Fixed drug eruption from amoxycillin

We present a case of fixed drug eruption on the genital mucosa induced by amoxycillin. Topical provocation was carried out, applying amoxycilin (10% pet) on the glans penis. No reaction was observed. Oral challenge with amoxycillin was followed by pruritic erythema on the glans penis 6 hours after the intake of 125 mg. The study of cross-reactivity to other betalactams showed good tolerance of phenoxymethyl-penicillin, which shares an identical nuclear structure with amoxycillin. The patient also tolerated cephadroxil, a cephalosporin with a side chain identical to that of amoxycillin. On reviewing the literature we have only found three reports of fixed drug eruption fue to amoxycillin.     

Nonpigmenting fixed drug eruption due to pseudoephedrine

BACKGROUND: The nonpigmenting fixed drug eruption is a distinctive drug reaction characterized by large, tender and symmetric erythematous plaques that disappear with no residual pigmentation. METHODS: A case of a non-pigmenting fixed drug eruption due to pseudoephedrine is reported. RESULT: The reappearance of typical lesions at the same sites after oral challenge with 60 mg pseudoephedrine together with the absence of pigmentation confirm the diagnosis. CONCLUSION: A new case of proven nonpigmenting fixed drug eruption to pseudoephedrine is described.     

Isolated testicular relapse after bone marrow transplant with total body irradiation and testicular boost in acute lymphoblastic leukemia

A case of fixed drug eruption due to rifampin in a leprosy patient is described. Fixed drug eruption due to rifampin with the classical residual hyperpigmentation has not been described before.     

A rule-based postoperative pain controller: simulation results

We describe a system for controlling postoperative pain, a phenomenon that is difficult to treat by conventional control methods due to interpatient variability, interferences, non-linearity and the lack of a plausible, well-defined mathematical model. The system consists of two phases. In Phase 1 a closed-loop fuzzy controller implementing a suitable control strategy brings the patient to a zero-pain state. In Phase 2, an open-loop computer-assisted continuous infusion controller maintains a constant concentration of the analgesic (alfentanil) in plasma, subject to an upper safety limit on infusion rate; the set-point of this controller is periodically revised (either maintained or reduced) on the basis of feedback on the duration of zero pain (set-point reduction is necessary because the open-loop system has no means of knowing whether analgesic is accumulating in the patient). Pain is quantified by the patient on a numerical scale of 1 to 10 at 1.5-min intervals during Phase 1 and 9-min intervals during Phase 2. In simulation trials in which a fixed approximate model was used for the effect of sedation on pain while the pharmacokinetics of alfentanil were varied from one simulated patient to another, zero pain was achieved in under 15 min with minimal overshoot in plasma drug concentration and was maintained, with only minor deviation, by means of low drug concentrations.     

Photoleukomelanodermatitis (Kobori) induced by afloqualone

We reported a case of photoleukomelanodermatitis (Kobori) type drug eruption due to afloqualone (Arofuto). The patient was given afloqualone and imipramine hydrochloride (Chrytemin) for cervical spondylosis from November of 1990. Edematous erythema with slight itching appeared on the sun-exposed areas in December of 1990. As drug eruption was suspected, drugs were ceased, and the cutaneous lesions almost disappeared but pigmentations and depigmentations developed in spots in sun-exposed areas in March of 1991. Photopatch and oral challenge tests were positive.     

Nipple shields: LCs not looking for quick fix

Citiolone (N-acetylhomocysteinethiolactone) is a thiolic-derived medication frequently used in Spain and in other countries as a mucolytic agent for the treatment of certain hepatic disorders. Mucolytic drugs have rarely been implicated in the fixed drug eruption etiology. We report on a patient who presented several episodes of fixed exanthema related to citiolone intake. The patch test with citiolone (10% in dimethyl sulfoxide) was negative. The diagnosis was confirmed by a positive controlled oral challenge test. Other mucolytic thiolic-derivatives (N-acetylcysteine) were tolerated by the patient, thus crossreactivity between these drugs seems to be unlikely.     

