药物超敏反应综合征ppt课件
合集下载
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
in addition to anticonvulsants,diaphenylsulfone(DDS). allopurinol(别嘌醇),salazosulfapyridine(柳氮磺胺吡啶) and dapsone(氨苯砜) can also cause DIHS
3
4
5
Defition
Drug-Induced Hypersensitivity Syndrome (DIHS) is a severe and rare systemic reaction triggered by a drug (usually an antiepileptic drug).
accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas
Later,SaItzstein described this kind of drug reaction as pseudo lymphoma
In the 1960s with the development of carbamazepine, the disease named antispasmodic syndrome
Herpesvirus:associated sequential reactivation of herpesvirus family.(Recently,accumulating evidence suggests that other HHVs, such as HSV, EBV, HHV-7 and CMV might be reactivated during the course of DIHS)
Gene:NAT2 and certain human leukocyte antigen (HLA) alleles (immune response)
7
Clinical manifestations
incubation period(2-6weeks) Fever,：often high (38.5-40oC) Rash:Maculopapular rash developing＞ 3 weeks after starting
8
The maculopapular eruption later becomes infiltrated with edematous follicular accentuat-ion.Swelling of the face, with marked periorbital involvement. Vesicles may arise and fine vesicles by edema of the dermis can be present.No necrosis of the epidermis like TEN occurs,except in rare cases of overlapping DRESS/DIHS andTEN. Small sterile perifollicular pustules and nonfollicular pustules may appear, which are different from acute generalized exanthematous pustulosis,and does not predominate on the main folds of the skin.. Over time the rash becomes purplish, sharply lower limbs andthe resolution is scaling. Another form of presentation is a picture of exfoliative dermatitis, which may be associated with mucosal involvement, such as cheilitis, erosions, pharygitis and enanthematous enlarged
is characterized by late onset, infectious mononucleosis-like symptoms, and herpesvirus 6 (HHV-6) reactivation.
6
Etiopathogenesis
Drug:deficiency or abnormality of the epoxide hydroxylase enzyme(环氧酶羟化酶) that detoxifies the metabolites of aromaticamine anticonvulsants (metabolic pathway)
therapy with a limited number of drugs.The cutaneous eruption consists of a morbilliform rash, which is also common in other less severe drug reactions and both presentations are indistinguishable The face, upper trunk and upper extremities are initially affected, with subsequent progression to the lower extremities. Lymphadenopathy (>2mm)
学习
1
Drug-induced hypersensitivity syndrome (DIHS)
2
Байду номын сангаас
HISTORY
Drug-Induced Hypersensitivity Syndrome (DIHS), was first recognized in 1950 by Chaiken, in a patient using anticonvulsant.
3
4
5
Defition
Drug-Induced Hypersensitivity Syndrome (DIHS) is a severe and rare systemic reaction triggered by a drug (usually an antiepileptic drug).
accompanied by fever, lymphadenopathy, hepatitis, hematologic abnormalities with eosinophilia and atypical lymphocytes, and may involve other organs with eosinophilic infiltration, causing damage to several systems, especially to the kidneys, heart, lungs, and pancreas
Later,SaItzstein described this kind of drug reaction as pseudo lymphoma
In the 1960s with the development of carbamazepine, the disease named antispasmodic syndrome
Herpesvirus:associated sequential reactivation of herpesvirus family.(Recently,accumulating evidence suggests that other HHVs, such as HSV, EBV, HHV-7 and CMV might be reactivated during the course of DIHS)
Gene:NAT2 and certain human leukocyte antigen (HLA) alleles (immune response)
7
Clinical manifestations
incubation period(2-6weeks) Fever,：often high (38.5-40oC) Rash:Maculopapular rash developing＞ 3 weeks after starting
8
The maculopapular eruption later becomes infiltrated with edematous follicular accentuat-ion.Swelling of the face, with marked periorbital involvement. Vesicles may arise and fine vesicles by edema of the dermis can be present.No necrosis of the epidermis like TEN occurs,except in rare cases of overlapping DRESS/DIHS andTEN. Small sterile perifollicular pustules and nonfollicular pustules may appear, which are different from acute generalized exanthematous pustulosis,and does not predominate on the main folds of the skin.. Over time the rash becomes purplish, sharply lower limbs andthe resolution is scaling. Another form of presentation is a picture of exfoliative dermatitis, which may be associated with mucosal involvement, such as cheilitis, erosions, pharygitis and enanthematous enlarged
is characterized by late onset, infectious mononucleosis-like symptoms, and herpesvirus 6 (HHV-6) reactivation.
6
Etiopathogenesis
Drug:deficiency or abnormality of the epoxide hydroxylase enzyme(环氧酶羟化酶) that detoxifies the metabolites of aromaticamine anticonvulsants (metabolic pathway)
therapy with a limited number of drugs.The cutaneous eruption consists of a morbilliform rash, which is also common in other less severe drug reactions and both presentations are indistinguishable The face, upper trunk and upper extremities are initially affected, with subsequent progression to the lower extremities. Lymphadenopathy (>2mm)
学习
1
Drug-induced hypersensitivity syndrome (DIHS)
2
Байду номын сангаас
HISTORY
Drug-Induced Hypersensitivity Syndrome (DIHS), was first recognized in 1950 by Chaiken, in a patient using anticonvulsant.