{"id":7510,"date":"2020-03-06T16:03:25","date_gmt":"2020-03-06T14:03:25","guid":{"rendered":"https:\/\/primaderma.ro\/?page_id=7510"},"modified":"2020-07-01T11:55:09","modified_gmt":"2020-07-01T09:55:09","slug":"prof-dr-deleanu-diana","status":"publish","type":"page","link":"https:\/\/pdi.ro\/2020\/prof-dr-deleanu-diana\/","title":{"rendered":"Prof. Dr. Deleanu Diana"},"content":{"rendered":"

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Prof. Dr.\u00a0Deleanu Diana<\/strong><\/span>
Universitatea de Medicin\u0103 \u0219i Farmacie”Iuliu Ha\u021bieganu”, Cluj Napoca<\/strong><\/span><\/h4>\n

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Reactii cutanate adverse severe la medicamente
\nAutor: Diana Deleanu<\/span><\/p>\n

Reac\u0163iile adverse severe la medicamente, cu manifestare cutanat\u00e3, chiar dac\u00e3 sunt rare pot fi extrem de severe, evolu\u0163ia fatal\u00e3 nefiind exclus\u00e3! Aceste manifest\u00e3ri particulare a reac\u0163iilor adverse medicamentoase sunt sindromul Stevens-Johnson (SSJ), sindromul de necroliz\u00e3 epidermic\u00e3 toxic\u00e3 (sindromul Lyell) (NET) \u015fi sindromul DRESS (sindromul cu reac\u0163ie la medicament cu eozinofilie \u015fi reac\u0163ie sistemic\u00e3). Au fost utilizate denumirile de sindrom Stevens-Johnson \u015fi cel de necroliz\u00e3 toxic\u00e3, ambele fiind de fapt aceea\u015fi afec\u0163iune, dar cu grade de severitate diferite (forma mai pu\u0163in sever\u00e3 este sindromul Stevens-Johnson). SSJ este o afec\u0163iune rar\u00e3, sever\u00e3 ce intereseaz\u00e3 pielea \u015fi mucoasele. Poate fi indus\u00e3 de medicamente (reac\u0163ie advers\u00e3 sever\u00e3) dar \u015fi de infec\u0163ii. S-a mai numit eritem multiform major. Debuteaz\u00e3 prin simptome generale nespecifice urmate rapid de afectare cutanat\u00e3 \u015fi\/sau a mucoaselor. Pielea devine eritematoas\u00e3 intens sau violacee, dureroas\u00e3, mai rar pruriginoas\u00e3, apoi apar vezicule\/bule, care se sparg, iar stratul superficial cutanat se descuameaz\u00e3 masiv. Leziune pot fi localizate (\u020bn situa\u0163iile cu evolu\u0163ie mai pu\u0163in sever\u00e3), dar de cele mai multe ori sunt extinse, pe suprafe\u0163e mari, ce pot cuprinde \u020bntregul corp – situa\u0163iile cele mai severe, numite TEN. SSJ\/TEN este o urgen\u0163\u00e3 medical\u00e3, necesit\u00e3 internare, preferabil \u020bntr-o sec\u0163ie de terapie intensiv\u00e3 (leziunile cutanate sunt asimilate cu cel din arsurile cutanate). Aspectele cutanate din DRESS sunt apropiate cu cel observate \u020bn reac\u0163ia grefei contra gazd\u00e3: erup\u0163ie maculo-papular\u00e3, dar se pot dezvolta \u015fi vezicule, bule, pustule, purpur\u00e3, edem facial, cheilit\u00e3 etc Tabloul clinic este polimorf: apare de regul\u00e3 \u020bntre 2-8 s\u00e3pt\u00e3m\u00e2ni de la introducerea medicamentului. Majoritatea pacien\u0163ilor prezint\u00e3 febr\u00e3, eritem cutanat intens, adenopatii. Pacien\u0163ii prezint\u00e3 leucocitoz\u00e3, eozinofilie (90% dintre pacien\u0163i), mai rar monocitoz\u00e3, sindrom citolotic. Afectarea organelor interne poate lua aspectul unei hepatite, pneumonii, miocardit\u00e3, pericardit\u00e3, nefrit\u00e3 \u015fi colit\u00e3. Medicamentele care au indus SSJ\/TEN \u015fi DRESS sunt carbamazepina, lamotrigina, fenitoin, fenobarbital, alopurinolul, abacavirul, minociclina etc. Mecanismul acestor afec\u0163iuni nu este elucidat \u020bn totalitate, dar este necesar\u00e3 o predispozi\u0163ie genetic\u00e3 \u015fi o implicare a hipersensibilit\u00e3\u0163ii tardive celulare. Pacien\u0163ii trebuie s\u00e3 opreasc\u00e3 imediat medicamentul incriminat, dar nu exist\u00e3 o terapie specific\u00e3. Prezent\u00e3m cazul unei paciente cu DRESS tratat\u00e3 cu benralizumab (anticorp monoclonal anti-IL 5, care are ca \u0163int\u00e3 terapeutic\u00e3 eozinofilul).<\/p>\n

