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Related Experiment Videos

Generalized pustular eruption associated with converting enzyme inhibitor therapy

J Carroll1, M Thaler, E Grossman

  • 1A.J. Chorley Institute for Hypertension, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Cutis
|November 1, 1995
PubMed
Summary

A patient with a generalized rash and fever was diagnosed with mycosis fungoides. Discontinuation of captopril led to unexpected recovery, suggesting a drug-induced condition.

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Area of Science:

  • Dermatology
  • Immunology
  • Pharmacology

Background:

  • Mycosis fungoides is a type of cutaneous T-cell lymphoma.
  • Drug reactions can sometimes mimic cutaneous lymphomas.
  • ACE inhibitors like captopril are known to cause various adverse effects.

Observation:

  • A 67-year-old man developed fever, rash, lymphadenopathy, and splenomegaly.
  • Skin biopsies were consistent with mycosis fungoides.
  • The patient's condition improved significantly after discontinuing captopril.

Findings:

  • The patient experienced recurrent staphylococcal bacteremia and skin lesions that became hyperpigmented, dry, and atrophic.
  • A positive macrophage inhibiting factor response to captopril and enalapril indicated the non-sulfhydryl component as the antigenic stimulant.

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  • These findings suggest a drug-induced hypersensitivity reaction mimicking mycosis fungoides.

    • Implications:

    • This case highlights the importance of considering drug-induced reactions in the differential diagnosis of mycosis fungoides.
    • Identifying the specific antigenic component of ACE inhibitors responsible for such reactions is crucial for patient management.
    • Further research into drug-induced cutaneous conditions is warranted to improve diagnostic and therapeutic strategies.