Mucocutaneous reactions

The exact role of rituximab in RA is not clearly defined, but it is indicated for patients with moderate to severe RA with a history of inadequate response to DMARDs and other BRMs. Rituximab carries a black-box warning of fatal infusion reactions and severe mucocutaneous reactions even though these events did not occur during the RA clinical trials. The benefits of rituximab must be tempered against the safety concerns reported with use of rituximab in the oncology setting. 

Allergic reactions The possibility of allergic or other mucocutaneous reactions must be borne in mind upon readministration (and during initial courses). Monitor patients requiring repeated courses during each treatment course. 

Adverse effects Pulmonary toxicity is the most serious adverse effect, progressing from rales, cough, and infiltrate to potentially fatal fibrosis. Mucocutaneous reactions and alopecia are common. Hypertrophic skin changes and hyperpigmentation of the hands are prevalent. There is a high incidence of fever and chills and a low incidence of serious anaphylactoid reactions. Bleomycin is unusual in that myelosuppression is rare. 

Hypersensitivity reactions (generalized urticaria or angio-edema) after the use of Japanese encephahtis vaccine have been reported from some countries (see Table 1) the vaccine constituents responsible for these events have not been identified (12). There has been a detailed report of the adverse effects, mainly allergic mucocutaneous reactions, of Biken vaccine in Danish travellers and US Marine Corps personnel (SEDA-22, 351). 

In clinical trials about 50% of patients experienced one or more adverse effects and withdrawal was necessary in about one-third (22-26). A mucocutaneous reaction (for example a rash or stomatitis) is the most frequent reason for discontinuing the drug (27). Long-term follow-up studies have shown that many patients (up to 80%) stop taking penicillamine, either because of adverse effects or lack of efficacy (27-31). 

The adverse effects of stepronin, a sulfhydryl compound, which is used in rheumatoid arthritis, are similar to those of penicillamine. In a long-term open study, treatment had to be interrupted in 30% of 36 patients because of severe adverse effects (1). Seven patients had mucocutaneous reactions (dermatitis, pruritus, stomatitis, glossitis, ageusia), three proteinuria, and one thrombocytopenia and leukopenia. 

Bone marrow depression mucocutaneous reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis... 

Mucocutaneous reactions (1982) Halla JT +, Am J Med 72, 423 Mucosal lesions (pemphigus-like)... 

Mucocutaneous reactions (2006) Scheinfeld N, Dermatol Online J 12(1), 3 Orogenital ulceration... 

Bleomycin (CCS) Complexes with Fe and 02 —> DNA strand scission (G2 phase) Hodgkin s, testicular, head, neck, skin CA Pneumonitis, pulmonary fibrosis, mucocutaneous reactions (blisters), alopecia, hypersensitivity... 

Answer A. It can help to know which anticancer drugs are cell-cycle specific and which have characteristic toxicities. Bleomycin fits both categories acting mainly in G2, it is cell cycle specific and is distinctive for causing mucocutaneous reactions and pulmonary dysfunction. Busulfan and procarbazine may also cause pulmonary toxicity, but neither drug is cell-cycle specific. 

Chalmers [111] reported 6 rheumatoid arthritis patients with D-penidllamine-induced systemic lupus erythematosus syndrome. All patients had previous mucocutaneous reactions to chry so therapy. Manifestations included pleurisy in 5 of 6 patients, rashes in 3, and nephritis in 2. LE cells were present in 5 patients. 

Toxicity The toxicity profile of bleomycin includes pulmonary dysfunction (pneumonitis, fibrosis), which develops slowly and is dose-limiting. H)q)ersensitivity reactions (chills, fever, anaphylaxis) are common, as are mucocutaneous reactions (alopecia, blister-formation, hyperkeratosis). 

Rituximab An++, C+, D++, M+, P+, R++ Severe, fatal hypersensitivity reaction possible. Tumor lysis syndrome has caused acute renal failure. Potentially fatal mucocutaneous reactions reported,... 

The most common side effects of gold therapy are mucocutaneous reactions (Svensson and Theander... 

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