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Isr Med Assoc J 2019 Feb;21(2):82-84

Department of Dermatology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel.

Background: Frozen section (FS) is often performed when histopathological evaluations are urgently required for implementation of therapeutic measures. In dermatology, this method is most commonly used to evaluate excision margins of tumors. FS are also routinely employed to differentiate toxic epidermal necrolysis from staphylococcal scalded skin syndrome. Read More

J Eur Acad Dermatol Venereol 2019 Feb 15. Epub 2019 Feb 15.

Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Background: Although tissue-eosinophilia has traditionally been considered diagnostically supportive of adverse cutaneous drug reactions (ACDRs), studies have suggested it is neither a sensitive nor a specific finding in drug eruptions (DEs).

Objectives: Determining whether skin-tissue eosinophilia is a reliable indicator of ACDR.

Methods: A nested case-control retrospective study conducted in a cohort of 170 patients at a single institution. Read More

Eur J Case Rep Intern Med 2018 21;5(3):000724. Epub 2018 Mar 21.

Serviço de Anatomia Patológica, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.

Little has been documented about hypersensitivity reactions caused by treatment with rivaroxaban. This paper reports a bullous pemphigoid-like skin eruption that occurred in a 76-year-old female patient during rivaroxaban treatment. This case highlights the vigilance required by healthcare workers in recognising potential adverse effects of newly marketed drugs and in making medication changes when necessary. Read More

Photodermatol Photoimmunol Photomed 2019 Feb 8. Epub 2019 Feb 8.

Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.

Background: Glutathione S-transferases (GSTs) play a critical role in cellular protection against oxidative damage. Polymorphisms in three major GST loci have been described. A number of studies have looked for an association between GSTs and skin diseases. Read More

Curr Drug Saf 2019 Jan 30. Epub 2019 Jan 30.

National Center Chalbi Belkahia of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis.. Tunisia.

Imatinib is the treatment of choice in patients with locally advanced or metastatic gastrointestinal stromal tumours (GIST). Clinical tolerance of imatinib is excellent except the common adverse drug reaction (ADR). Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a severe, potentially life-threatening drug-induced hypersensitivity reaction, characterized by cutaneous eruptions, fever, diffuse lymphadenopathy, along with eosinophilia, and elevated liver function tests. Read More

Am J Trop Med Hyg 2019 Jan 21. Epub 2019 Jan 21.

Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.

Praziquantel is widely used for treating parasitic infections globally, especially in countries with endemic schistosomiasis. However, severe hypersensitivity to praziquantel has rarely been reported. We report the case of a 30-year-old Japanese man who developed acute generalized exanthematous pustulosis (AGEP), which is a rare and severe cutaneous reaction usually triggered by drugs, after taking praziquantel. Read More

Allergy Asthma Clin Immunol 2019 17;15. Epub 2019 Jan 17.

3Department of Medicine, Western University, London, ON Canada.

Background: Omalizumab is a humanized monoclonal antibody widely used for treatment of persistent allergic asthma and antihistamine-refractory chronic urticaria. Immediate adverse events to omalizumab are well characterized. Delayed anaphylactoid and serum sickness-like reactions have also been described; however, their relationship to the drug remains uncertain, and the frequency is unknown. Read More

Acta Dermatovenerol Croat 2018 Dec;26(4):337-338

Associate Professor Suzana Ljubojević Hadžavdić, MD, PhD, Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Šalata 4, 10000 Zagreb, Croatia;

Herpes zoster (HZ) is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus (VZV) (1). It is a frequent medical condition with an incidence rate of 2-3 cases per 1000 person/years in the general population and 7-10 cases per 1000 person/years after the age of 50 (1,2). Risk factors and triggers for reactivation of HZV have not yet been determined precisely, but are likely to include malignancies, immune deficiencies, solid organ and bone marrow transplant recipients, autoimmune diseases, psychological conditions, emotional stress, human immunodeficiency virus (HIV) infection, and other patients receiving immunosuppressive therapies (1,3). Read More

Allergy Asthma Immunol Res 2019 Mar;11(2):241-253

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Purpose: Although severe cutaneous adverse drug reactions (SCARs) are rare, they are associated with high morbidity and mortality, and thus early diagnosis and treatment are critical for improving prognoses. However, few studies have reported the characteristics of SCARs in children. Thus, we aimed to evaluate the clinical characteristics, current management and prognosis of pediatric SCARs. Read More

BMC Ophthalmol 2019 Jan 18;19(1):22. Epub 2019 Jan 18.

