1/16. hypersensitivity reaction in a child due to lamotrigine.Lamotrigine is an anticonvulsant with a broad spectrum of activity that has been approved in the united states for use in adults with either partial or generalized seizures. This drug is being widely prescribed by pediatricians and neurologists because it is effective in children with idiopathic, resistant, generalized seizures and does not impair cognition. As with other anticonvulsants, a hypersensitivity syndrome has been described. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, and lymphadenopathy. We report the first case of hypersensitivity syndrome in a child due to lamotrigine in which we believe the coadministration of valproic acid increased the duration of the reaction. Our patient had a high spiking fever, generalized morbilliform eruption, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and an elevation in his liver function tests. The syndrome resolved with the discontinuation of the medication. Anticonvulsant hypersensitivity syndrome may occur with the administration of lamotrigine. Variable presentations may be seen, as hypersensitivity syndromes may be multisystem in nature. The prompt recognition of the signs and symptoms of this condition allows an accurate diagnosis so that the drug may be discontinued and other anticonvulsant treatment options instituted.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/16. Delayed hypersensitivity to enoxaparin.A 65-year-old woman experienced immediate itchy erythematous patches at the subcutaneous injection sites of sodium enoxaparin. An erythematous and infiltrated 40 x 20 mm lesion on the abdominal wall could be observed at the site of enoxaparin injection when she was referred to our clinic 48 h after injection. Lesions subsided spontaneously within 1 week. She had been on this treatment 1 and 3 years before without any adverse reaction. To clarify the nature of the reaction, epicutaneous tests with sodium enoxaparin, calcium nadroparin and calcium heparin were performed, all with negative results. Skin prick test with sodium enoxaparin was also negative. biopsy of the cutaneous lesion showed spongiotic dermatitis, strongly suggesting a delayed hypersensitivity mechanism. We report here on a new case of delayed hypersensitivity to enoxaparin. Being female, overweight and having prolonged application of the drug were suggested risk factors present in our patient. biopsy was essential for diagnosis. Although type IV hypersensitivity reactions to enoxaparin are rare, we should start to suspect this condition in order not to underdiagnose it.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/16. Macular exanthema appearing 5 days after X-ray contrast medium administration.We report a case of widespread, pruritic macular exanthema appearing 5 days after intravenous administration of the X-ray contrast medium, iohexol (Omnipaque) in a patient who had not previously received any X-ray contrast medium. The eruptions resolved in 7 days, leaving no residual lesions. When the patient was challenged intradermally with the same contrast medium 1.5 months after recovery, the same type of eruption developed 1 day after challenge. Histological examination of biopsies from positive skin test sites revealed the presence of a dermal infiltrate of lymphocytes. This case is another example of a late-onset adverse reaction to an X-ray contrast medium, mediated by specific T cells. The usefulness of intradermal skin testing for confirming the allergic nature of the reaction and for studying cross-reactivity pattern is emphasized.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/16. warfarin-induced skin necrosis associated with acquired protein c deficiency.A 36-year-old woman developed skin necrosis of the inner thighs following the re-introduction of warfarin after a laparoscopic cholecystectomy. She had a history of liver disease and cardiomyopathy and was on warfarin for 10 years. warfarin-induced skin necrosis secondary to protein c deficiency was diagnosed. Although warfarin was ceased immediately, the prothrombin time measurements remained prolonged and warfarin levels remained therapeutic. Our patient, who had attached great significance to warfarin therapy, had continued the ingestion of warfarin despite our advice. She required three surgical debridements. Protein C levels, as measured 1 year later, were within normal limits, confirming the transient nature of the acquired deficiency during the acute event. This is the second reported case of warfarin necrosis associated with acquired protein c deficiency.