Optimizing drug therapy based on genetic differences: implications for the clinical setting

Differences in drug responses due to gene alterations are rapidly being identified. Gene alterations may inhibit the function of an enzyme so that an active drug accumulates, causing adverse reactions with normal doses. Alternatively, gene alterations may accelerate enzymatic function so that an active drug is rapidly eliminated, causing subtherapeutic responses to normal doses. Mutations and polymorphisms have been identified that affect a person's response to many currently prescribed medications including cardiovascular, anti-infective, chemotherapeutic, psychiatric, and analgesic drugs. The potential exists for drug therapy to be optimized by selecting medication and doses based on a person's genotype rather than by trial and error. In the near future, advanced practice nurses in the acute care setting may be expected to order, provide patient education about, and explain results of genetic tests before initiating a specific drug therapy. Advanced practice nurses must be knowledgeable about what genetic tests are analyzing and their benefits, limitations, and risks.     

Serum antibody titers in a systemic lytic therapy with streptokinase

BACKGROUND: Anaphylactic reactions to streptokinase are rare but potentially life-threatening complications. Gamma E immunoglobulin (IgE) mediated mechanisms, probably due to streptococcal infections, have been implicated. We investigated the value of in vitro laboratory or dermatologic tests in predicting anaphylactic reactions due to streptokinase and the value of antistreptolysin titers (ASL) in predicting the amount of specific IgE (sIgE) and specific gamma G immunoglobulin (sIgG) neutralizing antibodies to streptokinase. METHODS: We measured serum levels of total IgE, streptokinase sIgE and sIgG, and ASL in 16 patients before and 9 and 41 days after streptokinase therapy. Immediately before therapy, intracutaneous testing with 100 IU streptokinase was done. RESULTS: Dermatologic testing did not identify patients prone to allergic reactions. Moreover, not all patients with increased sIgE levels had allergic reactions. These reactions were independent of the dose of streptokinase given. In spite of steroid prophylaxis, allergic reactions occurred in 3 of 16 patients, but none showed life-threatening anaphylaxis. Streptokinase sIgE and sIgG concentrations were closely related to ASL titers. CONCLUSIONS: Plasma levels of sIgG, sIgE, and ASL titers showed a good correlation. We believe ASL titers can be used for the estimation of neutralizing antibodies instead of streptokinase sIgG antibodies. Currently, no laboratory or dermatologic test allows reliable predictions of allergic reactions to streptokinase.     

New radiologico-clinical classification of changes in stress incontinence in women

In a series of patients who suffered severe histamine mediated reactions to induction agents and muscle relaxants, intradermal testing enabled the drug involved to be distinguished. The correct use of intradermal testing to give reliable results is discussed and a protocol described. Prausnitz Kustner testing was of little help in confirming the results. A number of patients tested showed high levels of immunoglobulin G (IgG) and it is believed that IgG mediated anaphylaxis may be the mechanism responsible for reactions that have been previously described as anaphylactoid or direct chemical histamine release.     

Biochemical Implications.

Discusses the use of experimental animals, particularly rats, in research exploring the effectiveness of compounds such as painkillers. The author describes an experiment testing the effectiveness of a pain killer, Pentazockine. In past clinical trials, if the drug failed to produce the desired analgesic effect with the rats, further experimentation was terminated. In one particular instance, the investigators in a clinical study chose to ignore past failure of the drug on rats and tested the effect of the drug with humans--and it worked. The implications of these unexpected results on further experimentation with rats is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ranitidine-induced photosensitivity

We report the case of a 72-year-old male patient who developed a florid photosensitive eruption while on ranitidine therapy. Ultraviolet A sensitivity was detected by irradiation monochromator testing, suggesting drug-induced photosensitivity. Ranitidine was concluded to be the cause of his photosensitivity since the eruption resolved and the phototest abnormalities returned to normal following cessation of therapy. Similar cases have been reported to the Committee on Safety of Medicines but not published.     