Department of Ophthalmology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China.

Background: To identity the effect of lacrimal system irrigation in the acute stage in children with Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

Methods: A retrospective review of 39 patients with SJS or TEN from 2012 to 2017 was analyzed. Patients were divided into two subgroups according to whether they received irrigation in the acute stage. Read More

Med J Malaysia 2018 Dec;73(6):397-399

Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

Cutaneous adverse drug reactions (cADR) are common. However, only very few audits reported the clinical characteristics of cADR captured at district hospitals. We performed a 4-year audit on cADR reported to the Department of Pharmacy in Hospital Pakar Sultanah Fatimah between May 2012 and March 2016. Read More

Am J Dermatopathol 2019 Jan 11. Epub 2019 Jan 11.

Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Western Australia, Australia.

Flagellate erythema is a distinctive eruption characterized by "whip-like" linear or curvilinear streaks and plaques, occurring mainly on the trunk. It has classically been described in 2 disparate clinical settings: chemotherapy with bleomycin and ingestion of mushrooms (most commonly Shiitake mushrooms). Most of the literature comprises single case reports, often with minimal histological description of rather nonspecific features. Read More

Int J Trichology 2018 Sep-Oct;10(5):237-239

Department of Pathology, Northshore University Health System, University of Chicago, Chicago, IL, USA.

Here, we present the case of a 16-year-old male who developed pityriasis amiantacea (PA) after the use of valproic acid. We propose that the keratinocyte proliferative activity of valproic acid mediated through the inhibition of glycogen synthase kinase-3β, and subsequent activation of the Wnt/β-catenin pathway could play a role in the development of PA. We additionally review the most relevant characteristics of this disease. Read More

PLoS Negl Trop Dis 2018 12 28;12(12):e0007035. Epub 2018 Dec 28.

London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom.

Background: Erythema nodosum leprosum (ENL) is a systemic inflammatory complication occurring mainly in patients with lepromatous leprosy (LL) and borderline lepromatous leprosy (BL). Prednisolone is widely used for treatment of ENL reactions. However, it has been reported that prolonged treatment with prednisolone increases the risk for prednisolone-induced complications such as osteoporosis, diabetes, cataract and arteriosclerosis. Read More

J Drugs Dermatol 2018 Dec;17(12):1338-1339

Rituximab is a chimeric anti-CD20 monoclonal antibody that is very effective in treating patients with pemphigus vulgaris. Though infrequent, the development of human anti-chimeric antibodies in patients receiving rituximab results in loss of efficacy. Ofatumumab is a second-generation fully-human anti-CD20 monoclonal antibody currently used to treat chronic lymphocytic leukemia. Read More

J Allergy Clin Immunol 2019 Jan 17;143(1):66-73. Epub 2018 Dec 17.

Dermatology and Allergy Department, Tenon Hospital, Medecine Sorbonne University, Paris, France; Assistance publique-hopitaux de Paris, Paris, France.

Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Read More

Australas J Dermatol 2018 Dec 18. Epub 2018 Dec 18.

Department of Dermatology, Taipei Medical University Hospital, Taipei, Taiwan.

J Community Hosp Intern Med Perspect 2018 11;8(6):360-362. Epub 2018 Dec 11.

Department of Internal Medicine, Reading Hospital and Medical Center, Tower Health, Reading, PA, USA.

Acute Generalized Exanthematous Pustulosis (AGEP) is a rare drug reaction manifesting as pustular lesions with surrounding erythema following exposure. The disease is often self-limited and treatment is supportive. It may present in an atypical variant with vesicles that desquamate into erosions, which classifies the disease as an AGEP/SJS Overlap. Read More

Medicine (Baltimore) 2018 Dec;97(49):e13211

Department of Hematology.

Rationale: Primary cutaneous anaplastic large cell lymphoma (pcALCL) is a rare subtype of non-Hodgkin lymphoma, which is rarely associated with erythema nodosum (EN).

Patient Concerns: A 57-year-old woman complained of recurrent rashes involving her abdomen, back, upper and lower limbs for over 20 years, with severity in symptoms for 2 weeks.

Diagnoses: The first skin biopsy was performed in 2011 in another hospital and she was diagnosed idiopathic EN. Read More

Indian J Pharmacol 2018 Jul-Aug;50(4):192-196

Department of Pharmacology and Dermatology, SCB Medical College, Cuttack, Odisha, India.

