1/16. Quinolone drug rash in a patient with infectious mononucleosis.infectious mononucleosis and the associated ampicillin rash are well documented. The case of a patient with infectious mononucleosis who was treated with levofloxacin and developed a rash similar to the ampicillin rash is reviewed. The exact mechanism is not understood. With closer observation, physicians may be able to recognize more cases with similar phenomena.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/16. Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after hiv exposures--worldwide, 1997-2000.In September 2000, two instances of life-threatening hepatotoxicity were reported in health-care workers taking nevirapine (NVP) for postexposure prophylaxis (PEP) after occupational human immunodeficiency virus (hiv) exposure. In one case, a 43-year-old female health-care worker required liver transplantation after developing fulminant hepatitis and end-stage hepatic failure while taking NVP, zidovudine, and lamivudine as PEP following a needlestick injury (1). In the second case, a 38-year-old male physician was hospitalized with life-threatening fulminant hepatitis while taking NVP, zidovudine, and lamivudine as PEP following a mucous membrane exposure. To characterize NVP-associated PEP toxicity, CDC and the food and Drug Administration (FDA) reviewed MedWatch reports of serious adverse events in persons taking NVP for PEP received by FDA (Figure 1). This report summarizes the results of that analysis and indicates that healthy persons taking abbreviated 4-week NVP regimens for PEP are at risk for serious adverse events. Clinicians should use recommended PEP guidelines and dosing instructions to reduce the risk for serious adverse events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/16. Nonpigmenting solitary fixed drug eruption after skin testing and intra-articular injection of triamcinolone acetonide.BACKGROUND: Although several medications have been reported to cause fixed drug eruption (FDE) reactions, triamcinolone acetonide has not been previously described as an offending agent. OBJECTIVE: To emphasize both an unprecedented causative agent and the extraordinary development of a FDE, we describe this response in a 42-year-old female patient. methods: Because her history included a questionable reaction to corticosteroid preparations, prick and intradermal testing with triamcinolone acetonide was done to determine whether she could safely receive a triamcinolone acetonide injection. RESULTS: Both skin test procedures and the intra-articular administration of triamcinolone acetonide caused FDEs on her right retroauricular area. CONCLUSIONS: Because any drug may induce a FDE by any administration route, physicians should be aware of this delayed skin reaction when skin testing drugs.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/16. life threatening tongue angioedema associated with an angiotensin-converting enzyme inhibitor.We present a case with angioedema of the tongue, following 1 dose of an angiotensin-converting enzyme (ACE) inhibitor ingestion. A gradual progression of angioedema required tracheotomy despite aggressive medical treatment and illustrates the severity of this adverse reaction. Although ACE inhibitors are considered safe, emergency physicians should be alert for minor angioedema at presentation that may progress to life threatening airway compromise.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/16. Chemotherapy-induced palmer planter erythrodysesthesia.We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/16. Liposuction and extravasation injuries in ICU.Liposuction is a minimally invasive surgical technique, occasionally used to minimize the risk of devastating soft tissue necrosis following extravasation of noxious substances. Anaesthetists and intensive care physicians frequently use agents that may cause serious tissue injury if extravasated. Therefore, knowledge on how to manage this complication is important. We present two cases of percutaneous extravasation of noxious agents in intensive care patients and discuss their subsequent management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/16. Olanzapine-induced vasculitis.INTRODUCTION: Elderly patients are particularly vulnerable to adverse drug reactions as a result of polypharmacy and metabolic changes associated with aging. We present a case of leukocytoclastic vasculitis induced by olanzapine, a medication commonly used in elderly patients. CASE SUMMARY: An 82-year-old woman was admitted to the extended-care center for short-term rehabilitation after prolonged hospitalization for a pulmonary embolism requiring mechanical ventilation. The pulmonary problem resolved, but her hospitalization and subsequent rehabilitation were complicated by agitated delirium, which was treated with olanzapine and modification of contributory factors. At the time of admission to the rehabilitation facility, the patient had been receiving warfarin for 2 weeks and olanzapine for 6 days. On the eighth day after initiation of olanzapine, erythematous skin lesions developed on dependent areas. The international normalized ratio for warfarin was within the acceptable range; however, because warfarin has been associated with subcutaneous bleeding presenting as petechiae and ecchymosis, subcutaneous enoxaparin was substituted for warfarin. The skin lesions continued to worsen over the next week and developed into palpable lesions. biopsy of the rash revealed leukocytoclastic vasculitis. In the absence of another cause, olanzapine was discontinued and the rash improved significantly. When the agitation recurred, risperidone was initiated, but the patient experienced dizziness with this agent. Olanzapine was resumed and the skin lesions recurred. Olanzapine was then changed to quetiapine, and the skin lesions improved over the next few weeks. DISCUSSION: Olanzapine is commonly used in elderly patients to control behavioral disturbances associated with dementia, delirium, and other psychiatric disorders. Leukocytoclastic vasculitis is an infrequently reported adverse drug reaction with olanzapine. Its exact pathogenic mechanism is unknown, but both cell-mediated and humoral immunity appear to play important roles. Because drug-induced vasculitis has an identical clinical presentation and identical serologic/pathologic parameters to idiopathic forms of vasculitis, a high index of suspicion is necessary for its accurate diagnosis. CONCLUSIONS: Because adverse drug reactions are common in elderly patients taking multiple medications, physicians should be vigilant when starting new medications and should attempt to eliminate unnecessary medications. Clinicians should be aware of the potential for leukocytoclastic vasculitis in association with olanzapine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/16. Delayed hypersensitivity reaction to subcutaneous heparin.Two women developed well-demarcated eczematous and erythematous plaques localized to the injection sites of subcutaneous preservative-free heparin 72-96 h after heparin administration. The plaques resolved within a week of discontinuing the therapy. Neither epicutaneous testing with preservative-free heparin nor in vitro proliferation assays to heparin and two low molecular weight glycosaminoglycans could elicit a response in either patient. In contrast, both patients developed localized eczematous plaques 48-96 h after re-challenge with intradermal and/or subcutaneous heparin. Delayed hypersensitivity reactions to subcutaneous heparin are uncommon and have not been reported in the Australasian medical literature. Given the frequency with which heparin preparations are used, it is important for physicians and surgeons to be aware of this potential adverse reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/16. Fixed drug eruption following rifampin treatment.A case of fixed drug eruption (FDE) associated with ingestion of rifampin in a young physician is reported. The drug was prophylactically administered because of a previous close contact with a meningococcemic patient. The eruption consisted of two solitary painless purplish lesions located over the extensor surface of the left forearm, characteristic of FDE, except for the absence of residual hyperpigmentation. It is suggested that slight lesions of FDE could be unnoticed or misdiagnosed, thus raising the possibility that such skin reactions to rifampin are more frequent than is reflected in the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/16. Fixed drug eruption to sulindac.We report a case of fixed drug eruption secondary to sulindac (Clinoril). Owing to the drug's current popularity we believe that physicians should be made aware of this phenomenon. We present a patient who had the unusual feature of hypopigmentation associated with healing of his lesion. A brief review of clinical features and pathophysiology of fixed drug eruption is also presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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