Lydia Sharon, K (2022) Estimation of Serum Thymus and Activation Regulated Chemokine (TARC) in Drug Induced Skin Reaction and Severe Cutaneous Adverse Drug Reactions (SCAR). Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: The cutaneous adverse drug reactions (CADR) are commonly classified as non-life threatening or life-threatening reactions (1). The non-life-threatening CADR include maculo-papular exanthem (MPE), fixed drug eruption, etc. The severe cutaneous adverse reactions (SCAR) include Stevens Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN), and acute generalised exanthematous pustulosis (AGEP) & drug reaction with eosinophilia and systemic symptoms (DRESS) (1–3). Life-threatening cutaneous drug reactions are rare but cause significant morbidity and mortality. The diagnosis of a CADR is based on a temporal correlation of drug intake with cutaneous and systemic features of CADR, drug probability scoring for adverse reaction (e.g., Naranjo’s algorithm, WHO-UMC scale, etc.), investigations (e.g., eosinophilia and transaminitis in DRESS, neutrophilia in AGEP) and supportive histopathology. However, there are no conclusive diagnostic tests for CADR. For instance, an exanthematous or a maculopapular rash could be due to a drug or a viral infection or a connective tissue disorder, etc. Also, a rash due to a drug could be either a benign drug-induced MPE or a serious DRESS. The misdiagnosis of a rash and absence of a follow-up can lead to perilous consequences. In this context identification of a biomarker to differentiate a SCAR from an MPE or a viral exanthem can be beneficial. There are a few reports of serum thymus regulation and activated chemokine (TARC) or CCL17, a Th2 mediated chemokine which has been reported to be a biomarker for SCARs especially for DRESS. OBJECTIVES: To evaluate the clinical profile in patients with drug induced maculopapular eruptions (MPE) and severe cutaneous adverse reactions (SCARs) and evaluate the role of serum levels of thymus and activation regulated chemokine (TARC) as a potential biomarker. METHODS: A cross sectional observational study was done over a period of 21 months in a tertiary care Centre in South India. Subjects with cutaneous adverse drug reactions (CADR) with MPE and SCARs were recruited. Patients with viral exanthem served as controls. All relevant demographical, clinical, biological details were recorded. Drug causality scores (Naranjo’s algorithm, ALDEN score) and SCAR diagnostic score (RegiSCAR validation for DRESS and Euro SCAR for AGEP, Bastuji-Garin for SJS/TEN) and prognostic score (SCORTEN, GPS, SIRS, NLR) were applied and serum TARC levels were measured. RESULTS: Out of 44 cases there were 23 patients with MPE, 13 with DRESS, 5 with SJS/TEN and 3 with AGEP. Nine patients with a viral exanthem were taken as controls. Clinical and biological features such as fever, facial edema, lymphadenopathy, peripheral eosinophilia and deranged liver enzymes were significantly more in DRESS than in MPE. Serum TARC was elevated in SCARs especially in DRESS as compared to MPE and viral exanthem. Serum TARC correlated to peripheral eosinophilia in both DRESS and MPE. CONCLUSIONS: TARC significantly correlates with peripheral eosinophilia. TARC was elevated in DRESS as compared to MPE and viral exanthem but no statistical correlation was found.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201930302 |
| Uncontrolled Keywords: | Cutaneous adverse drug reactions, severe cutaneous adverse reactions, drug reaction eosinophilia and systemic symptoms, Thymus activation and regulated chemokine, CCL-17. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy > MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Jun 2021 16:20 |
| Last Modified: | 03 Mar 2024 14:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/17547 |
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