ABSTRACT
Urticaria multiforme is a condition which manifests as acute, polycyclic, annular oedematous pink plaques with an ecchymosis hue that is associated with acral edema. The condition is often misdiagnosed as erythema multiforme, serum-sickness-like reactions, or urticarial vasculitis. Author present a case of acute annular urticaria in a 3-year-old girl who presented with unusual clinical manifestations of the condition. Through this case report, Author aim to emphasize the wide range of morphologic manifestations that can be seen in urticaria multiforme. This can assist pediatric physicians to differentiate urticaria multiforme from other clinical dermatologic conditions and prevent misdiagnosis. A detailed case history and physical examination, along with relevant diagnostic tests can enable prompt and effective management of the condition.
ABSTRACT
Background: Ischemic heart disease is one of the leading causes of global disease burden. Despite treatment with standard therapy, many patients with chronic stable angina pectoris remain symptomatic making it an urgent necessity to introduce new strategies. Hence this study was planned to compare the efficacy and tolerability of Ivabradine and Ranolazine; the two novel antianginal drugs. Methods: This was a single blind, randomised, controlled trial. Thirty patients each taking IVA 5 mg twice daily or RAN 500 mg twice daily were randomised into two groups. Patients filled a pretested questionnaire on frequency of angina attacks and adverse reactions experienced at baseline and 2, 4 and 8 weeks. The haemodynamic parameters, routine laboratory investigations were evaluated at the baseline and after intervention. Results: There was no significant difference in the frequency of angina attacks per week between the IVA and RAN study groups. There was a statistically significant difference (P < 0.01) in the number of patients reporting ADR from the IVA group as compared to RAN group. In the IVA group, the most common ADR was dizziness (36.6%); whereas nausea (30%) and dizziness (23.3%) was most common in RAN group. The routine haematological and biochemical evaluations did not show any significant difference between the baseline and post intervention. However, IVA significantly decreased the resting heart rate after eight weeks of intervention.. Conclusion: Both IVA and RAN are comparable and efficacious antianginal agents. However, RAN had a better safety and tolerability profile than IVA.
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RESUMEN Introducción: Las mordeduras de serpiente continúan siendo un problema de salud pública, especialmente en países tropicales como Colombia. Objetivo: Caracterizar los casos de accidente ofídico atendidos en un nuevo centro de asesoría toxicológica de Medellín, Colombia. Metodología: Se realizó un estudio descriptivo, retrospectivo, revisando la base de datos donde se registra la información relacionada con la asesoría brindada por dicho centro desde el 1 de enero hasta el 31 de diciembre de 2016. Resultados: Se registraron 117 casos de accidente ofídico, de los cuales 93 (79%) eran hombres y 24 (21%) mujeres, con una mediana de edad de 32 años (rango: 2 a 82 años). El seguimiento de los casos pudo lograse en 55 de los 117 accidentes (47%), y se describieron complicaciones en 18 de los 55 (33%) pacientes. La complicación descrita con mayor frecuencia fue brote maculopapular pruriginoso asociado con la administración del suero, sin que se identificaran diferencias entre las distintas marcas de suero antiofídico utilizado. Se documentó la muerte de un paciente (0,85%). El género Bothrops produjo la mayoría de los accidentes. Discusión: Los datos obtenidos coinciden con la bibliografía publicada.
ABSTRACT Introduction: Snakebites continue to be a public health problem, especially in tropical countries like Colombia. Objetive: To characterize the snakebite cases attended by a new poison center in Medellin, Colombia. Methodology: A descriptive, retrospective study was carried out, reviewing the information of the Center's database from January 1st to December 31st, 2016. Results: There were 117 cases of ophidian accidents, affecting 93 men (79%) and 24 women (21%), with a median age of 32 years (range: 2 to 82 years). The follow-up of the cases could be done in 55 of the 117 accidents (47%), and complications were described in 18 of those 55 (33%) patients. The most commonly reported complication was a pruritic maculopapular rash that was associated to serum administration, without differences between the several brands of anti-ophidian serum used. The death of one patient (0.85%) was documented. The genus Bothrops caused most of the accidents. Discussion: Our results agree with previously published data.
