Photo-distributed neutrophilic drug eruption and adult respiratory distress syndrome associated with antidepressant therapy.
Drug reactions are well-known complications of antidepressant therapy, often related to photosensitization. Herein is reported a singular case of antidepressant (amoxapine and citalopram) and anxiolytic related (perphenazine) photo-distributed neutrophilic dermatosis and adult respiratory distress syndrome (ARDS). The clinicopathologic findings displayed overlapping features with drug-induced Sweet's syndrome, acute generalized exanthematous pustulosis (AGEP), and so-called sterile neutrophilic folliculitis with perifollicular vasculopathy. Of the three medications, only amoxapine has been associated with AGEP. Treatment with high-dose systemic corticosteroids and cessation of drug therapy was followed by rapid resolution of the cutaneous eruption and respiratory distress. The possibility that neutrophil infiltration of the lung and/or accumulation of neutrophils in the skin and blood served as a source for reactive oxygen species, leading to lung injury and subsequent ARDS, is discussed.
Mecca
Patricia
P
Division of Dermatology and Division of Dermatopathology, Albany Medical College, Albany, NY, USA.
Tobin
Ellis
E
Andrew Carlson
J
J
D000208:Acute Disease; D000328:Adult; D000657:Amoxapine / Q000009:adverse effects*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects; D015283:Citalopram / Q000009:adverse effects; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009504:Neutrophils / Q000473:pathology*; D010546:Perphenazine / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000473:pathology*; D016463:Sweet Syndrome / Q000175:diagnosis
D018687:Antidepressive Agents, Second-Generation; D014150:Antipsychotic Agents; D005938:Glucocorticoids; D015283:Citalopram; D010546:Perphenazine; D000657:Amoxapine