Objectives: To identify the association of cutaneous adverse drug reactions (CADRs) with use of fixed-dose combinations (FDCs) and to compare the occurrence of preventable CADRs between self-medication and prescribed medication of FDCs.

Patients And Methods: All cases of suspected CADRs with the use of FDCs were collected, and causality assessment was carried out using the WHO UMC scale. The burden of CADRs on self-medication and prescribed medication was found out. Read More

Rev Soc Bras Med Trop 2018 Nov-Dec;51(6):877-878

Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brasil.

J Allergy Clin Immunol Pract 2018 Dec 1. Epub 2018 Dec 1.

Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass. Electronic address:

Background: Hypersensitivity reactions (HSRs) are immunologic responses to drugs. Identification of HSRs documented in the electronic health record (EHR) is important for patient safety.

Objective: To examine HSR epidemiology using longitudinal EHR data from a large United States health care system. Read More

An Bras Dermatol 2018 Nov/Dec;93(6):942-943

Medical Residency Program in Dermatology, Faculdade de Medicina de Jundiaí, Jundiaí (SP), Brazil.

An Bras Dermatol 2018 Nov/Dec;93(6):938-939

Department of Clinical and Surgical Dermatology and Venereology, Hospital Universitario de Fuenlabrada, Madrid, Spain.

An Bras Dermatol 2018 Nov/Dec;93(6):874-877

Department of Pathology, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Autoimmune progesterone dermatitis is an uncommon, poorly recognized and under-diagnosed catamenial dermatosis associated with hypersensitivity reactions to progestagens. Most cases manifest as urticaria, eczema or erythema multiforme-like. A 26-year-old woman developed violaceous plaques on the groin and abdomen, 4 days after a spontaneous abortion resolved with uterine curettage. Read More

Pediatr Dermatol 2019 Jan 26;36(1):e62-e63. Epub 2018 Nov 26.

Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Vemurafenib, a selective BRAF kinase inhibitor, has been found to induce several cutaneous adverse effects, ranging from a keratosis pilaris-like reaction to squamous cell carcinoma. While photosensitivity has been well described as one of these manifestations, we report a case of a 6-year-old boy on vemurafenib who developed a severe blistering sunburn after only two 30-minute episodes of sun exposure. A brief review of other common cutaneous adverse effects of vemurafenib is also provided. Read More

Pediatr Dermatol 2019 Jan 26;36(1):e27-e30. Epub 2018 Nov 26.

Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Drug-induced reactions are complications associated with high mortality and significant morbidity. Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of these conditions, which are characterized by skin and mucous lesions. Here, we report a case of a 9-year-old girl who presented with blisters associated with an extensive vesicular rash and multiple ulcerations on the lips and oral cavity. Read More

J Eur Acad Dermatol Venereol 2018 Nov 23. Epub 2018 Nov 23.

Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.

Background: B-rapidly accelerated fibrosarcoma (BRAF) inhibitor encorafenib alone and in combination with MEK inhibitor binimetinib improves survival in BRAF-mutated melanoma patients. So far, the range of cutaneous adverse events has been characterized only for established BRAF inhibitors (vemurafenib, dabrafenib) and MEK inhibitors (trametinib, cobimetinib).

Objective: The aim of this study was to investigate cutaneous adverse events emerging in melanoma patients treated with encorafenib and binimetinib. Read More

Histopathology 2018 Nov 8. Epub 2018 Nov 8.

Department of Dermatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Aims: Persistent pruritic eruptions (PPEs), presenting with dyskeratotic keratinocytes histologically, are characteristic skin rash in patients with adult-onset Still's disease (AOSD). The lesions may be histologically similar to other entities that present with dyskeratosis. In the present study, we compared the histopathological features between PPEs and other entities presenting with dyskeratosis. Read More

Medicine (Baltimore) 2018 Nov;97(45):e13002

Pediatric Ophthalmology Unit, Niguarda Ca' Granda Metropolitan Hospital, Milan, Italy.

