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- W2103575229 abstract "In patients with suspected Strongyloides, ivermectin treatment should be considered because corticosteroid therapy poses a serious risk of hyperinfection syndrome. None. A 29 yo Indian woman developed unremitting fever, rash and diarrhea after eating raw oysters. Despite therapy with prednisone, doxycycline and ceftriaxone, she worsened. By Day 14 of illness, she exhibited a desquamating rash, lymphadenopathy, and eosinophilia (AEC 1000), therefore ciprofloxacin and clindamycin were added for presumed Vibrio infection. Eosinophilia increased (AEC 2800) and IgE spiked (17,561). Skin biopsy confirmed a drug reaction, therefore IVIG (1g/kg) was administered and antibiotics discontinued. Work up for malignancy and infection continued in the setting of persistent liver dysfunction. Serology was strongly positive for Strongyloides both pre and post IVIG, though stool studies and biopsies were negative for parasitic infection. Ivermectin and methylprednisolone were administered on Day 25 after which eosinophilia resolved and she improved dramatically. Within one week she developed a coalescing maculopapular rash with numerous dusky areas consistent with TEN. Additional IVIG and solumedrol were ineffective. She was transferred to a burn unit and succumbed to pseudomonas septicemia. We speculate that reactivation of a dormant Strongyloides infection fostered DRESS. Given that ivermectin is not associated with hypersensitivity reactions, its empiric use may be valuable in at risk individuals with DRESS before instituting corticosteroids. Perhaps corticosteroids and ivermectin modified the cytokine milieu from the eotaxin and IL5 environment associated with DRESS, such that re-exposure caused SJS-TEN, with characteristic keratinocyte cell death through Fas ligand. Clinical research is ongoing." @default.
- W2103575229 created "2016-06-24" @default.
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- W2103575229 date "2015-02-01" @default.
- W2103575229 modified "2023-09-27" @default.
- W2103575229 title "A Fatal Case of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)-Stevens Johnson (SJS)/Toxic Epidermal Necrolysis (TEN) in the Setting of Strongyloides Infection: Treatment Considerations" @default.
- W2103575229 doi "https://doi.org/10.1016/j.jaci.2014.12.1338" @default.
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