221/750. subarachnoid hemorrhage and death following coingestion of MDMA with other drugs. Ecstasy, the popular name for 3,4-methylenedioxymethamphetamine (MDMA), is a synthetic amphetamine derivative. It stimulates the sympathetic nervous system, producing serious adverse effects on the cardiovascular system. We present a 20-year-old female patient, who developed subarachnoid hemorrhage (SAH) and death following MDMA and coingestion with other drugs. She suffered from severe headache followed by vomiting, and conscious change 5 hours after an intake of 1 tablet MDMA and other drugs at a dance club. Her blood pressure was 226/164 mmHg, pulse rate 164/min, respiratory rate 30/min on arrival at our emergency department. Diffuse rales were heard over both lung fields. Both pupils' sizes were 4 mm, with sluggish reaction to light. A 12 lead electrocardiograph showed sinus tachycardia, ST depression in the inferior leads and V4 to V6 precordial leads. Laboratory findings revealed normal except a slightly raised white cell count and glucose. Arterial blood gas analysis showed pH was 7.333, with PaCO2 24.6 mmHg, PaO2 151.7 mmHg and HCO3 12.8 mmol/L. Chest x-ray revealed acute pulmonary edema. Urgent computerized tomography scanning of the head demonstrated SAH. Her condition continued to deteriorate, and went to deep coma and shock status. She expired on the second day although we treated aggressively. ( info) |
| electroconvulsive therapy (ECT) can be used for the treatment of mental disorders, either alone or along with psychotropic agents and/or drugs for other medical conditions. We present in this case report a patient with postpartum depression on ciprofloxacin therapy for a urinary tract infection. The seizure in the first ECT treatment lasted for 30 seconds. While under the care of ECT, the patient was diagnosed as having a urinary tract infection; therefore, ciprofloxacin therapy of 1000 mg/day was initiated. Her second ECT seizure, which was on the third day of ciprofloxacin therapy, was terminated with 3 mg of intravenous midazolam at the 150th second. The ciprofloxacin therapy was discontinued. The patient had not previous history of epilepsy, and the investigation results for the extended seizure were found to be normal. The ECT therapy was restarted 3 days later, and total of 8 treatments were completed, lasting 35-70 seconds. Because the first ECT lasted for 30 seconds and subsequent therapy, which was reinitiated 3 days after the discontinuation of ciprofloxacin, lasted no longer than 70 seconds, the extended seizure in this patient is thought to be related to ciprofloxacin. ( info) |
223/750. escherichia coli: development of carbapenem resistance during therapy. A 76-year-old woman had recurrent urosepsis due to extended-spectrum beta -lactamase-positive escherichia coli. imipenem resistance was detected after long-term imipenem-meropenem therapy. The carbapenem-hydrolyzing enzyme gene was identified as blaKPC-3. To our knowledge, this is the first documented case in which carbapenem-resistant E. coli emerged during therapy with imipenem and meropenem, and the first identification of the carbapenem-hydrolyzing enzyme in E. coli isolates. ( info) |
224/750. Neonatal group B streptococcus sepsis after negative screen in a patient taking oral antibiotics. BACKGROUND: Group B streptococcus (GBS) is a leading cause of serious neonatal infection. Neonatal morbidity and mortality can be reduced by appropriate prenatal screening and intrapartum chemoprophylaxis. CASE: A 20-year-old primigravida was treated with oral antibiotics at 35 weeks for a recurrent urinary tract infection. Her GBS screen following the antibiotic treatment showed a negative culture. The patient, therefore, did not receive intravenous antibiotics during her induction of labor for mild preeclampsia. The infant developed early onset neonatal GBS pneumonia and sepsis. CONCLUSION: Oral antibiotics can cause a temporary negative culture in a GBS-colonized patient. Relying on a negative culture for management may not be appropriate in a patient treated with oral antibiotics. Additional studies are necessary to elucidate the effects of oral antibiotics on GBS. ( info) |
| Three middle-aged males and one female were diagnosed as having urinary tract infections (UTIs) between 2001 and 2003 in the Wesley Guild Hospital, Ilesa, a unit of Obafemi Awolowo University teaching hospitals Complex, Ile Ife, Osun State, nigeria. Of the 4 patients, only the female was asymptomatic. The 3 males had pseudomonas aeruginosa, klebsiella species, and staphylococcus aureus, respectively, in their urine samples, while the female had escherichia coli. All 4 patients were treated with grapefruit seeds (citrus paradisi) orally for 2 weeks and they all responded satisfactorily to the treatment except the man with P. aeruginosa isolate. However, the initial profuse growth of Pseudomonas isolate in the patient that was resistant to gentamicin, tarivid, and augmentin later subsided to mild growth with reversal of the antibiotic resistance pattern after 2 weeks' treatment with grapefruit seeds. These preliminary data thus suggest an antibacterial characteristic of dried or fresh grapefruit seeds (C. paradisi) when taken at a dosage of 5 to 6 seeds every 8 hours, that is comparable to that of proven antibacterial drugs. ( info) |
