1/15. Lamotrigine overdose presenting as anticonvulsant hypersensitivity syndrome.OBJECTIVE: To describe the laboratory and physical manifestations of lamotrigine toxicity presenting as anticonvulsant hypersensitivity syndrome. CASE SUMMARY: A 49-year-old white man presented to our institution with a two-day history of low-grade fever, erythema, and edema involving the periorbital area. Five days earlier, he had been placed on lamotrigine treatment for bipolar disorder. He inadvertently received four daily doses of lamotrigine 2700 mg each. physical examination was significant for periorbital edema and discrete and confluent blanching red macules and papules involving the face, trunk, and extremities. Laboratory tests revealed leukocytosis, hepatitis, and acute renal failure. With normalization of the laboratory results, the eruptions and edema gradually resolved. DISCUSSION: Lamotrigine toxicity can lead to periorbital edema, rash, and multiorgan system abnormalities. This presentation has clinical and laboratory similarities with anticonvulsant hypersensitivity syndrome, which suggests that at some threshold concentration the amount of lamotrigine may overwhelm the body's ability to metabolize the drug, leading to a similar hypersensitivity reaction. Lamotrigine is a relatively new agent, and this report may provide useful insights on evaluating the clinical toxicology of this agent. CONCLUSIONS: Healthcare providers should be aware that lamotrigine overdose may present with multiorgan involvement, similar to anticonvulsant hypersensitivity syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/15. Gadodiamide as an alternative contrast medium in cerebral angiography in a patient with sensitivity to iodinated contrast medium.The physical and pharmacological properties of gadolinium enable its chelates to be used as a contrast medium in digital subtraction angiography. We report the use of gadodiamide, a low-osmolar nonionic gadolinium chelate, for selective angiography in a patient with known sensitivity to iodinated contrast medium. No adverse effects were encountered during or after injection. Contrary to a single previous report of the use of these agents in cerebral angiography, contrast in the angiogram was not particularly good, especially in the distal circulation, but the angiogram was diagnostic.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/15. heparin-induced thrombocytopenia as the cause of gluteus muscle necrosis: a case study describing the benefits of multidisciplinary physical and psychosocial interventions.heparin-induced thrombocytopenia, an increasingly recognized aspect of heparin therapy, occurs in 0.6% to 30% of patients receiving heparin. Approximately 1% of those patients develop the more severe heparin-induced thrombocytopenia II, also called white clot syndrome, in which synchronous venous and arterial thrombi impede blood flow in central vessels. mortality (as high as 25%) and morbidity are related to the site and extent of thrombi formation. Following vascular surgery, one patient manifested an unusual consequence of heparin-induced thrombocytopenia II when thrombotic blockage of the vessels supplying the bilateral gluteus maximus and minimus muscles resulted in tissue ischemia and death. Supporting the patient through numerous complications and managing the extensive wound healing process required multidisciplinary skills and innovative technology, including use of vacuum-assisted closure therapy, platelet-derived growth factors, parenteral and enteral nutritional support, and spirit-restoring favorite foods. This article describes the patient's life-threatening and long-lasting effects from an allergic reaction to heparin therapy. In addition to information about the diagnosis of heparin-induced thrombocytopenia, this article also describes management of the wound and other aspects of care and comforting that occurred over a 9-month hospitalization.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
4/15. hypersensitivity reaction to mizolastine: study of cross reactions.A 26-year-old male suffering from acute rhinitis took the first dose of Zolistan (mizolastine, 10 mg), orally, and 15 minutes later he developed intense generalized pruritus, cutaneous rash, oropharyngeal pruritus, edema on his face, difficulty in swallowing, and mild dyspnea. He was treated with methylprednisolone and epinephrine and improved within 30 minutes. The patient had not taken mizolastine before and he has avoided it since the reaction. Cutaneous tests with Zolistan and its excipients proved negative. Simple-blind oral challenge tests with the excipients and then with Zolistan were positive only with Zolistan. In order to confirm the absence of cross-reactivity between mizolastine and other benzimidazoles, we tested omeprazole, domperidone and mebendazole, all of which yielded negative results. To our knowledge, this is the second case of immediate hypersensitivity to mizolastine documented to date. In our case, the clinical history, physical examination and provocation tests allow us to establish the diagnosis of hypersensitivity to mizolastine and exclude the cross reactivity with other benzimidazole derivatives.- - - - - - - - - - ranking = 5.5674059682137keywords = physical examination, physical (Clic here for more details about this article) |
5/15. Allergic or pseudoallergic reaction following epidural steroid deposition and skin testing.A 46-year-old female with a history of low back pain and sciatica was referred for evaluation for epidural steroid injection. Following appropriate history, physical examination and laboratory testing, an epidural injection was performed using triamcinolone diacetate (Aristocort Intralesional (R), Lederle Pharmaceuticals) and lidocaine. Despite good pain relief, the patient presented one week later to a hospital emergency room with signs and symptoms consistent with a delayed allergic or pseudoallergic reaction. Subsequent skin testing, performed one month following the epidural injection, with the same drug precipitated the onset of an accelerated but similar reaction 12 hours later. To our knowledge, this is the first known report of allergic or pseudoallergic reactions following epidural steroid deposition and subsequent skin testing in the medical literature.- - - - - - - - - - ranking = 5.5674059682137keywords = physical examination, physical (Clic here for more details about this article) |
