Neutrophilic Dermatosis After Azathioprine Exposure

Cyrus, Nika; Stavert, Robert; Mason, Ashley R.; Ko, Christine J.; Choi, Jennifer N.

doi:10.1001/jamadermatol.2013.137

Cited by 37 publications

(62 citation statements)

References 32 publications

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“…More recently azathioprine (AZA), the nitroimidazole of 6-mercaptopurine, which is widely used as a corticosteroid-sparing agent in a variety of autoimmune inflammatory diseases, has been increasingly reported as a potential cause of SS [4,5,6,7,8,9,10,11,12,13,14]. Here we report a severe case of SS associated with AZA therapy, review the literature concerning similar cases reported to date and analyze the expression of the proinflammatory cytokine interleukin-1β (IL-1β) in our patient's skin lesions.…”

Section: Introductionmentioning

confidence: 99%

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Imhof¹,

Meier²,

Frei

et al. 2015

Dermatology

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Sweet's syndrome (SS) is a dermatosis with systemic symptoms characterized by tender, red nodules or papules, occasionally covered with vesicles, pustules or bullae, usually affecting the upper limbs, face and neck. SS is frequently observed in patients with leukemia or connective tissue diseases, while it is rather seldom in patients with inflammatory bowel disease. The exact pathogenesis of SS is only partially understood. We report the case of a 50-year-old patient with indeterminate colitis, presenting with a febrile diffuse papulopustular and necrotizing skin eruption that healed with significant scarring and appeared 14 days after onset of treatment with azathioprine. Histological examination revealed the presence of features typical of SS, gene expression analysis very high levels of interleukin-1β (IL-1β) mRNA in lesional skin, and immunohistochemistry high levels of IL-1β at the protein level. SS associated with azathioprine is being increasingly reported and is reviewed herein.

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Section: Introductionmentioning

confidence: 99%

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Imhof¹,

Meier²,

Frei

et al. 2015

Dermatology

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“…Clinical features include constitutional symptoms with or without a cutaneous reaction, and a high index of suspicion is required to avoid a delay in diagnosis 1,2 . Less commonly, liver and renal dysfunction, hypotension, and shock may occur 1 .…”

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confidence: 99%

“…Less commonly, liver and renal dysfunction, hypotension, and shock may occur 1 . Laboratory abnormalities include neutrophilia, leukocytosis, anemia, elevated inflammatory markers, and rarely, positive antineutrophilic cytoplasmic antibodies 2,3 .…”

mentioning

confidence: 99%

“…While the exact etiology of AHS remains unknown, current studies have suggested a type III or IV immune-mediated reaction 1,2 . Given the mortality associated with AHS, for patients who present with systemic and cutaneous symptoms while taking AZA, the safest course is to stop taking it.…”

mentioning

confidence: 99%

“…Given the mortality associated with AHS, for patients who present with systemic and cutaneous symptoms while taking AZA, the safest course is to stop taking it. Upon AZA cessation, complete resolution typically occurs within a week 2,4 . Rechallenge is not recommended because of an increased risk of morbidity and mortality 4 .…”

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confidence: 99%

See 2 more Smart Citations

Azathioprine Hypersensitivity Syndrome

Frank

Fett

2017

J Rheumatol

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Assessing the Patient With Arthralgia, Fevers, and Rash

Sarantopoulos

Gkougkourelas

Boura

2016

JAMA

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Both scenarios imply that the average GRS-BMI should be lower for study participants in earlier birth cohorts. However, we showed (Table 2 in the article and eTable 1 in the Supplement) that genetic risk remained stable across the birth cohorts, despite major changes in BMI. Furthermore, GRS-BMI did not predict mortality for white participants in HRS (P = .45). Additionally, we estimated a model testing whether the birth year by GRS-BMI interaction differed for white respondents above or below age 65 years and found no evidence of such effect modification by age (P = .24).With respect to Mr Liu and Dr Guo, upon reviewing their article, 6 we agree that our results for white respondents substantially overlap with theirs. This type of overlap is always a risk with publicly available data sets such as the HRS, but missing their citation was a mistake on our part. Our manuscript was mostly finished prior to their publication (first full draft completed March 2014). We attempted to update our literature review, but we failed to identify this important publication. We apologize for our error. We consider it an indication of the importance of this research question that it was undertaken by multiple independent research groups, and we are pleased that the findings are consistent.

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Neutrophilic Dermatosis After Azathioprine Exposure

Cited by 37 publications

References 32 publications

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Severe Sweet's Syndrome with Elevated Cutaneous Interleukin-1β after Azathioprine Exposure: Case Report and Review of the Literature

Azathioprine Hypersensitivity Syndrome

Assessing the Patient With Arthralgia, Fevers, and Rash

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