Severe skin adverse reactions to drugs
\nAuthor: Diana Deleanu<\/span><\/p>\n

Severe skin adverse reations to drugs even they are seldom, they may be life threatening! This severe skin adverse reactions are Stevens-Johnson syndrome (SSJ), Toxic epidermal necrolysis (TEN), known also as Lyell syndrome, and drug rash with eosinophilia and systemic symptoms syndrome (DRESS). SSJ and TEN were used, but they define the same disease with different severity grades (less severe being SSJ). SSJ is a rare disease affecting the skin and mucosa, which can be induced by drugs or infections. Major multiform erythema is another name given to SSJ. It presents general nonspecific symptoms followed rapidly by skin and mucosa lesions: the skin present rash, then became violet, painful and very rare itchy. The specific lesions are blisters. The lesions may be localized (less severe cases), but frequently they are present on large area, which may cover the entire body (TEN). SSJ\/TEN are emergency! Patients need to be hospitalized, preferably in intensive care units (lesions are comparable to burns lesions). Skin lesions in DRESS are similar to those in graft versus host: maculo-papular eruptions, but blisters may develope, edema, cheilitis etc. DRESS develops after 2-8 weeks from the start of new drug and the synmptoms are polimorf. The majority of patients have fever, sever erythema, enlarge lymph nodes. Increase numaber of leukocytes with eosinophilia are present in 90% of the patients, seldom is present mononucleosis. Patients have increase hepatic enzymes. Others organs involved are lungs, heart (miocarditis, pericarditis), renal, gut.Drugs that produce SSJ\/TEN and DRESS were carbamazepine, lamotrigine, fenitoin, fenobarbital, allopurinol, abacavir, minocyline etc. The mechanism of the severe skin reactions is not known, but it needs a genetic tendency and a type IV hypersensitivity. Patients must stop the offending drug, but there is not a specific therapy for SSJ\/TEN or DRESS. We present a case of DRESS treated with benralizumab (anti-IL 5 monoclonal antibody with eosinophils as target).<\/p>\n

Scurt CV<\/span><\/p>\n

A absolvit Facultatea de Medicina si Farmacie a Institutului de Medicina si Farmacie Cluj-Napoca (actuala Universitate de Medicina si Farmacie Iuliu Hatieganu) in 1983. Este medic primar de Medicina Interna si de Alergologie si Imunologie Clinica (din 1995). Este angajata la UMF Iuliu Hatieganu, disciplina de Imunologie si Alergologie (sef de disciplina) si la Institutul Regional de Gastroenterologie si Hepatologie (IRGH) \u201cProf. dr. Octavian Fodor\u201d, sectia Medicina Interna (sef de sectie) cu compartimente de Alergologie si de Imunologie. Conduce programul nationale pentru boli rare \u2013 imunodeficiente primare.
Specializari la UMF Cluj-Napoca, UMF Carol Davila, Bucuresti, Universitatea de Medicina Southampton (boli respiratorii), la Spitalul Brompton, Londra, Serviciul de recuperare boli respiratorii Paderborn, la Clinica Nantes, Universitatea Navarra, Clinica San Miguel (alergologie) din Pamplona. Si-a sustinut teza de doctorat in domeniul medicine cu o tema de imunologie, in 1996. Autoare si coautoare a numeroase articole, cu indice Hirsch peste 9 si autoare la mai multe carti, capitole de carte in domeniul imunologiei si alergologiei. A introdus teste de provocare si imunoterapia specifica. Preda cursuri de imunologie si alergologie la studentii de la UMF “Iuliu Hatieganu” Cluj-Napoca, la anul 3 si 6 medicina generala, la medicina dentara, farmacie, nutritie si este responsabila de pregatirea medicilor rezidenti in specialitatea de Alergologie si Imunologie Clinica. Este investigator principal in numeroase studii clinice internationale privind bolile alergice (astm, rinita, soc anafilactic, urticarie). Participant la numeroase manifestarii de medicina, imunologie, alergologie, pediatrie, dermatologie regionale, nationale si internationale. A organizat “Scoala de Vara” 2007 la Cluj-Napoca, impreuna cu Academia Europeana de Alergologie si Imunologie Clinica (EAACI). A fost vicepresedinte (200-2006) si presedinte (2006-20017) al Societatii Nationale de Alergologie si Imunologie Clinica (SRAIC) , in prezent este \u201cfost-presedinte\u201d al SRAIC. Este membra la mai multe societati internationale de alergologie (EAACI, organizatia mondiala de Alergologie \u2013 WAO, la AAAAI, la ACAAI etc) si face parte din Comisiile de specialitate ale MS si Colegiului Medicilor. Are doi copii si trei nepoti.<\/p>\n

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Contacteaz\u0103 operatorul PDI 2020<\/p>\n

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Operatorul PDI 2020<\/p>\n

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Adresa: Str. A. Panu nr. 13, Iasi<\/span>
Tel.: 0332.40.88.00-05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
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Parteneri Media<\/p>\n

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Prof. Dr.\u00a0Deleanu Diana Universitatea de Medicin\u0103 \u0219i Farmacie”Iuliu Ha\u021bieganu”, Cluj NapocaReactii cutanate adverse severe la medicamente Autor: Diana Deleanu Reac\u0163iile adverse severe la medicamente, cu manifestare cutanat\u00e3, chiar dac\u00e3 sunt rare pot fi extrem de severe, evolu\u0163ia fatal\u00e3 nefiind exclus\u00e3! Aceste manifest\u00e3ri particulare a reac\u0163iilor adverse medicamentoase sunt sindromul Stevens-Johnson (SSJ), sindromul de necroliz\u00e3 epidermic\u00e3 […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-7510","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/7510","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/comments?post=7510"}],"version-history":[{"count":6,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/7510\/revisions"}],"predecessor-version":[{"id":8509,"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/pages\/7510\/revisions\/8509"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/2020\/wp-json\/wp\/v2\/media?parent=7510"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}