6/15. oral manifestations of drug therapies in the geriatric patient.oral manifestations of drug therapies in the geriatric patient must be considered in a multifactorial approach. A logical pattern of individual "normality" must be perceived, and variation from this pattern, with the aid of both physical examination and adequate drug history, will enable the clinician to interpret protean manifestations of untoward actions of chemotherapeutic agents in and about the oral cavity.- - - - - - - - - - ranking = 5.5674059682137keywords = physical examination, physical (Clic here for more details about this article) |
7/15. tocainide: a severe adverse reaction.tocainide is a primary analog of lidocaine with antiarrhythmic properties used to treat ventricular rhythm disorders. A 76-year-old man with benign paroxysmal premature ventricular contractions was treated with tocainide and developed a generalized maculopapular lupoid eruption, bleeding from the lips and gingivae, vertigo, gross tremors of the extremities, fever, and short-term memory loss, which required hospitalization. The patient recovered slowly over three months with no permanent sequelae after discontinuing the drug and receiving rigorous supportive care. His excellent physical status and absence of concomitant illness contributed to an uneventful recovery. tocainide is a potent cardioactive drug with a long biological half-life and should be used with caution.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/15. Systemic anaphylaxis induced by physical exertion: a case report.anaphylaxis is a systemic reaction which can be very dangerous in many patients. In addition to the most common antigens (drugs, venoms, foods), physical exercise can provoke anaphylaxis in the sensitized patients. The mechanism of this reaction is still unknown. In this report, we describe a case of exercise-induced anaphylaxis in a 25 year old female who had experienced two syncopal attacks during strong physical activity. On other occasions she had noticed that prolonged work would cause urticaria, pruritus and numbness. During hospitalization, on two occasions a treadmill stress test induced bronchial spasm, urticaria and hypotension. We believe that the association of urticaria and anaphylaxis would suggest the possible presence of a vasoactive substance released from the mast-cells and basophil leucocytes.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |
9/15. Psychosomatic vulvovaginitis.Psychosomatic vulvovaginitis is a real clinical entity that should be suspected in any patient whose vaginal complaints do not correlate with the physical findings. Such patients have usually seen multiple physicians, are "allergic" to most vaginal medications, and exhibit signs of emotional lability. In many cases, psychiatric evaluation and therapy can be of great benefit.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/15. Adverse external ocular effects of topical ophthalmic therapy: an epidemiologic, laboratory, and clinical study.New knowledge of adverse external ocular reactions to topical ophthalmic medications was obtained by means of a computerized epidemiologic study, laboratory studies, and clinical observations. Listed below are the major findings and conclusions that represent facts or concepts that were previously unknown, uncertain, misunderstood, or forgotten: The incidence of clinically important drug reactions among all cases was at least 13.09% and may have been as high as 16.02%. Among treated patients it was at least 16.26% to 19.90%. Taken together, drug reactions were the second most common external disease diagnosis. The incidence of each kind of drug reaction was determined. Toxic papillary reactions accounted for 79.10% of drug cases and 10.35% of all cases. Toxic papillary keratoconjunctivitis was the third most common single diagnosis. The following epidemiologic factors were found to be related to the development or presence of drug reactions: number and variety of treating practitioners, number of practitioners consulted, number of practitioners consulted who treated, specific ophthalmologist consulted (8.24% of ophthalmologists referred 39.55% of all drug cases and showed a tendency habitually to overtreat), number and kinds of patients' symptomatic complaints, number of medications prescribed and used, number of days of treatment, particular drugs and preservatives used (but not their strengths or vehicles), underlying (primary) diagnoses, and inaccuracy of referring ophthalmologists' diagnoses. patients with dry eyes were especially at risk for the development of toxic papillary reactions. Among all cases, the incidence of reactions to preservatives (mainly thimerosal) in contact lens solutions was 0.39% to 1.95%, depending on whether definite or probable cases, respectively, were considered. The incidence among the 54 patients who used daily-wear lenses (excluding extended-wear therapeutic and optical contacts) was 7.41% for definite reactions and 37.04% for probable ones. Factors relating to the development of papillary contact-lens reactions were daily wear, number of days of wear, and, especially, the preservatives to which the patients were exposed. Reactions occurred more often with soft lenses than with hard ones. Of patients with drug reactions, 5.22% had two different ones simultaneously. Coexisting reactions to pharmacologically active agents were also present in 15% of patients who reacted to preservatives in contact lens solutions. The ocular tissues that were affected by each kind of drug reaction were tabulated, and the relative degrees and sequences of involvement were discussed. The frequencies with which particular drugs, physical ag- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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