Rationale: Studies performed in animal models of corneal neovascularization suggested the possible efficacy of a treatment with propranolol. Corneal neovascularization is one of the most feared complications of Stevens-Johnson syndrome that frequently involves ocular surface. We report the first 2 patients with severe ocular neo-vascularization treated with different degrees of success, with propranolol eye drops. Read More

Acta Dermatovenerol Croat 2018 Oct;26(3):233-242

Corresponding author: Maha Fathy Elmasry, MD , Dermatology Department , Faculty of Medicine , Cairo University, Cairo, Egypt;

A cutaneous adverse drug reaction (CADR) is any undesirable change in the structure or function of the skin, its appendages, or mucous membranes caused by a drug. The frequency of CADRs is variable, with only few studies evaluating it. Our aim was to identify the clinical spectrum of CADRs and document the epidemiological data of different types of drug eruptions among Egyptian patients attending a tertiary care center. Read More

Korean J Pediatr 2018 Oct 30. Epub 2018 Oct 30.

Department of Pediatrics, Kangwon National University Hospital, chuncheon, Korea.

Although rare, antihistamines can casue adverse effects, including drug-induced eruptions or anaphylaxis. A 4-year-old child visited the pediatric department of a hospital for skin eruptions after administration of antihistamines, (e.g. Read More

Cutis 2018 Sep;102(3):E8-E9

Department of Dermatology, Uniformed Services University of the Health Sciences; Section of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

We report the case of an 8-year-old boy who was taking amantadine off label for multiple childhood neurobehavioral disorders and subsequently developed livedo reticularis. Although this side effect is well-described in adult patients taking amantadine for Parkinson disease, it is now being seen in children as the off-label use of amantadine is expanded to this population. Read More

BMJ Case Rep 2018 Oct 27;2018. Epub 2018 Oct 27.

Department of Dermatology, Kawasaki Medical School, Kurashiki, Okayama, Japan.

We experienced a 6-year-old case of drug-induced hypersensitivity syndrome (DiHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) with subsequent development autoimmune thyroiditis (Hashimoto's thyroiditis), type 1 diabetes with antithyroglobulin, thyroid peroxidase, insulinoma-associated antigen and anti-insulin antibodies at 4 months, alopecia at 7 months, vitiligo, uveitis due to Vogt-Koyanagi-Harada disease at 8 months after clinical resolution of the DiHS/DRESS. He was diagnosed as type III polyglandular autoimmune syndrome (PASIII) after DiHS/DRESS. Prompted by this case, we sought to determine which triggering factors were responsible for later development of PASIII in previously published cases with autoimmune sequelae. Read More

Acta Parasitol 2018 Dec;63(4):845-847

Department of Pharmacology, University of Medicine, Avenue Avicenne 5019 Monastir, Tunisia.

We report a case of a 64-year-old woman treated with meglumine antimoniate (Glucantime®). On day 20, she developed fever, a pruriginous skin rash and myalgia. The blood tests showed eosinophilia and hepatic cytolysis. Read More

Pan Afr Med J 2018 12;30:120. Epub 2018 Jun 12.

Service de Dermatologie, HMIMV Rabat, Maroc.

We report the case of a 60-year old patient with a 1-month history of hyperuricemia treated with allopurinol. The patient presented to the Department of Dermatology with acute rash on the face and the lower limbs associated with fever, arthralgias and myalgias. Clinical examination showed symmetric macular erythema on the face at the level of the cheeks with discreet edema (A), erythematous plaques at the level of both legs with healthy skin areas extending progressively from the bottom-up. Read More

Rheumatol Int 2019 Jan 24;39(1):161-166. Epub 2018 Oct 24.

Department of Connective Tissue Diseases, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, Japan.

Tocilizumab (TCZ) is a humanized antihuman interleukin-6 (IL-6) receptor antibody used for the treatment of inflammatory diseases such as rheumatoid arthritis (RA). While TCZ could act as a therapeutic agent, it has a potential for inducing adverse drug events including psoriasis-like eruption. Seven cases with specific reference to TCZ-induced psoriasis eruption have been reported worldwide so far. Read More

Indian J Ophthalmol 2018 Nov;66(11):1627-1629

Department of Pediatrics, Dr Shroff's Charity Eye Hospital, New Delhi, India.

Fixed drug eruption (FDE) is a type of drug-induced cutaneous disorder that characteristically presents with recurrence of similar lesion at the same skin or mucosal site as a result of systemic exposure to a drug. Paracetamol is commonly prescribed analgesic-antipyretic agent in all age group of patients. FDE due to paracetamol is not very common but it is well reported in literature for all age groups. Read More

Pan Afr Med J 2018;30:83. Epub 2018 May 29.

Service de Dermatologie et Vénérologie, Centre Hospitalier Universitaire Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc.

