We present the case of an 80-year-old lady known to be sensitive to chlorocresol (4-chloro-3-methyl phenol) who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin. All medications except insulin were stopped, without major improvement. It was noted that the insulin contained m-cresol (m-methyl phenol) so a parabens-based insulin was substituted. There was a significant improvement in her clinical condition within 72 hr. Further patch and intradermal testing to the insulin and m-cresol was planned, but she developed a nosocomial infection and died. We hypothesize that the adverse cutaneous reaction was a systemic manifestation of cresol sensitivity, given the rapid clinical resolution on changing insulins and the previously demonstrated sensitivity to chlorocresol, particularly as cross-reactivity between different low molecular weight methyl phenols is documented. Local injection site reactions and systemic side-effects including nausea, diarrhoea and vomiting have previously been reported with cresol-containing insulins, although to our knowledge, this is the first reported case of a severe cutaneous reaction. It is important to be aware of m-cresol as a potential allergen, as it is contained in most commercially available insulins.

译文

:我们介绍了一位80岁的女士,她对氯甲酚(4-氯-3-甲基苯酚)敏感,在开始皮下注射胰岛素2周后发展出严重的非典型性红皮病性剥脱性皮炎。除胰岛素外,所有药物均已停止使用,无明显改善。注意到胰岛素包含间甲酚(间甲基苯酚),因此取代了基于对羟基苯甲酸酯的胰岛素。她的临床状况在72小时内有了显着改善。计划对胰岛素和间甲酚进行进一步的贴片和皮内测试,但她发生了医院感染并死亡。我们假设不利的皮肤反应是对甲酚敏感性的全身表现,考虑到快速变化的胰岛素临床解决方案和先前证明的对氯甲酚的敏感性,特别是由于记录了不同低分子量甲基酚之间的交叉反应性。含甲酚的胰岛素以前曾报道过局部注射部位反应和全身副作用,包括恶心,腹泻和呕吐,尽管据我们所知,这是首次报道的严重皮肤反应病例。重要的是要意识到间甲酚是一种潜在的过敏原,因为它包含在大多数市售胰岛素中。

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