A 34-year-old HIV-infected African woman developed fever, weight loss and widespread papules on her trunk, arms and face. Skin biopsy and culture revealed histoplasmosis caused by Histoplasma capsulatum varietas capsulatum (American histoplasmosis). Even though antimycotic treatment and intensive care were started immediately the patient died because of the systemic mycosis within a few days. Histoplasmosis is a rare disease in Europe but endemic in some areas of the USA (e.g., Ohio, Mississippi) and of Africa. Additionally histoplasma capsulatum varietas duboisii is endemic in Central and South Africa.
We report on the results of the registration of SJS, SJS/TEN overlap and TEN with maculae in West‐Germany and Berlin from 01.04.90 to 31.12.92. The results are based on the ‘Dokumentationszentrum schwerer Hautreaktionen’, a registry on severe skin reactions, which regularly contacts more than 1500 hospitals (departments of dermatology, departments of pediatrics, burn units and internal medicine departments with intensive care facilities). With a response rate ranking from 77% to 95% over a period of 33 months 270 cases of SJS, SJS/TEN overlap and TEN have been included into the registry. More than 1690 single drugs had been taken two weeks prior to the skin reaction. Among those drugs ranitidine was found in 25 patients. Other H2‐antagonists were taken in 12 cases (famotidine in 11 cases and cimetidine in one case). Evaluation of drug risk incidences for these drugs were calculated based on prescription data in defined daily doses (DDD), which were obtained from the ‘Wissenschaftliches Institut der Ortskrankenkassen’ (WIDO), Heidelberg, Germany. For ranitidine incidences of 0.19, 0.14, 0.10 could be evaluated, compared to 0.11, 0.29 for famotidine and 0.06 for cimetidine for 1990, 1991 and 1992, respectively. Over the observation period the incidences for ranitidine were stable in contrast to famotidine. As probable confounding factors co‐medication with phenytoin, dexamethasone, heparin and, in addition, concomitant illnesses as brain‐tumours and cerebral metastasis could be found. The example of the H2‐antagonists shows that incidence data should be interpreted cautiously. To avoid misinterpretation incidences should be observed over a period of several years, and in every case confounding factors should be taken into account.
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