Drug hypersensitivity reactions (DHRs) are a type of adverse drug reactions with heterogeneous pathophysiological mechanisms and a broad spectrum of clinical manifestations. Since over-diagnosing is common in children, a complete allergy work-up is needed. A cross-sectional study was conducted at a tertiary care institution, covering the five-year period. Five hundred and four patients of both sexes, mean age 7.5 and with a medical history suggestive of DHR were evaluated. ENDA/EAACI guidelines were used for a diagnostic algorithm. Single drug hypersensitivity was registered in 375 patients and multiple drug hypersensitivity in 129. The main culprits in medical history were antibiotics (83%), non-steroidal anti-inflammatory drugs (NSAIDs) (8.4%) and analgoantipyretics (3.8%). Skin involvement was registered in 96.2%. DHRs were confirmed in 4.4% patients—six patients had positive skin tests and 13 had a positive drug provocation test. In the proven DHRs group, the main agents were antibiotics (72.7%), followed by NSAIDs (8.3%), and of all the skin manifestations, urticaria was most common (78.2%), followed by exanthema (10.5%) and angioedema (5.3%). Considering the above, anticipating DHRs and a proper referral of children to an allergologist is a key step in the assessment of drug hypersensitivity. A complete allergy work-up prevents unnecessary drug exclusion and allows most children to safely continue the use of first-line medications when needed.

Therapeutic recommendations for pediatric acute respiratory distress syndrome (PARDS) include conventional (CMV) and rescue high-frequency oscillatory mode (HFOV) of mechanical ventilation (MV). The pediatric risk of mortality (PRISM) is a frequently used mortality score for critically ill patients. In search of methods to recognize those patients, we analyzed the PRISM III score as a potential predictor of the short-term outcome in MV subjects with PARDS. A retrospective five-year study of PARDS in children on MV was conducted in the Pediatric ICU. Seventy patients were divided into two groups (age group <1 year and age group 1–7 years). The PRISM III score was used to assess the 28-day outcome and possible development of complications. The most common causes of PARDS were pneumonia and sepsis. Male sex, malnourishment, sepsis, and shock were significant indicators of poor outcome. The PRISM III score values were significantly higher in those who died, as well as in subjects requiring HFOV. The score had a significant prognostic value for short-term mortality. There was no significant difference in outcome based on the comparison of two modes of ventilation. A significantly higher score was noted in subjects who developed sepsis and cardiovascular insufficiency. The PRISM III score is a fair outcome predictor during the 28-day follow-up in MV subjects with PARDS, regardless of the ventilation mode.

Psoriasis is a chronic inflammatory disease associated with an increased cardiovascular risk (CVR). The mechanisms linking psoriasis to coronary atherosclerosis have not yet been fully elucidated. A dynamic interplay between metabolic disturbances, immune mechanisms, and elevated atherogenic lipoprotein particles may contribute to the accelerated development of atherosclerosis. Patients with psoriasis (n = 104) without known coronary artery disease underwent coronary computed tomography angiography (CCTA) to detect subclinical coronary atherosclerosis. Clinical data, metabolic parameters and indices, lipid fractions including remnant cholesterol, and immunological markers (immunoglobulin A- IgA) were analyzed. Associations with CT-confirmed coronary stenosis were assessed using univariate and multivariate logistic regression models. Patients with coronary atherosclerosis exhibited a more adverse metabolic and lipid profile. Remnant cholesterol emerged as a strong independent predictor of coronary stenosis. Elevated IgA levels were associated with the presence of coronary atherosclerosis, suggesting a potential role of immune activation that extends beyond general systemic inflammation. Longer duration of psoriasis correlated with the presence of coronary atherosclerosis, highlighting the importance of cumulative inflammatory burden. Our findings indicate that subclinical coronary atherosclerosis in patients with psoriasis is closely associated with an immuno-metabolic risk profile encompassing atherogenic lipoprotein fractions and immune activation. These results underscore the need for a broader approach to cardiovascular risk assessment in this population, extending beyond the evaluation of traditional cardiovascular risk factors alone.

Mycosis fungoides (MF) is a rare primary cutaneous T-cell lymphoma (pCTCL) that generally has an indolent course with a favorable prognosis. However, numerous clinical variants have been described that differ substantially from classic Alibert–Bazin MF, resulting in altered prognosis, treatment response, and patient outcomes. This narrative review considers rare MF variants—bullous, ichthyosiform, hypopigmented, folliculotropic, poikilodermatous, granulomatous, granulomatous slack skin, pagetoid reticulosis and syringotropic MF—with emphasis on practical diagnostic approaches for clinicians. Given that MF can mimic more than 50 different dermatoses and is frequently associated with prolonged diagnostic delay, we provided detailed clinical and dermoscopic features that should raise diagnostic suspicion and guide biopsy decisions. We discussed extensive differential diagnoses for each variant and highlighted MF’s status as dermatology’s “great imitator.” Additionally, we addressed the risk of second primary malignancy in patients with MF, as well as the genetic and microenvironmental factors proposed to contribute to its clinical heterogeneity. Furthermore, we evaluated existing classification systems and suggested future directions that integrate molecular data and tumor biology to improve prognostic assessment and guide therapeutic decision-making.

Background/Aim. Psoriasis is a chronic, immune-mediated, genetically determined disease, which is manifested by the appearance of erythematous scaly plaques. Treatment includes conventional therapies and biologics. The coronavirus disease 2019 (COVID-19) raised widespread concern for patients with psoriasis treated with immunosuppressive drugs, especially biologics. Even though there was no data at the beginning of the pandemic on the efficacy and safety of vaccines against COVID-19 in patients with psoriasis treated with biologics, the National Psoriasis Foundation (United States of America) recommended vaccination in these patients. The aim of this study was to evaluate the influence of COVID- 19 on clinical characteristics and quality of life of psoriatic patients treated with biologics and evaluate the effectiveness of biologic therapy during the pandemic. Methods. A retrospective cross-sectional study was conducted at the Clinic of Dermatology and Venereology of the University Clinical Center of Serbia from March 2020 to January 2022. Data was collected from medical documentation during the consecutive hospitalization of patients with psoriasis who received biologics. Results. The study included a total of 181 patients with psoriasis divided into two groups. Patients from each group were treated with different biologics (ustekinumab in 63.0% and secukinumab in 37.0% of patients). They achieved significant improvement regarding their clinical characteristics after a two-year follow-up [Psoriasis Area and Severity Index (PASI) before treatment: 14.1 (0-50.5) and after treatment: 1.2 (0-49.7), p < 0.001] and quality of life [Dermatology Life Quality Index (DLQI) before treatment: 15.0 (0-34) and after treatment: 0 (0-28), p < 0.001]. Due to unsatisfactory therapeutic response in 4 (2.2%) patients, secukinumab was changed to ustekinumab. The vaccine against COVID-19 was given to 53.0% of patients, but only 20.4% received all three doses. Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed in 64 (35.4%) patients, and 68.0% of those infected contracted the disease before the first dose of the vaccine. Therapy with biologics was delayed due to SARS-CoV-2 infection in 52 (28.7%) patients, of which 11 (21.2%) had exacerbation of psoriasis. Conclusion. The vaccination rate in patients with psoriasis receiving biologics was hardly 50.0%, and about a third of the vaccinated patients had a milder form of COVID-19. The therapy with biologics was successful regardless of the short-term interruption of drug administration due to the beginning of the COVID-19 pandemic and the worsening of psoriasis in some patients during that time.