, follicular, erosive, atrophic, hypertrophic or vesiculobullous. Certain drugs have been reported to induce lichen ruber planus. We report here a 46 year-old-woman with breast carcinoma diagnosed as bullous lichen planus possibly induced by naproxen sodium administration. The patient presented with a two-month history of pruritic, violaceous maculopapular eruptions on her knees and elbows. Two weeks after the first examination tense blisters developed at the site of preexisting lesions. She had diagnosed as breast carcinoma in 1989 and had undergone total mastectomy, chemotherapy and radiotherapy. She has used naproxen sodium for osteoarthritis since one month before beginning of eruptions. In detailed investigations, there were no metastases or recurrence of carcinoma.
IP29
Skin necrosis vinorelbine
from extravasation
Uttiversitario
de la Pritrcesa,
Madrid,
Dertnatology; 2Departtnent of Ophthaltttology, Hospital
Spain
Skin necrosis from intravenous infiltration of soft tissue is a rare but potentially devastating complication of intravenous therapy. Intravenously induced skin injury can be produced by several different chemicals such as nutrients, electrolytes, chemotherapeutic agents and vasoconstrictors. A man aged 66 diagnosed of non small cell lung cancer was treated with cycles of cisplatin and vinorelbine. Accidentally intravenous extravasation of vinorelbine produced a central ulcerated area with surrounding swelling and erythema. A biopsy showed the separation of the dermis from a necrotic epidermis, associated with cytologic atypia and focal necrosis of eccrine glands. The patient was treated with local and systemic corticosteriods and analgesics, with a slow but favorable course. Vinorelbine is a semisynthetic analog of vinblastine. Like the other vinca alkaloids is a cell cycle specific agent that blocks cells in mitosis. Vinorelbine has activity against non small cell lung and breast cancer. Extravasation of vinorelbine produces lesions characterized by central ulcerated areas surrounded of erythema. These lesions are less severe than those with the same dose of any other vinca alkaloids. However, since the clinical dose of vinorelbine is higher than the other vincas, the likelihood of extravasating a toxic volume is probably similar. P30 El
Vasculitis and hepatitis of 2 cases
B vaccination:
Report
P Gmzard, E Berard, F. Wolf, B. Balme, H. Perrot. Hopital I’Atuiquaille,
Lyon,
de
France
We report 2 cases of cutaneous vasculitis occurring hepatitis B vaccination.
A case of toxic epidermal necrolysis with intravenous immunoglobulin
treated
S. Magina’, C. Lisboa’, E. Goncalves’, F. Concei@o?. V. LeaP, J. Mesquita-Guimarses’. ‘Department of
Mg.J. Moreno de Vega, B. Bartolome, J. Fraga’, E. Dauden, A. Garcia-Diez. Departtnetus of Dermatology; ‘Pathology, Hospital
Case 1: Sandra P., 7-year-old, received the first injection of Cienhevac B Pasteur@ on October 1995. She was examined 15 days after as she presented cutaneous infiltrated papule on both limbs in some area mimicking erythema multiforme. There was no pathogical medical history and no more clinical abnormality. Histopathologic findings showed an allergic vasculitis. Direct immunofluorescence of the skin wasn’t improved. Spontaneous remission was observed in February 1996. Case 2: Celine M., 16-year-old. received 2 injections at monthly intervals of hepatitis B vaccination (Genhevac B Pasteur’) during 1995 summer. She was examined 15 days after the last injection as she presented purpuric vascuiitis on both limbs confirmed by skin biopsy (leucocytoclastic vasculitis). Direct immunofluorescence was negative. Spontaneous revolving occurred rapidly. Discussion: In both cases, etiologic investigations were negative. A few cases of cutaneous vasculitis occurring after hepatitis B vaccination are reported in the literature, sometimes associated with auto-immune disorders. We herein conclude that hepatitis B vaccination could be an etiologic factor of cutaneous vasculitis.
IP31
of
s193
drug reactions
during
of Internal Medicine; ‘Department de S. Jocio, Porto, Portugal
A 16-year-old woman was treated with co-trimoxazole (960 mg b.i.d.) for a sinusitis. After two weeks she developed erythematous papules on the face and trunk. Two days later she presented with conjunctivitis, cheilitis, high grade fever, cutaneous pain, erythema of palms and soles and blisters on the trunk with Nikolsky’ sign. The patient was hospitalised and the drug intake was stopped. Hepatic dysfunction and leukopenia were present on admission. The maximal skin involvement was reached on hospital day 7, with 90% of mucocutaneous detachment and 95% of skin erythema. Several complications arose in the course of disease, namely rhabdomyolysis, anaemia and pneumonia, that led to systemic antibiotic therapy. On day 10 she started i.v. immunoglobulin (Sandoglobulina@). 0.4 g/Kg/day for 5 days, without any significant side effect. Re-epithelialization started 1 day later and, apart from post-inflammatory pigmentary changes, the skin had healed completely on day 18. She was discharged on day 30.
IP32
Cushing steroids
syndrome
induced
by topical
J.R. Santamaria, EA. Mulinari-Brenner, A.S. Dal Pizzol, L.C. Manfrinato. Hospital de Clinicas de Curitiba, Federal University
of Pat-an&,
Paratui,
Brazil
The objective of this study is to show the side effects of topical corticoterapy, and the necessity to avoid their abusive use. A retrospective study was performed in 4 patients with Cushing Syndrome induced by topical use of lobetasol and Betametasone. The patients’ age ranged from 1.s \to 37 years. Three patients were female and one male. The basic derma-