Allergic reactions to drugs and biologic agents

Drug allergies are adverse reactions resulting from immunologic responses to drugs or their metabolites. These reactions result in predictable patterns of organ-specific or systemic hypersensitivity that usually recur on subsequent exposure to the same drug. Although diagnostic testing for drug allergy is available for only a few drugs, protocols have been developed to assist in management of allergic reactions to many drugs and biologic agents. Other protocols assist in the management of patients who develop drug reactions while undergoing multiple drug therapy or those with a history of adverse drug reactions who again require treatment for the same condition.     

Allergic contact dermatitis to quinones in Paphiopedilum haynaldianum (Orchidaceae)

An eczematous eruption developed on the hands and forearms of a 68-year-old man after frequent contact with homebred specimens of the lady slipper Paphiopedilum haynaldianum. Patch tests with leaves, petals, and stems, as well as with two quinones isolated from the plant by thin-layer chromatography, gave strongly positive reactions. The results demonstrated that the recurrent skin lesions were the expression of an allergic contact dermatitis due to the quinoid constitutnets, which are the main contact allergens in this orchid species.     

Infantile spinal muscular atrophy. An unusual disease with various differential diagnoses

Patients with human immunodeficiency virus (HIV) infection are prone to severe drug reactions, mainly from sulfonamides. We report the case of a 33-year-old male patient with HIV infection (group IV C-2 of CDC staging system) that developed a toxic epidermal necrolysis (TEN) affecting more than 70% of the body surface area and severe mucosal involvement after starting fluconazole for a recurrent oral thrush with dysphagia. This is to our knowledge the first reported case of TEN due to fluconazole.     

Drug testing, drug treatment, and marijuana use: A fairness perspective.

The authors conducted a random statewide telephone survey of 1,484 individuals to study the relationship between marijuana use (in terms of participants' history of marijuana use) and reactions to drug testing and to study 2 hypothetical drug-treatment policies. Job safety sensitivity was related to perceived fairness of drug testing for the participant's job, and more recent marijuana use was associated with more negative reactions. Safety sensitivity was related to perceived fairness of drug treatment. Organizations with voluntary treatment were more attractive than ones with monitored treatment. Marijuana use interacted with drug treatment policy type in predicting reactions to drug treatment. Results suggest that organizations should consider job and employee characteristics when developing a drug treatment policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new technique for sacral nerve stimulation: a percutaneous method for urinary incontinence caused by spinal cord injury

We report a 40-year-old Japanese man with a creeping eruption caused by a larva of the nematode suborder Spirurina type X. He had eaten raw small squid (hotaruika) 4 weeks before the serpiginous erythematous eruption appeared on his abdomen. Routine laboratory tests revealed only slight eosinophilia in his peripheral blood. Although we could not find the larva in an excised skin specimen, an indirect immunofluorescence test confirmed the presence of antibodies against larvae of the suborder Spirurina type X. We review 28 reported cases in Japan which showed that creeping eruption caused by larvae of the suborder Spirurina type X has the following clinical characteristics: an incubation time of 1-4 weeks; a migratory, well-defined, narrow, serpiginous erythematous eruption; and only slight peripheral blood eosinophilia. Excision of the advancing end of the track was curative in our patient.     

Drug allergies: management and current aspects

ALLERGIC AND PSEUDOALLERGIC REACTIONS: Adverse drug reactions occur in 1 to 3% of hospitalized patients and 10% are due to allergic and pseudoallergic reactions. Allergic reactions are unpredictable reactions related to immunologic mechanism. Pseudoallergic reactions mimic allergic reactions but no drug-specific antibody or T cell proliferation can be demonstrated. PREVENTION: We are lacking clinical and biological tools and the available ones still need to be validated. However, a precise diagnosis is required in order to set up prevention measures. We focus here on some basic and new data concerning these reactions, in particular epidemiological studies, mechanisms and diagnostic methods.     