Subject(s)
Humans , Snake Bites , Serum Sickness , Toxicology , Colombia , Animals, PoisonousABSTRACT
Serum sickness-like reaction (SSLR) is an abnormal self-limited reaction that can cause fever, myalgia, fatigue, lymphadenopathy, arthralgia, and skin rashes. Its etiology is yet unknown; however, SSLR often develops in patients with hepatitis B and after drug and vaccination administration. SSLR's typical cutaneous manifestations include polycyclic, erythematous wheal-like or plaque-like lesions. A 47-year-old male hepatitis B carrier visited our emergency department with high fever and multiple annular erythematous plaques with clear centers on his trunk and upper and lower extremities. The patient's hematologic laboratory results indicated an acute exacerbation of hepatitis B, and his symptoms correlated with those of SSLR. Here, we report a case of SSLR in a patient with an acute exacerbation of hepatitis B with clinical, hematological, and histopathological evidence.
Subject(s)
Humans , Male , Middle Aged , Arthralgia , Emergency Service, Hospital , Exanthema , Fatigue , Fever , Hepatitis B , Hepatitis , Lower Extremity , Lymphatic Diseases , Myalgia , VaccinationABSTRACT
El paraquat es un herbicida frecuentemente utilizado en Colombia. Sabiendo su potencial tóxico es fundamental que el personal de salud conozca las características de la intoxicación y su tratamiento. Se presenta el caso de un paciente masculino quien sufrió una intoxicación auto infringida con paraquat, el cual fue tratado según los protocolos de manejo propuestos para Colombia; no obstante con resultados oscuros para el paciente, dejando claro de esta manera, la intención de tratamiento y las expectativas que deben tener en la mayoría de los casos el médico, el paciente y su familia. Se revisa la evolución clínica del paciente y se correlaciona con la fisiopatología del herbicida. Adicionalmente, se revisan nuevas alternativas en el manejo.
Paraquat is an herbicide commonly used in Colombia with a known toxic potential. It is vital that health workers know the characteristics of poisoning and its treatment. In this article we present the case of a male patient who suffered a self-inflicted poisoning by Paraquat, which was treated according to the Colombian protocols, although with dark results for the patient. For this reason the physician, the patient and his family should always have clear the intention to treat and the expectations for these cases. In the article the patient's clinical progress is reviewed and correlated with the pathophysiology of the herbicide. New alternatives are also presented and reviewed.
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Bee venom injection therapy is an alternative treatment sometimes used for chronic inflammatory diseases, including rheumatoid arthritis and multiple sclerosis, to reduce pain. Several chemical components of bee venom have anti-inflammatory effects, and apitoxin, one of the mixed components, has been used for pain prevention therapy. However, there have been no large-scale investigations regarding the efficacy or side effects or apitoxin. In this study, a case of serum sickness reaction that developed after receiving bee venom injection therapy is reported.
Subject(s)
Arthritis, Rheumatoid , Bee Venoms , Bees , Multiple Sclerosis , Serum Sickness , SkinABSTRACT
Rifampin is commonly used as a first-line anti-tuberculosis drug, but it can induce a serum sickness-like reaction or anaphylaxis. However, it is possible for 1 drug antigen to induce 2 or more simultaneous immunologic reactions. Here, we report a case of a serum-sickness-like reaction and anaphylaxis induced concurrently by rifampin. A 25-year-old male presented with high fever and a maculopapular rash with vesicles on the hands, which developed 2 weeks following regular administration of anti-tuberculosis drugs for tuberculous meningitis, including rifampin. Elevated liver enzymes, peripheral neuropathy, and decreased serum C3 and C4 levels were found. Interestingly, these symptoms were accompanied by severe hypotension. A serum-sickness-like reaction was considered after excluding other potential causes for the fever. A drug provocation test showed that the fever developed after oral administration of rifampin, suggesting that rifampin was the cause of the allergic reaction. However, hypotension, epigastric discomfort, and diarrhea also accompanied these symptoms, indicating that IgE-mediated type I hypersensitivity could be part of the serum sickness-like reaction. An intradermal skin test clearly showed an immediate positive reaction to rifampin. This case was diagnosed as concurrent serum-sickness-like reaction and anaphylaxis induced by rifampin. One drug may therefore induce combined allergic reactions via 2 or more simultaneous hypersensitivity responses.
