Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018133 (graft-versus-host disease)
 18,032 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Toxic epidermal necrolysis (TEN) is a severe life-threatening disorder which has many features in common with graft-versus-host disease. However, immunosuppression with steroids gives disappointing results and is possibly detrimental. We treated two patients who had TEN with a combination of cyclosporin and steroids which resulted in an apparent halt to the evolution of the disease, and a further relapse was aborted using cyclosporin in one of these patients. We feel that the use of this drug in the early treatment of TEN where it is used as a specific therapy aimed at the primary immunopathological events and is used in conjunction with the supportive care patients require, needs to be further evaluated.
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PMID:Toxic epidermal necrolysis treated with cyclosporin. 145 17

Acute ocular lesions are usual during Toxic Epidermal Necrolysis (T.E.N.) and may induce persistent alterations. These were thought to be of cicatricial nature. 26 patients recovering from TEN had a systematic ophthalmological follow-up of at least six months after the acute stage (mean: 3 years). 11 of 26 patients (42%) exhibited a dry eye, associated in 7 with decreased salivary flow. The sicca syndrome appeared during the acute phase of TEN or, more often, a few weeks later. The reduction of the lacrymal flow induced corneal lesions in all 11 patients and 6 patients suffered permanent visual impairment. Biopsies of labial accessory salivary glands showed a lymphocytic infiltration of the glandular tissue in 5 of 7 cases. In 2 cases the lymphocytic infiltrate was nodular, grade III of Chisholm's classification, considered as pathognomonic of Sjogren's syndrome. The occurrence of Sjogren-like syndrome in patients recovering from TEN suggests an auto-immune pathogenesis for TEN, and is one more analogy between TEN and graft-versus-host disease.
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PMID:[Ocular complications of Lyell's syndrome: recent concepts apropos of 26 cases]. 405 15

Cutaneous graft-versus-host disease in humans can be regarded as a potential model for the study of lymphocytotoxic reactions directed against the epidermis, and immunologically mediated cutaneous sclerosis. Toxic epidermal necrolysis and lichen planus are closely reproduced in graft-versus-host disease; sclerosis of chronic graft-versus-host disease cannot be regarded as strictly similar to any type of scleroderma. Sclerosis is the most consistently reproducible feature of cutaneous graft-versus-host disease in mouse chimeras; it offers the opportunity to study a dermal sclerosing reaction which may be considered as T cell dependent. Murine graft-versus-host disease presently appears debatable for use as a model of T cell dependent injury of the epidermis since stable established epidermal lesions are difficult to reproduce.
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PMID:Human and murine cutaneous graft-versus-host diseases. Potential models for the study of immunologically mediated skin diseases. 623 23

Toxic epidermal necrolysis (TEN) has been reported following bone marrow transplantation. This rare and unfortunate complication may portend fatal outcome. We report on a patient with an allogeneic bone marrow transplant and graft-versus-host disease (GVHD) in whom TEN subsequently developed. In contrast to a previously reported case, our patient survived and is well two years after bone marrow engraftment.
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PMID:Toxic epidermal necrolysis following bone marrow transplantation. 638 33

Toxic epidermal necrolysis (TEN) is a severe blistering skin disease of high mortality. TEN may occur after bone marrow transplantation (BMT). In such cases, TEN have been attributed to graft-versus-host disease (GVHD) or an adverse drug reaction. It is very difficult to distinguish the causes of TEN after BMT. We report a 21-year-old Japanese man who developed TEN eight days after BMT, evaluate the differential diagnosis of hyperacute GVHD and an adverse drug reaction, and deduce that hyperacute GVHD was the more likely pathogenesis of TEN in this patient.
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PMID:Toxic epidermal necrolysis possibly linked to hyperacute graft-versus-host disease after allogeneic bone marrow transplantation. 937 62

