DRESS Syndrome; Just a Rash or Much More?? Time to Rethink

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan drug induced idiosyncratic reaction. As the name suggests it is characterized by peripheral eosinophilia and systemic symptoms like fever, rash, lymphadenopathy, liver failure. Incidence is around 1:1000 to 1:10,000 drug exposures and has a high mortality if not diagnosed and treated timely. Diagnosis is difficult and challenging due to the diversity of symptoms this syndrome has, hence scoring systems like the RegiSCAR and Japanese criteria may be used. Mortality rate is around 10-20% and mostly due to liver failure. Most important step in treatment is withdrawal of the offending drug and supportive line of therapy with corticosteroids forming the mainstay of therapy. This paper reports two such cases which were a diagnostic dilemma and timely withdrawal of the offending drug and corticosteroids changed the course of the condition completely.

A case of Lymphocytic Interstitial Pneumonia in a defaulter HIV-positive patient

Background:Chronic Renal Failure (CRF) is characterized by gradual, progressive and permanent decrease in the renal functions. Moreover, CRF adversely effects the functioning of the various other organs. Dyslipidemia is the characteristic of the CRF, moreover lipid profile disorder appear from the onset of the CRF. However, severity of disturbance depends on the stage of CRF. MDA one of the important marker of oxidative stress is the product of lipid peroxidation, which is produced by oxidation of poly unsaturated fatty acid. Increased oxidative stress leads to distruction of bio-molecules, protein, DNA and RNA of the cells. Methods: This was a cross sectional type of study conducted in the TMMC & RC, Moradabad (U.P.). Total sixty patients of CRF patients > 20 years were included in the study. Lipid profile which included serum concentration of total cholesterol (TC), triglycerides (TG) and high density lipoprotein (HDL) were calculated enzymatic method CHOD-POD method, GPO-PAP method, CHOD-POD/ Phosphotungstate method respectively Results:There was a significant difference between the mean values of TC (< 0.001), TG (< 0.001), LDL (< 0.001), VLDL (< 0.001) of CRF patients and Control group III. MDA level was significantly high in group I and group II compare to group III. Further, the levels of MDA were significantly high in group I CRF patients on dialysis when compared to group II conservatively managed patients (p < 0.001). Conclusion: Findings of the present study showed that there is increased oxidative stress level as well elevated risk of CVD in CRF patients on dialysis. More of altered level of lipids induces atherosclerosis in CRF patients. Therefore, the present study suggest that management lipids and oxidative stress should be included during the treatment of CRF patients.

Hyperinfection Syndrome Case report and review of Literature

After the introduction of the Antiretroviral Therapy (ART) very few case reports of Lymphocytic interstitial pneumonitis (LIP) with HIV are available till date, especially in adults. In children LIP is still considered as AIDS defining condition. LIP is a polyclonal proliferation of lymphocytes, which can be misdiagnosed as Pneumocystis carnii pneumonia (PCP) or Hypersensitivity pneumonitis (HP) if proper sampling is not done. The mainstay of treatment is ART. Here we are presenting a case of lymphocytic interstitial pneumonitis in a defaulter case of HIV-positive patient. The Video-Assisted Thoracoscopic lung biopsy was taken and diagnosis was made on the basis of histopathology examination. Hence, it is suggested to consider for LIP as a differential for cough and dyspnoea in all HIV positive cases, who are not on ART