Hydroxychloroquine-induced erythema multiforme in a patient with COVID-19

Monte‐Serrano, Juan; Cruañes‐Monferrer, Joana; García‐García, Mar; García‐Gil, Miguel Fernando

doi:10.1016/j.medcle.2020.05.011

Cited by 6 publications

(6 citation statements)

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“…Drug-induced EM in COVID-19 patients has been related to hydroxychloroquine and has been reported to appear 3 to 10 days after starting the treatment. Drug discontinuation and systemic corticosteroid led to resolving the symptoms [ 18 ]. A case also reported the possible link between EM appearance and azithromycin [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Erythema Multiforme and COVID-19: What Do We Know?

et al. 2021

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(1) Background: Erythema multiforme (EM) is an acute cutaneous eruption often associated with infections and more rarely with drugs. This review aimed to evaluate the association between erythema multiforme and coronavirus disease 2019 (COVID-19). (2) Methods: A systematic search of PubMed/MEDLINE, Scimago Scopus, and ISI/Web of Science was performed. Original articles, case series, or case reports were evaluated and selected. (3) Results: Fourteen articles were selected, describing a total of 70 patients. EM is a cutaneous eruption rarely occurring in COVID-19 and is, in most cases, associated with a hypersensitivity reaction to the virus. In these cases, EM seems to affect patients younger than 30 years or older than 55 years. Infrequently, some drugs used in the management of COVID-19 may induce EM, especially hydroxychloroquine. The three groups of patients seem to have different clinical characteristics and courses. (4) Conclusions: From these data, it is possible to preliminarily propose that EM or EM-like eruptions linked to COVID-19 might be divided into three types: the virus-related juvenile type (affecting patients <30-year-old), the virus-related older type (affecting patients >55 years), and the drug-induced type. The occurrence of a skin rash does not seem to be related to the severity and clinical course of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Erythema Multiforme and COVID-19: What Do We Know?

et al. 2021

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“…A total of 26 articles reporting cases related to the safety of HCQ or CQ during treatment for COVID-19 were found [ 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 ]. Table 6 synthesises the data from the cases reporting HCQ and CQ adverse drug reactions in COVID-19-affected patients and Table S21 of Supplementary Material part 2 provides full details.…”

Section: Resultsmentioning

confidence: 99%

“…A smaller number of cases were reported in patients treated with CQ for autoimmune conditions or malaria although one fatal case was reported [ 27 , 28 , 29 , 30 , 32 , 33 , 37 , 39 , 49 , 54 , 58 , 61 ]. In connection with treatment for COVID-19, 12 cases were reported in patients treated with HCQ including cases of psoriasis exacerbation, rash, acute generalised exanthematous pustulosis (AGEP), drug rash with eosinophilia and systemic symptoms (DRESS), urticaria, palmoplantar itching, and purpuric erythematous rashes [ 185 , 187 , 196 , 197 , 198 , 199 , 200 , 201 , 202 ].…”

Section: Resultsmentioning

confidence: 99%

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

et al. 2022

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Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.

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“…We have evaluated 20 case reports including 25 cases of COVID‐19 who were treated with multiple drugs in Table 1 4‐23 . In Tables 2, 4 cohort studies are shown.…”

Section: Resultsmentioning

confidence: 99%

“…We have evaluated 20 case reports including 25 cases of COVID-19 who were treated with multiple drugs in Table 1. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In Tables 2, 4 cohort studies are shown. In cohort studies based on the drugs have been used the overall rate of mucocutaneous dermatologic eruptions ranged from 0.004% to 4.15%.…”

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review on treatment‐related mucocutaneous reactions in COVID ‐19 patients

Nobari

Seirafianpour

Mashayekhi

et al. 2020

Dermatologic Therapy

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Most of drugs could have certain mucocutaneous reactions and COVID‐19 drugs are not an exception that we focused. We systematically reviewed databases until August 15, 2020 and among initial 851 articles, 30 articles entered this study (20 case reports, 4 cohorts, and 6 controlled clinical trials). The types of reactions included AGEP, morbiliform drug eruptions, vasculitis, DRESS syndrome, urticarial vasculitis, and so on. The treatments have been used before side effects occur, included: antimalarial, anti‐viral, antibiotics, tocilizumab, enoxaparin and and so on. In pandemic, we found 0.004% to 4.15% of definite drug‐induced mucocutaneous reactions. The interval between drug usage and the eruption varied about few hours to 1 month; tightly dependent to the type of drug and hydroxychloroqine seems to be the drug with highest mean interval. Antivirals, antimalarials, azithromycin, and tocilizumab are most responsive drugs for adverse drug reactions, but antivirals especially in combination with antimalarial drugs are in the first step. Types of skin reactions are usually morbilliform/exanthematous maculopapular rashes or urticarial eruptions, which mostly may manage by steroids during few days. In the setting of HCQ, specific reactions like AGEP should be considered. Lopinavir/ritonavir is the most prevalent used drug among antivirals with the highest skin adverse reaction; ribarivin and remdisivir also could induce cutaneous drug reactions but favipiravir has no or less adverse effects. Logically the rate of dermatologic adverse effects among anivirals may relate to their frequency of usage. Rarely, potentially life‐threatening reactions may occur. Better management strategies could achieve by knowing more about drug‐induced mucocutaneous presentations of COVID‐19.

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Hydroxychloroquine-induced erythema multiforme in a patient with COVID-19

Cited by 6 publications

References 0 publications

Erythema Multiforme and COVID-19: What Do We Know?

Erythema Multiforme and COVID-19: What Do We Know?

Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review

A systematic review on treatment‐related mucocutaneous reactions in COVID ‐19 patients

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