Estudo retrospectivo dos casos de farmacodermia atendidos por um serviço de interconsulta de dermatologia em um hospital quaternário da cidade de São Paulo
Nenhuma Miniatura disponível
Data
2014-04-30
Autores
Botelho, Luciane Francisca Fernandes [UNIFESP]
Orientadores
Tomimori, Jane [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: As reações cutâneas às drogas são freqüentes no ambiente hospitalar, com uma prevalência aproximada de 2% a 3% dos pacientes internados, podendo ser responsáveis pelo aumento da morbidade, mortalidade e custos socioeconômicos. Objetivo: Avaliar as características epidemiológicas, clínicas e histológicas das reações a drogas no ambiente hospitalar. Estimar a frequência das reações cutâneas desencadeadas por drogas, formas clínicas, medicamentos envolvidos e achados histopatológicos. Métodos: Foi um estudo descritivo e retrospectivo, realizado entre setembro de 2008 a abril de 2012, com pacientes internados em um hospital público quaternário. Os critérios de inclusão foram a solicitação de avaliação dermatológica e diagnóstico de reação adversa cutânea a droga. Foram analisados os dados epidemiológicos, drogas suspeitas, apresentação clínica, diagnóstico histopatológico, tratamento e evolução. Os dados histológicos foram classificados pela análise de padrão proposta por Ackerman e avaliamos
a presença ou ausência de linfócitos atípicos no infiltrado dérmico. Na análise estatística foi aplicado o teste de qui-quadrado e McNemar com nível de significância de 5% e teste de t Student. Resultados: 1428 pacientes foram atendidos pelo Serviço de interconsulta da dermatologia e 117 tiveram o diagnóstico clínico e histopatológico de reação adversa cutânea a droga no período. As mulheres representaram a maioria dos pacientes atendidos (54,7%). A idade média dos pacientes foi de 49,1 anos ±19,72. As causas responsáveis pela internação hospitalar foram: neoplasias (25,6%), infecção (24,8%), internação pelo quadro cutâneo (10,3%), doenças neurológicas (9,4%) e infecção pelo vírus da imunodeficiência humana (7,7%). Os anticonvulsivantes foram responsáveis por 23,9% dos casos, seguidos pelos antibióticos (22,2%), derivados pirazolônicos (10,3%), quimioterápicos (5,1%), antiinflamatório não hormonal (2,6%), antigotoso (2,6%) e terapia antiretroviral (2,6%). Em 29% dos casos os pacientes faziam uso de duas ou mais classes de medicamentos que poderiam desencadear a reação. As formas clínicas mais frequentes foram exantema (37,6%), DRESS (14,5%), eritema polimorfo (12%), vasculite (11,1%), SSJ (9,4%), urticária (5,1%), NET (3,4%) e PEGA (2,6%). A classe dos anticonvulsivantes se associou com as formas mais graves de reação adversa cutânea a droga (p= 0,040). A maioria dos pacientes, 89,7%, evoluiu com melhora, 1,7% apresentou recidiva do quadro, 6% evoluíram para óbito por outras comorbidades e 2,6% evoluíram para óbito pela reação adversa à droga. O padrão histológico predominante foi o Ie.1 (56,4%), seguido pelo Ib.1 (17,1%), V (16,2%), Ia.1 (4,3%), IId (2,6%), IVa(2,6%) e Ie.2 (0,9%). Houve relação significante no sentido de que o uso de anticonvulsivantes e a forma clínica DRESS estão mais associados à presença de linfócitos atípicos no infiltrado dérmico (p <0,0001). Conclusão: A frequência de reações adversas cutâneas a drogas confirmadas entre os pacientes atendidos pela interconsulta de dermatologia foi de 8,2%. Os anticonvulsivantes e antibióticos foram os principais fármacos desencadeantes do quadro e predominaram as reações agudas como o exantema. O uso de anticonvulsivantes esteve mais associado a formas clínicas graves de reação adversa cutânea a droga, se comparado aos outros grupos de medicamentos. O padrão histológico Ie.1 predominou e a presença de linfócitos atípicos no infiltrado dérmico esteve associada a forma clínica DRESS e também ao uso de anticonvulsivantes.
