Púrpura de Schönlein-Henoch Buloso. Caso clínico

Hasbún, Trinidad; Chaparro, Ximena; Kaplan, Viera; Cavagnaro, Felipe; Castro, Álex

doi:10.4067/s0370-41062018000100103

Cited by 6 publications

(2 citation statements)

References 8 publications

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“…It may require treatment when the condition presents with a bullous or necrotic rash that jeopardizes the skin integrity, but this is rare. Proposed treatment for severe skin involvement suggested within the literature is based on single case reports or small case series, with corticosteroids recommended as the first line treatment (34–36) and should be started as soon as the bullae or concerning necrotic areas appear. They are usually given orally at a dose of ~1 mg/kg/day.…”

Section: Treatmentmentioning

confidence: 99%

Childhood IgA Vasculitis (Henoch Schonlein Purpura)—Advances and Knowledge Gaps

2019

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Immunoglobulin A vasculitis (IgAV; formerly Henoch Schonlein Purpura) is the most common form of childhood vasculitis. It can occur in any age and peaks around 4–6 years old. It demonstrates seasonal variation implicating a role for environmental triggers and geographical variation. The diagnosis is made clinically and 95% of patients will present with a rash, together with any from a triad of other systems—gastrointestinal, musculoskeletal, and renal. Most cases of IgAV in children have an excellent outcome. Treatment may be required during the acute phase for gastrointestinal involvement and renal involvement, termed IgAV nephritis (previously HSP nephritis), is the most serious long-term manifestation accounting for ~1–2% of all childhood end stage kidney disease (ESKD). It therefore requires a period of renal monitoring conducted for 6–12 months. Patients presenting with nephrotic and/or nephritic syndrome or whom develop significant persistent proteinuria should undergo a renal biopsy to evaluate the extent of renal inflammation and there are now international consensus guidelines that outline the indications for when to do this. At present there is no evidence to support the use of medications at the outset in all patients to prevent subsequent renal inflammation. Consensus management guidelines suggest using oral corticosteroids for milder disease, oral, or intravenous corticosteroids plus azathioprine or mycophenolate mofetil or intravenous cyclophosphamide for moderate disease and intravenous corticosteroids with cyclophosphamide for severe disease. Angiotensin system inhibitors act as adjunctive treatment for persisting proteinuria and frequently relapsing disease may necessitate the use of immunosuppressant agents. Renal outcomes in this disease have remained static over time and progress may be hindered due to many reasons, including the lack of reliable disease biomarkers and an absence of core outcome measures allowing for accurate comparison between studies. This review article summarizes the current evidence supporting the management of this condition highlighting recent findings and areas of unmet need. In order to improve the long term outcomes in this condition international research collaboration is urgently required.

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Section: Treatmentmentioning

confidence: 99%

Childhood IgA Vasculitis (Henoch Schonlein Purpura)—Advances and Knowledge Gaps

2019

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“…This suggests the need for regular scheduling of patient visits in patients on CDK4/6 inhibitors, once every 4 weeks, despite the lack of significant toxicity in the initial months of treatment. Third, others have reported the benefit of topical or systemic steroid use in managing severe skin toxicities, [20][21][22] but the toxicity resolved completely in our case with discontinuation of ribociclib. This suggests that the first intervention should be withdrawal of CDK4/6 inhibitor followed by careful monitoring of skin toxicity.…”

Section: Discussionmentioning

confidence: 58%

Ribociclib-Induced Delayed Dermatological Reaction: Case Report of a Rare Adverse Effect and Review of Literature

Kothari,

Parab,

Gulia

et al. 2023

Indian J Med Paediatr Oncol

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Ribociclib is a selective cyclin-dependent kinase (CDK) 4/6 inhibitor approved in combination with endocrine-based therapy for the treatment of hormone receptor-positive (HR + )/human epidermal growth factor receptor 2-negative (HER2 − ) advanced or metastatic breast cancer. It can significantly prolong the progression-free survival and improve the objective response rate compared with hormone therapy alone. However, the combined regimen results in a higher risk of adverse events, one of them being dermatological reactions. We present a case of late severe skin toxicity in a patient who had received ribociclib for 5 months. The toxicity led to severe pruritus and maculopapular and patchy rash on upper and lower extremities, which completely resolved 1 month after cessation of the drug. We conclude that ribociclib-induced skin toxicity is a noteworthy side effect that can lead to permanent cessation of this drug and is reversible. There are clinical decision dilemmas related to continuation, withholding, or switching CDK4/6 inhibitors, and benefits should be weighed against toxicities and costs.

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