Table 1.
Characteristics of patients who developed PAS after drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms
| Patient no. (Ref no.) |
Age (y)/sex | Suspected medications | Systemic corticosteroid therapy (mg/day) | Additional therapy | PAS type | Symptoms of PAS | Autoantibodies | Occurrence of autoimmune sequelae and detection of autoantibodies (weeks or months after onset) |
| 16 | 15/F | Minocycline | PSL 40 mg; escalation dose from 10 mg to 40 mg for 4 days) | None | IIIA | Autoimmune thyroiditis, autoimmune- associated type 1 diabetes | Anti-TPO, TG, TSI, TSHR, GAD, IA2, ANA, Sm and SS-A antibodies |
7 weeks: autoimmune thyroiditis in the thyrotoxic phase with anti-TG and TPO antibodies. 5 months: Graves disease with anti-TSI and TSHR antibodies. 7 months: type 1 diabetes with anti-GAD and IA2 antibodies. ANA, anti-Sm and SS-A antibody titres were elevated. |
| 27 | 17/F | Zonisamide | Pulsed PSL; 1 g of mPSL for 3 days followed by 45 mg of PSL | None | IIIA+C | Autoimmune thyroiditis, immune-mediated type1 diabetes, alopecia, vitiligo. Photophobia, vision impairment, uveitis due to Vogt-Koyanagi- Harada disease |
Anti-TPO, TG and TSHR antibodies |
2 months: type 1 diabetes, autoimmune thyroiditis (Hashimoto’s thyroiditis) with anti-TPO, TG and TSHR antibodies. 5 months: alopecia. 6 months: vision impairment. 9 months: vitiligo. 10 months: Vogt-Koyanagi-Harada disease. |
| 38 | 21/F | Lamotrigine | mPSL 160 mg (40 mg every 6 hours) followed by 80 mg of PSL |
IVIG | IIIA | Autoimmune thyroiditis, immune-mediated type 1 diabetes | Anti-TPO, anti-insulin and IA2 antibodies |
5 months: type 1 diabetes with anti-insulin and IA2 antibodies. 8 months: autoimmune thyroiditis. |
| 43 | 46/F | Zonisamide | Pulsed PSL, 1 g of mPSL for 3 days | IVIG | IIIC | Alopecia, autoimmune thyroditis, Raynaud’s phenomenon, sclerodermatous lesions | ANA, RF, anti-ss-DNA, centromere, cardiolipin and TSHR antibodies |
6 months: alopecia. 3 years: thyroid dysfunction, Raynaud’s phenomenon. 4 years: sclerodermatous lesions with increased titres of ANA. |
| Five present case | 6/M | Sulfamethoxazole/trimethoprim | PSL 36 mg (1.5 mg/kg/day) | IVIG | IIIA+C | Autoimmune thyroditis, immune-mediated type 1 diabetes, alopecia, vitiligo, uveitis | Anti-TG, TPO, IA-2 and anti-insulin antibodies |
4 months: autoimmune thyroiditis (Hashimoto’s thyroiditis), type 1 diabetes with anti-TG, TPO, IA-2 and anti-insulin antibodies. 7 months: alopecia. 8 months: vitiligo, uveitis due to Vogt-Koyanagi-Harada disease. |
ANA, antinuclear antibodies; F, female; GAD, glutamic acid decarboxylase; IA2, insulinoma-associated antigen-2; IVIG, intravenous immunoglobulin; M, male; PAS, polyglandular autoimmune syndrome; PSL, prednisolone; TG, thyroglobulin; TPO, thyroid peroxidase; TSHR, thyroid stimulating hormone receptor; TSI, thyroid stimulating immunoglobulin.