A psychological perspective of irritable bowel syndrome

We report on a 32-year-old female patient who had had a history of complex partial seizures since the age of 14. Phenobarbital was the most effective anticonvulsant drug in this patient. However, the drug treatment was complicated by a phenobarbital-induced exanthematous eruption. Reintroduction of the phenobarbital some years later resulted in a skin rash again; therefore, treatment with this substance had to be discontinued a second time. Because of the satisfactory antiepileptic efficacy, phenobarbital was introduced a third time using a desensitization procedure with increased oral doses, starting with a dose of 1 mg. After a daily dose of 90 mg phenobarbital, on day 6 an exanthematous eruption appeared. The exanthem disappeared parallel to a dose reduction of phenobarbital and with a gradually increasing dosage up to a maintenance dose of 200 mg. Tolerance to the allergic effect of phenobarbital was preserved and the seizure frequency was significantly reduced by phenobarbital monotherapy with a daily dose of 200-175 mg.     

Hypersensitive urticarial vasculitis after natisedine intake

BACKGROUND: Various skin and mucosal reactions can be observed after administration of quinidine derivatives. CASE REPORT: A patient who was taking Natisédine (quinidine phenylethyl barbiturate) intermittently and at reintroduction developed a papulopurpuric eruption (without thrombopenia) producing extensive centrifugal annular infiltration and central healing which regressed approximately one week after drug withdrawal. This eruption was associated with moderate 24 h proteinuria. The clinical aspect was that of vasculitis purpura as confirmed histology. Direct immunofluorescence only demonstrated C3 deposits in the vessel walls of the superficial dermis. The quinidine moiety of this drug (currently removed from the formulation) appears to be the responsible agent (imputability score: 13 B3). DISCUSSION: Thrombopenic purpura by synthesis of anti-platelet antibodies induced by quinidine derivatives is well known. Inversely, cases of non-thrombopenic purpura imputable to these same derivatives is uncommon (7 reported cases). The pathophysiological mechanisms involved might be similar (antigenic similarity between the platelet surface and endothelium).     

Allergic contact dermatitis: clinical features and profile of sensitizing allergens in Riyadh, Saudi Arabia

BACKGROUND: No reports are available on allergic contact dermatitis in Saudi Arabia, although it seems to be a common skin problem. We attempted to explore certain clinical aspects in addition to the profile of sensitizing allergens in our area. As no standard panel for patch testing is available in our geographic region, we examined the suitability of the European Standard Series. METHODS: Patch testing was performed on 271 consecutive patients with various forms of dermititis, referred for evaluation of possible allergic contact dermatitis. The study included 147 women and 124 men. The patients were between 12 and 75 years of age. RESULTS: Out of 271 subjects, 152 (56.1%) showed one or more positive reactions. Of these, 80 (52.6%) were women and 72 (47.4%) were men. Almost one quarter of the patients (25.7%) presented with hand dermatitis. Positive reactions to 21 out of the 22 allergens were found. Sensitization was most common to nickel sulfate (39.5%), potassium dichromate (32.9%), and cobalt chloride (30.9%). Reactions to the other allergens ranged between 14.5% and 1.3%). Less than one percent of the patients (0.66%) reacted to benzocaine and showed no reaction to primin. CONCLUSIONS: Allergic contact dermatitis is a common skin problem in Saudi Arabia. Further studies that address the prevalence and incidence of the disease are indicated. The European Standard Series is suitable for patch testing patients in our community; however, we suggest exclusion of benzocaine and primin. The addition of three allergens of local relevance, black seed oil, local perfume mix, and henna, are presented and discussed. The formulation of a regional standard series for patch testing dermatitis patients in our geographic area requires further collaborative studies.