226/750. Transient psychosis in an immune-competent patient after oral trimethoprim-sulfamethoxazole administration. We describe a rare adverse reaction to trimethoprim-sulfamethoxazole (TMP-SMX; Septra, Bactrim) in an immune-competent female adolescent. She was prescribed TMP-SMX for a urinary tract infection, which she had developed while being treated in the hospital for an extensive leg cellulitis. Shortly after receiving her third dose of TMP-SMX, she developed an acute altered mental status with agitation as well as vivid visual and auditory hallucinations. After prompt discontinuation of TMP-SMX, the patient slowly began to improve and was able to return to her baseline mental status within 10 days. No residual mental status changes were present. Despite the recent emergence of multidrug-resistant bacterial pathogens, TMP-SMX, one of the first-generation broad-spectrum antibiotics, continues to be widely prescribed, in part because of its low cost and its easy availability. It is generally well tolerated and is associated with relatively few adverse effects. More common toxicities associated with TMP-SMX include hypersensitivity reactions, bone marrow suppression, and gastrointestinal side effects. central nervous system toxicity is very rare; when reported, it has been in an immune-compromised or an elderly patient. ( info) |
227/750. Transvaginal contraception--avoid the bladder. We report two cases of female contraceptive methods, resulting in urological presentation, with bladder foreign bodies. history, mode of diagnosis and surgical extraction technique differed in both patients. The first, where a thermometer was lost intravesically whilst measuring an internal temperature, presented immediately. A plain abdominal X-ray confirmed the position of the foreign body. Extraction was performed cystoscopically with the thermometer intact. A second patient, with recurrent urinary tract infections, was found to have an intrauterine contraceptive device (IUCD) in her bladder on ultrasound. Attempts to remove it endoscopically failed, and an, open procedure was required to free the IUCD from the bladder sidewall. ( info) |
| OBJECTIVE: To report a case of sulfhemoglobinemia in a patient receiving phenazopyridine for a urinary tract infection. CASE SUMMARY: A 63-year-old white woman presented to the emergency department with complaints of fatigue and bluish discoloration of her body that had gradually progressed over the previous 6-8 weeks. About 4 months prior to presenting to the emergency department, she had started taking phenazopyridine, an over-the-counter medication for symptoms of dysuria. Because the cyanosis did not improve after the patient received oxygen and methylene blue, sulfhemoglobinemia was suspected and confirmed by spectrophotometer analysis. DISCUSSION: Sulfhemoglobin is a green-pigmented molecule containing a sulfur atom in one or more of the porphyrin rings. It is a rare cause of cyanosis, which is usually drug induced. sulfhemoglobinemia is suspected when a cyanotic patient has normal to near-normal oxygen tension, laboratory reports of elevated methemoglobin, and does not respond to methylene blue therapy. sulfhemoglobinemia is relatively rare, despite the widespread use of drugs that have been reported to cause it. Predisposing factors, such as chronic constipation, present in our patient, have been suggested as a source of hydrogen sulfide. CONCLUSIONS: This case of sulfhemoglobinemia, which occurred after the patient took phenazopyridine, is considered a probable adverse event according to the Naranjo probability scale. ( info) |
229/750. Fatal adverse drug reaction to trimethoprim. BACKGROUND: trimethoprim is the antibiotic of choice for treating uncomplicated community acquired urinary tract infections. However, before prescribing any drug it is vital to obtain a detailed drug history to exclude possible drug allergy. OBJECTIVE: We present the case of a fatal adverse drug reaction due to trimethoprim. We discuss some of the problems that led to the patient's death, and consider how to prevent similar events. DISCUSSION: Re-exposing a patient to a drug suspected of causing an adverse reaction is associated with considerable risk of morbidity and mortality. A detailed history is vital to correctly diagnose drug allergies but, even so, it is not always possible to identify the causative agent. Following an adverse drug reaction, health professionals must take appropriate steps to avoid inadvertently re-prescribing the culprit drug. This is essential to avoid the tragic outcome highlighted in this case. ( info) |
230/750. Fulminant hepatic failure possibly related to ciprofloxacin. OBJECTIVE: To report a case of hepatic failure in a patient who was receiving oral ciprofloxacin. DATA SOURCES: case reports, review articles, and relevant laboratory studies identified by medline. DATA EXTRACTION: Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors. DATA SYNTHESIS: A 66-year-old man was admitted for hip arthroplasty and developed fulminant hepatic failure during oral ciprofloxacin therapy. ciprofloxacin was started on postoperative day 13 for treatment of a urinary tract infection. Over the next three days he became confused and hypoglycemic. His prothrombin time increased to greater than 90 s. serum aspartate aminotransferase and alanine aminotransferase concentrations were markedly elevated. The patient died on postoperative day 20. Postmortem examination of the liver revealed extensive centrilobular necrosis. A skin biopsy was consistent with a drug reaction. It is unknown whether the patient had received a quinolone compound in the past or had a history of exposure to hepatotoxins. CONCLUSIONS: It cannot be concluded that ciprofloxacin directly caused hepatic failure in this patient. It is possible that the drug evoked a hypersensitivity reaction or exacerbated a preexisting hepatotoxicity. A detailed patient history and evaluation of hepatic function should be obtained prior to initiating ciprofloxacin therapy. A nonquinolone antimicrobial may be a safer alternative for patients with hepatic dysfunction. ( info) |