Background: Adverse cutaneous drug reactions are frequent in hospital setting, with a prevalence of approximately 2% to 3% of hospitalized patients and may be responsible for increased morbidity, mortality and socioeconomic costs. Objectives: To assess the epidemiological and clinicopathological profile of adverse drug reactions in hospitalized patients, determining frequency, clinical forms, drug involved and histological findings. Methods: This was a descriptive and retrospective study performed from September 2008 to April 2012, with patients admitted to a public quaternary hospital. Inclusion criteria was request for dermatology consultation and diagnosis of adverse cutaneous drug reaction. We reviewed the epidemiological data, suspected drugs, clinical presentation, histopathological diagnosis, treatment and outcome. The histological data were classified by pattern analysis proposed by Ackerman and we also evaluated the presence or absence of atypical lymphocytes in the dermal infiltrate. Statistical analysis was performed using the chi-square test and McNemar test with a significance level of 5% and Student's t-test. Results: 1428 patients were assisted by dermatology consultation service and 117 had the clinical and histopathological diagnosis of adverse cutaneous drug reaction in the period. Females comprised 53.8% of the patients studied. The mean age was 49.1 ± 19.7 years. The most common causes of hospitalizations were neoplasm (25.6%), infection (24.8%), skin eruption (10.3%), neurologic disease (9.4%) and human immunodeficiency virus infection (7.7%). Anticonvulsants accounted for 23.9% of cases, followed by antibiotics (22.2%), pyrazolones (10.3%), chemotherapy (5.1%), nonsteroidal anti-inflammatory agents (2.6%), anti-gout (2.6%) and antiretroviral therapy (2.6%). In 29% of cases the patients were taking two or more classes of drugs that could trigger the reaction. The most frequently clinical forms were exanthems (37.6%), DRESS (14.5%), erythema multiforme (12.0%), vasculitis (11.1%), SJS (9.4%), urticaria (5.1%), TEN (3.4%) and AGEP (2.6%). The class of anticonvulsants was associated with more severe forms of adverse drug reactions (p = 0.040). Most patients, 89.7%, presented an improvement, 1.7% had recurrence of the eruption, 6% died due to other diseases and 2.6% died due to adverse drug reaction. The predominant histologic pattern was Ie.1 (56.4%), followed by Ib.1 (17.1%), V (16.2%), IA.1 (4.3%), IId (2.6%), IVa (2.6%) and Ie.2 (0.9%).There was a relationship between the use of anticonvulsants and atypical lymphocytes in the dermal infiltrate, as well as, the clinical form DRESS and atypical lymphocytes in the dermal infiltrate (p <0.0001). Conclusion: The frequency of confirmed adverse cutaneous drug reactions among patients assisted by dermatology consultation service was 8.2%. Anticonvulsants and antibiotics were the main causative drugs and there is a predominance of acute reactions such as exanthems. The use of anticonvulsants was associated with more severe clinical forms of drug reactions, compared to other groups of drugs. The most common histological pattern was Ie.1 and the presence of atypical lymphocytes in the dermal infiltrate was associated with the clinical form DRESS and also the use of anticonvulsants.
Background: Adverse cutaneous drug reactions are frequent in hospital setting, with a prevalence of approximately 2% to 3% of hospitalized patients and may be responsible for increased morbidity, mortality and socioeconomic costs. Objectives: To assess the epidemiological and clinicopathological profile of adverse drug reactions in hospitalized patients, determining frequency, clinical forms, drug involved and histological findings. Methods: This was a descriptive and retrospective study performed from September 2008 to April 2012, with patients admitted to a public quaternary hospital. Inclusion criteria was request for dermatology consultation and diagnosis of adverse cutaneous drug reaction. We reviewed the epidemiological data, suspected drugs, clinical presentation, histopathological diagnosis, treatment and outcome. The histological data were classified by pattern analysis proposed by Ackerman and we also evaluated the presence or absence of atypical lymphocytes in the dermal infiltrate. Statistical analysis was performed using the chi-square test and McNemar test with a significance level of 5% and Student's t-test. Results: 1428 patients were assisted by dermatology consultation service and 117 had the clinical and histopathological diagnosis of adverse cutaneous drug reaction in the period. Females comprised 53.8% of the patients studied. The mean age was 49.1 ± 19.7 years. The most common causes of hospitalizations were neoplasm (25.6%), infection (24.8%), skin eruption (10.3%), neurologic disease (9.4%) and human immunodeficiency virus infection (7.7%). Anticonvulsants accounted for 23.9% of cases, followed by antibiotics (22.2%), pyrazolones (10.3%), chemotherapy (5.1%), nonsteroidal anti-inflammatory agents (2.6%), anti-gout (2.6%) and antiretroviral therapy (2.6%). In 29% of cases the patients were taking two or more classes of drugs that could trigger the reaction. The most frequently clinical forms were exanthems (37.6%), DRESS (14.5%), erythema multiforme (12.0%), vasculitis (11.1%), SJS (9.4%), urticaria (5.1%), TEN (3.4%) and AGEP (2.6%). The class of anticonvulsants was associated with more severe forms of adverse drug reactions (p = 0.040). Most patients, 89.7%, presented an improvement, 1.7% had recurrence of the eruption, 6% died due to other diseases and 2.6% died due to adverse drug reaction. The predominant histologic pattern was Ie.1 (56.4%), followed by Ib.1 (17.1%), V (16.2%), IA.1 (4.3%), IId (2.6%), IVa (2.6%) and Ie.2 (0.9%).There was a relationship between the use of anticonvulsants and atypical lymphocytes in the dermal infiltrate, as well as, the clinical form DRESS and atypical lymphocytes in the dermal infiltrate (p <0.0001). Conclusion: The frequency of confirmed adverse cutaneous drug reactions among patients assisted by dermatology consultation service was 8.2%. Anticonvulsants and antibiotics were the main causative drugs and there is a predominance of acute reactions such as exanthems. The use of anticonvulsants was associated with more severe clinical forms of drug reactions, compared to other groups of drugs. The most common histological pattern was Ie.1 and the presence of atypical lymphocytes in the dermal infiltrate was associated with the clinical form DRESS and also the use of anticonvulsants.
Descrição
Citação
BOTELHO, Luciane Francisca Fernandes. Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia. São Paulo, 2014. 82 f. Dissertação (Mestrado em Medicina Translacional) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2014.