Abstract |
The authors report the development of a papulosquamous psoriatic-like skin eruption following the introduction of mycophenolate mofetil (MM) in a patient with myasthenia gravis (MG). MM is a novel and potent immunosuppressive agent that blocks purine synthesis, thus selectively inhibiting T and B lymphocyte proliferation. Favorable results in refractory and steroid-dependent MG patients have been reported in open-label studies, revealing a rapid onset of action and a safe side effect profile. Drug eruption due to toxicity or immune-mediated damage has not been reported in association with MM. A 32-year-old man with generalized seropositive MG with a highly malignant clinical course was admitted to the authors' department due to an acute papulosquamous, psoriatic-like skin eruption 1 month following treatment initiation with MM. Skin biopsy revealed sparse perivascular infiltrate of lymphocytes intermingled with few eosinophils. Treatment with high-dose steroids together with discontinuation of MM induced a gradual improvement, with complete resolution of the symptoms 2 months later. A severe and fulminant skin eruption in association with MM treatment is described for the first time in the literature. The histopathologic diagnosis of " drug eruption" is supported by the resolution of symptoms following discontinuation of MM. However, other possibilities include an immune-mediated process supported by the presence of lymphocytic infiltrations, the clinical appearance and the distribution of lesions (simulating a psoriatic-like dermatitis), as well as the marked response to steroids.
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Authors | Netta Levin, Alexander Mali, Dimitrios Karussis |
Journal | Clinical neuropharmacology
(Clin Neuropharmacol)
2005 May-Jun
Vol. 28
Issue 3
Pg. 152-3
ISSN: 0362-5664 [Print] United States |
PMID | 15965319
(Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Inflammatory Agents
- Immunosuppressive Agents
- Mycophenolic Acid
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Topics |
- Adult
- Anti-Inflammatory Agents
(therapeutic use)
- Drug Eruptions
(drug therapy, pathology)
- Humans
- Immunosuppressive Agents
(adverse effects, therapeutic use)
- Male
- Myasthenia Gravis
(complications, drug therapy)
- Mycophenolic Acid
(adverse effects, analogs & derivatives, therapeutic use)
- Skin
(pathology)
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