Acute generalized exanthematous pustulosis in a patient with plaque psoriasis

Acute generalized exanthematous pustulosis [AGEP] is an acute febrile drug eruption characterized by sudden occurrence of numerous, non-follicular, pinhead-sized pustules. This usually occurs 3-5 days after the commencement of treatment. Development of pustular eruptions in patient with plaque psoriasis raises the differential diagnosis of AGEP versus pustular psoriasis of the Von Zumbusch type. Herein, we report a 56-year-old male who came into hospital with history of vomiting fresh blood. The patient was then admitted for management of hematemesis. He is a known case of psoriasis vulgaris, which was still present during admission. During admission, the patient developed pustular skin eruptions associated with fever 4 days after using clindamycin and ceftriaxone. Laboratory investigations revealed leukocytosis and neutrophilia. Histopathological examination showed sub-corneal neutrophilic collection and eosinophils in the papillary dermis. The pustular eruption disappeared completely within ten days after stopping clindamycin and ceftriaxone, confirming the diagnosis of AGEP

Chronic idiopathic ulcerative colitis in Saudi Arabia, a clinicopathological study of 76 cases

In this report we present our experience with 76 cases of chronic idiopathic ulcerative colitis [IUC] out of 1279 consecutive colorectal biopsies [6.0%], seen during an 11-year period [1983-1994], in a tertiary care teaching hospital. During the same period, 12 [0.8%] patients with Crohn's disease were seen. Of the 76 patients with IUC, forty-nine were male and 27 were female, with an age range of six to 88 years, a mean of 38 +/- 16 and a median of 36 years. Forty-nine patients were Saudi Nationals [27M, 22F], 21 were non-Saudi Arabs and six were Asians. In most patients, the onset of IUC was at 20 to 49 years [70%]. The disease duration at diagnosis ranged from one month to five years, with a median of 12 months. The follow-up period ranged from 13 months to 11 years, with a median of three years. Diarrhea, hematochesia and abdominal pain were the dominant symptoms. The disease grade was generally of mild to moderate severity [55 patients, 72%] and was of low stage [distal involvement in 69 patients, 91%]. The rarity of skin manifestations and of development of colonic cancer is to be noted in spite of the relatively short period of follow-up. Our findings compare with experience from the region, confirming the mild course of the disease as contrasted to Western experience. These findings will be discussed

Wilson's disease in Saudi Arabia: report of a Saudi Arab family

A Saudi family with Wilson's disease [hepatolenticular degeneration] is described. The index case presented with anicteric hepatitis and hydrops of the gallbladder. Neurological involvement appeared later. The diagnosis of Wilson's disease was based on the presence of Kayser-Fleischer rings, a low serum ceruloplasmin level, and an elevated urinary copper concentration. Histological examination of the liver biopsy specimen revealed active cirrhosis. Acute hepatic failure developed during D-penicillamine therapy. Continuation of the drug at a lower dose, along with other supportive measures, was successful in reversing this. After three years of therapy, the index patient's neurological signs disappeared, and liver function and gallbladder size and function returned to normal. Family screening revealed that three other siblings have the disease, and all have been treated with D-penicillamine. The parents are related but are asymptomatic. An unusual feature of the index case was the presence of a distended nonfunctioning gallbladder that reverted to normal with decoppering. Although D-penicillamine treatment possibly precipitated the acute hepatic failure, paradoxically it was also successful in treating it