Pan Afr Med J 2018;30:70. Epub 2018 May 29.

University Mohamed V-Suissi Rabat, Faculty of Medicine and Pharmacy of Rabat, Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.

J Fr Ophtalmol 2018 Nov 19;41(9):830-835. Epub 2018 Oct 19.

Service d'ophtalmologie II, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.

Purpose: To report cases of patients with severe bilateral corneal blindness and recurrent refractory perforation to keratoplasty and conventional treatment, for whom Boston keratoprosthesis (KP) was a satisfactory alternative when combined with a temporalis aponeurosis graft.

Description Of Cases: The first patient had progressive Lyell syndrome with spontaneous corneal perforation. The second had a severe graft vs. Read More

Tierarztl Prax Ausg G Grosstiere Nutztiere 2018 Oct 19;46(5):317-322. Epub 2018 Oct 19.

Objective: The aim of this study was the scientific evaluation of an intradermal vaccination method in comparison to an intramuscular vaccination against in suckling piglets with regard to skin reactions, performance parameters and procedural aspects. Possible effects on animal welfare should be deduced.

Material And Methods: Under field conditions, 672 suckling piglets in three batches were vaccinated; 338 intradermally and 334 intramuscularly. Read More

Am J Dermatopathol 2018 Nov;40(11):e143

Department of Dermatology, Boston University School of Medicine, Boston, MA.

Am J Dermatopathol 2018 Nov;40(11):859-860

Department of Dermatology, Boston University School of Medicine, Boston, MA.

Foot (Edinb) 2018 Dec 18;37:45-47. Epub 2018 Jun 18.

Dept. of Orthopedics, John Peter Smith Hospital, United States.

Drug eruptions represent a wide spectrum of cutaneous reactions to various pharmaceutical agents. Given their complexity and varied patterns of presentation, these phenomena are the subject of study of many fields of medicine. Gabapentin is a widely prescribed medication, with numerous drug reactions previously reported. Read More

J Am Acad Dermatol 2018 Nov;79(5):807-818

St. John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom.

Having reviewed the diverse clinical subtypes of lichenoid disease and the postulated molecular basis thereof in the first article in this 2-part continuing medical education series, we discuss herein the existing and emerging treatment strategies in the most common clinical forms of lichenoid inflammation and provide an overview of their pharmacodynamics and evidence base. The scope of this review is not to exhaustively discuss treatment modalities for all lichenoid variants discussed in the previous article of this series. Instead, the focus will be on frequently encountered subtypes of lichen planus and on linking mechanisms of disease with mechanisms of drug action. Read More

BMJ Case Rep 2018 Oct 12;2018. Epub 2018 Oct 12.

Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, Birmingham, Birmingham, UK.

A 38-year-old woman presented to casualty with bilateral red eyes associated with a recent upper respiratory tract infection. This was initially diagnosed as conjunctivitis, however systemic review revealed an erythematous facial and skin rash, mildly swollen lips and mild swallowing difficulties. The patient was referred for an urgent medical assessment, by which time she was found to have erythema affecting 54% of her body surface area and diagnosed with suspected toxic epidermal necrolysis (TEN). Read More

Contact Dermatitis 2019 Feb 11;80(2):118-124. Epub 2018 Oct 11.

Department of Dermatology and Allergy, University Hospital, Würzburg, Germany.

Background: Anaphylaxis-like reactions developing within a few minutes are the most frequent complications of subcutaneous or submucosal injections of local anaesthetics (LAs), and topically applied LAs are potential contact allergens. In addition, injected LAs have been reported to induce delayed reactions, including local inflammation at the injection site, and various general symptoms.

Objectives: To assess the frequency and symptoms of late-type hypersensitivity occurring several hours after LA injections. Read More

Rev Assoc Med Bras (1992) 2018 May;64(5):415-419

Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brasil.

Introduction: Direct-acting antivirals are new drugs for chronic hepatitis C treatment. They are usually safe and well tolerated, but can sometimes cause serious adverse effects and there is no consensus on how to treat or prevent them. We described a case of hand-foot syndrome due to hepatitis C virus interferon-free therapy. Read More

BMJ Case Rep 2018 Oct 8;2018. Epub 2018 Oct 8.

Division of Allergy and Clinical Immunology, Department of Medicine, East Tennessee State University James H Quillen College of Medicine, Johnson City, Tennessee, USA.