Toxic epidermal necrolysis is a drug-induced, rare, but life-threatening skin eruption. The main differential diagnoses are drug-induced erythema (hypersensitivity syndrome), acute graft-versus-host disease, staphylococcal scalded skin syndrome, and toxic shock syndrome. Because the therapy for toxic epidermal necrolysis and acute graft-versus-host disease differs largely from the others, it is necessary to make an accurate diagnosis. In addition to a detailed medical history, skin biopsy is mandatory because the skin eruptions are not always unequivocal. Discontinuation of the causing agent is crucial, and treatment in specialized intensive care units or burn units is supportive. Currently there is no specific treatment for toxic epidermal necrolysis. Advantages from corticosteroids, plasmapheresis, intravenous immunoglobulin, cyclophosphamide, cyclosporin, and N-acetylcysteine still remain to be established by controlled trials, or have failed to prove a benefit (thalidomide). The patient presented here demonstrates the difficulties in diagnosing toxic epidermal necrolysis in a critically ill patient. A short overview of the pathogenesis and the management of toxic epidermal necrolysis is provided.
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PMID:Toxic epidermal necrolysis after phenytoin usage in a brain trauma patient. 1217 97

Iatrogenic ocular dry eye disease remains a frequent associated cause of ocular dryness. Lachrymal secretion depends on hormonal and nervous factors. Anticholinergic agents play an important role in ocular dryness because of hyposecretion. Sexual hormones and particularly androgens greatly influence lachrymal and meibomian secretions leading to the main symptoms found during menopause or hormone replacement therapy. Rare causes such as graft-versus-host disease (GVHD) and Lyell disease must be identified and promptly managed to avoid severe complications. The treatment of iatrogenic ocular dryness is mainly based on lubricants while trying to decrease the use of desiccating systemic treatments.
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PMID:[Ocular dryness related to systemic medications]. 1951 18

BACKGROUND Toxic epidermal necrolysis (TEN) is characterized by widespread erythematous and bullous lesions on the skin. Nowadays, considerable progress has been made in the understanding of its pathogenesis. Immunologically it is similar to graft-versus-host disease. Therefore, we may propose that TEN is a disorder of cell-mediated immunity. CASE REPORT Our patient was a 74-year-old white female who had pneumonia and was positive for hepatitis C virus (HCV), and who had been on levofloxacin therapy. After the first levofloxacin dose, erythematous dusky red macules occurred on her extremities and trunk, and on the following day, confluent purpuric lesions tended to run together over 85% of her body. Her biopsy results indicated TEN. Laboratory testing for serum ECP (eosinophil cationic peptide) and serum immunoglobulin (Ig) levels were performed, and blister fluid was investigated. The patient responded positively to omalizumab treatment and after treatment laboratory tests revealed decreased high sensitive CRP, ECP, IgG1, IgG2, IgG3, IgG4, IgA, and IgM levels. CONCLUSIONS To the best of our knowledge, this is the first case of a patient with HCV who developed cutaneous adverse drug reaction on levofloxacin medication and recovered with omalizumab treatment. This is the first documentation of omalizumab treatment of a TEN patient.
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PMID:Levofloxacin Induced Toxic Epidermal Necrolysis: Successful Therapy with Omalizumab (Anti-IgE) and Pulse Prednisolone. 2763 12

This study report clinical course, etiology, management, and long-term outcome of children who developed toxic epidermal necrolysis-like reaction (TEN-LR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We retrospectively collected children with TEN-LR occurring after allo-HSCT performed in 2 pediatric bone marrow units between 2005 and 2014. We identified 6 cases of TEN-LR of 322 patients (1.8%). Possible triggers of TEN included antibiotics, antiepileptics, antimycotics, and Mycoplasma infection. In 3 patients TEN-LR occurred concurrently with severe multiorgan acute graft versus host disease. The management of TEN included administration of high doses of intravenous immunoglobulins and steroids (n=6), anti-tumor necrosis factor (n=3), and plasmapheresis (n=3) and whenever possible, discontinuation of the potentially causative drugs. Four patients (66%) reached a complete clinical response of TEN-LR after a median of 11.2 days. Two children (34%) are presently alive, 1 with long-term ocular sequelae. TEN-LR is a potentially lethal complication that may occur after HSCT also in pediatric patients. In our experience, TEN-LR and acute graft versus host disease probably coexisted and an overlap between the 2 forms is suggested. The multidisciplinary approaches involving specialized nurses, hematologists, dermatologists, burn surgeons, and infectious disease specialists is crucial to treat these patients.
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PMID:Toxic Epidermal Necrolysis-like Reaction After Hematopoietic Stem Cell Transplantation in Children. 2826 83