Subject(s)
Adult , Humans , Male , Administration, Oral , Anaphylaxis , Diarrhea , Exanthema , Fever , Hand , Hypersensitivity , Hypersensitivity, Immediate , Hypotension , Liver , Peripheral Nervous System Diseases , Rifampin , Skin Tests , Tuberculosis, MeningealABSTRACT
La enfermedad del suero constituye un síndrome clínico causado por la formación de complejos inmunes que generan una reacción de hipersensibilidad, con manifestaciones clínicas típicas de erupción cutánea, artritis, y fiebre que inician de 1 a 3 semanas después de la administración de un fármaco y suelen desaparecer al cabo de varios días de interrumpir la administración del agente causal, pudiendo persistir durante intervalos mayores, especialmente cuando son fármacos de acción prolongada o retardada. Se describe el caso de una paciente con síndrome de Sjõgren primario que presentó enfermedad del suero secundaria al uso de rituximab.
Serum sickness is a clinical syndrome caused by the formation of immune complexes that generate a hypersensitivity reaction. Typical manifestations are rashes, arthritis, and fever beginning within3 weeks after administration of a drug and usually disappear several days after the suppression of the causative agent, although theymight persist for longer periods, especially with long-acting drugs. We describe the case of a female patient with primary Sjogren'ssyndrome who presented secondary serum sickness after usingrituximab.
Subject(s)
Serum Sickness , Sjogren's SyndromeABSTRACT
Anaphylaxis is the most common systemic allergic reaction caused by bee stings. Delayed-type allergic reactions, including serum sickness, occur much less frequently. We report a 27-year-old man who developed serum sickness reaction nine days after multiple bee-stings. He had complained of erythematous skin rash, fever, arthralgia, myalgia and proteinuria. High specific IgE to bee venoms (honeybee, yellow jacket, yellow hornet) were observed by CAP system and C3, C4 and circulating immune complex levels measured by C1q binding assay showed normal values. We report a case of serum sickness reaction caused by multiple bee stings.
Subject(s)
Adult , Humans , Anaphylaxis , Antigen-Antibody Complex , Arthralgia , Bee Venoms , Bees , Bites and Stings , Exanthema , Fever , Hypersensitivity , Immunoglobulin E , Insect Bites and Stings , Myalgia , Proteinuria , Reference Values , Serum Sickness , WaspsABSTRACT
Nitrogen mustard encapsulated with liposomes was administered to the rabbits with acute experimental serum sickness(AESS). Then the serum levels of anti-BSA antibodies and circulating; immune complex(CIC), CH50, and WBC count were determined. The ACPase activity of spleen macrophages was measured. And the sections of renal tissues, after HE-stained, were studied for the accumulation of CIC and the pathological changes. It was found that liposome-encapsulated nitrogen mustard can increase the macrophage activity and in turn aggravate the renal damages of AESS rabbits.The results suggest that the renal damages of AESS rabbits can immunopatholo-gically be attributed to the increased activity of macrophages.
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The immunopharmacological effects of anisodamine(654-2)on immune complexnephritis were examined in rabbits with acute experimental serum sickness(AESS).The results showed that activities of renal calmodulin(CaM)and cathepsin D(Cath-D)were significantly high.654-2 could inhibit CaM activity and immune complex-induced lysosomal enzyme release,and lessen immune complex glomerulonephritis at thesame time.Our findings suggest that a marked inhibition of CaM activity by 654-2 mi-ght contribute greatly to the improvement of immune complex glomerulonephritis.
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An experiment was done to determine the immunotherapeutic effect of fresh rabbit serum on rabbits with acute experimental serum sickness(AESSR)induced by injecting large dose of bovin serum albumin(BSA),accoeding to the report that complement has the complement-mediated solubilization capacity of IC(CMSC).The results showed that CMSC and CH50 level in serum of rabbits treated with fresh serum were markedly higher and CIC was obviously lower than those of positive control group(p
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Anisodamine (654-2) was administered to rabbits with acute experimental serum sickness (AESS) to study the immunomodulatory effects of 654-2 on AESS. The results suggested that 654-2 may decrease the serum specific antibody and immune complex (IC), inhibit the activity of serum cathepsin D (Cath-D), make the level of complemnts in narrow change, and improved the renal injury.