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/16. Not all pustules are infective in nature: acute generalised exanthematous pustulosis causing pustular eruptions in an elderly woman.Acute generalised exanthematous pustulosis (AGEP) is an adverse drug reaction that can occur in any age group. It is commonly mistaken as pustular psoriasis or cutaneous infection, resulting in unnecessary commencement of medications such as methotrexate and antibiotics that can cause harm to the patient or interact and adversely affect the efficacy of other medications. early diagnosis of AGEP avoids unnecessary investigations and treatment, which not only can harm the patient but also escalate health care, as the condition is self-limiting. This case report illustrates AGEP secondary to cefaclor occurring in a 72-year-old Chinese woman. Although the literature has documented the occurrence of AGEP with cefaclor, the unique feature of this case is the occurrence of AGEP following repeated uneventful courses of cefaclor. This case highlights that AGEP must never be forgotten in the work-up for pustular eruptions in an elderly patient.- - - - - - - - - - ranking = 4keywords = nature (Clic here for more details about this article) |
6/16. Gentamicin: systemic exposure to a contact allergen.A case is presented of an allergic dermatitis provoked by intravenous gentamicin in a patient previously sensitized by topical medications. patch tests confirmed hypersensitivity to gentamicin and neomycin. The nature of reactions to contact allergens given systemically and the nature of cross-reactions between aminoglycoside antibiotics are reviewed.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
7/16. nephrotic syndrome and immune complex glomerulonephritis associated with chlorpropamide therapy.Therapeutic drugs are well-recognized as a cause of the nephrotic syndrome in humans. However, documentation of the renal histopathologic features is lacking or incomplete in many cases. Even when accurate histopathologic information is available, there is little evidence to support a specific pathogenetic mechanism of renal injury in the vast majority of cases. We describe a patient with diabetes who had hepatitis and dermatitis in association with the use of chlorpropamide. In addition to these well-described toxic reactions to this drug, the nephrotic syndrome developed. Renal biopsy revealed the presence of a proliferative glomerulonephritis that was shown to be of an immune complex nature on immunofluorescence and electronmicroscopic study. Serial serum complement levels and circulating immune complex levels were consistent with an immunologically mediated reaction. Repeated renal biopsy documented resolution of the renal changes. Thus, in this patient, a drug-induced nephrotic syndrome was associated with a proliferative glomerulonephritis, probably due to the formation of immune complexes.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/16. The captopril-induced eruption. A possible mechanism: cutaneous kinin potentiation.captopril, an orally active dipeptidyl-carboxypeptidase inhibitor, is a promising new antihypertensive agent. Cutaneous reactions are the most common side effects of this therapy. The data from 15 previous cases and seven new ones are reviewed. The cutaneous eruptions appear to be pharmacologic. In nature, occurring mostly at higher dosage schedules and resolving at lower dosage levels. Historical data, the results of skin tests, and the known pharmacology of captpril suggest that these captopril-induced eruptions may be the result of potentiation of kinin-mediated cutaneous reactions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/16. Skin reactions to carbamazepine.Three patients with a generalized eruption caused by carbamazepine are described. Two reactions were eczematous, and one was lichenoid in nature. Oral challenge with the drug reproduced the skin disorder in each of these patients. Immunofluorescence microscopy studies demonstrated that in four out of six subjects taking carbamazepine, there were deposits of immunoglobulins in the skin.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/16. ethambutol-induced pulmonary infiltrates with eosinophilia and skin involvement.A 67 year old woman presented with miliary tuberculosis. She was treated with streptomycin, isoniazid, rifampicin, ethambutol and pyrazinamide. However, she developed rifampicin-induced thrombocytopenia after 6 weeks of treatment, and skin rash, blood eosinophilia and pulmonary infiltrates after 8 weeks of therapy. The latter was found to be ethambutol related. Additional evidence, including blood and sputum eosinophilia and the rapidity of its response to corticosteroid, suggested that the pulmonary infiltrates might also be eosinophilic in nature. To the best of our knowledge, this constitutes the first report of such adverse drug reaction, induced by ethambutol.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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