Anaphylactic Reaction Following Injection Cefotaxime Sodium

This is a case study of anaphylactic reaction to cefotaxime sodium in a 23-year-old female who underwent a lower segment cesarean section under spinal anesthesia. Cefotaxime sodium, an antibiotic belonging to the class of cephalosporins, was administered intravenously postoperatively for prevention of infection. The patient complained of breathlessness, swelling around both eyes, and pruritus and urticarial rash over her abdomen, legs, and forehead. The case was successfully managed by withholding the medication and treatment of symptoms. According to the WHO-Uppsala Monitoring Centre causality assessment scale, a probable causal relationship between the suspected drug (cefotaxime sodium) and anaphylactic reaction was made. The severity was found to be moderate (Level 3). Although cefotaxime has well established place in surgical prophylaxis, this case study emphasizes on constant observation and meticulous follow-up of patients receiving it in clinical practice as there is possibility of an adverse drug reaction (ADR) which can be life-threatening. Such happenings can add to challenges faced by the treating physician in the present COVID-19 era. Recognizing ADR helps reduce morbidity and mortality. Reporting ADR helps in documentation and education of healthcare professionals.

Dapsone induced DRESS syndrome: a rare fatal complication

DRESS syndrome is a serious life threatening condition characterized by skin eruption, haematological abnormalities and multi organ involvement that can be fatal if unrecognized especially in patients with liver failure. Diagnosis may be difficult because it is rarely seen in children and it can mimic many different conditions. Author report a case of 12 year old female presented to this emergency department with moderate grade fever, skin rash and jaundice following dapsone ingestion. She was evaluated and was diagnosed as DRESS syndrome and successfully treated with steroids.

Drug rash with eosinophilia and systemic symptoms syndrome, a uncommon but fatal illness, paediatricians should be aware of: a case of 13 year old female child

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a fatal illness manifested by fever, morbilliform rash, multi systemic involvement and eosinophilic leucocytosis with about 10% mortality. Authors report DRESS syndrome in an adolescent girl due to anti-depressant and anti-psychotic which improved dramatically after withdrawal of offending drugs and starting of steroids

Clinical Analysis of Drug Eruptions among Inpatients Seeking a Consultation with the Department of Dermatology / 대한피부과학회지

BACKGROUND: Drug eruptions are common in hospitalized patients. Rapid and accurate diagnosis is essential but often difficult. OBJECTIVE: This study defined the clinical features and causative drugs among inpatients presenting with drug eruptions. METHODS: We retrospectively analyzed the clinical and laboratory data of inpatients who sought consultations with the Dermatology Department for a diagnosis of drug eruptions. RESULTS: A total of 228 patients were diagnosed with drug eruptions, and this study included 139 patients. The highest incidence of drug eruptions was observed in patients in their 50s (22.3%). The most common latent period was up to 1 week (57.6%). The most common drug eruptions were exanthematous eruptions (59.7%), acneiform eruptions (10.8%), and urticaria (9.3%). The most common causative drugs were antibiotics (53.2%), followed by anticancer drugs (19.4%), and contrast media (6.5%). Laboratory abnormalities included eosinophilia (15.8%), abnormal liver function tests (7.9%), leukopenia (4.3%), an elevated serum creatinine level (2.2%), and leukocytosis (0.7%). CONCLUSION: In descending order, the most frequent drug eruptions were exanthematous eruptions, acneiform eruptions, and urticaria, and the most common causative drugs were antibiotics, anticancer agents, and contrast media. Prompt diagnosis and discontinuation of the causative drug are important in this context. Clinicians should be aware of cutaneous adverse drug reactions.

Variables clínicas, de laboratorio e histopatológicas en Síndrome de hipersensibilidad o erupción por drogas con eosinofilia y síntomas sistémicos (DRESS) / Drug reaction with eosinophilia and systemic symptoms (DRESS)

INTRODUCCIÓN: La reacción a drogas con eosinofilia y síntomas sistémicos (DRESS) es una rara enfermedad que puede ser letal. OBJETIVOS: Describir los hallazgos clínicos, de laboratorio e histopatológicos en pacientes con DRESS. MATERIALES Y MÉTODOS: Estudio retrospectivo de fichas clínicas de pacientes con DRESS entre los años 2007 y 2017 con score regiSCAR mayor o igual a caso probable. RESULTADOS: Se estudiaron 24 pacientes: 14 fueron mujeres (58,3%), 2 tuvieron enfermedad autoinmune (8,3%), la edad promedio fue 45,04 años DS 17,2 (16-78). Los medicamentos frecuentemente implicados fueron Lamotrigina (33,3%) y Carbamazepina (20,8%). La latencia fue 28 días DS 17,7 (10-90). La clínica más frecuente fue prurito 87,5%, fiebre 75%, edema facial 62,5% y adenopatías 45,8%. En laboratorio lo más alterado fueron pruebas hepáticas (70,8%) y eosinofilia (45,8%). 11 pacientes (45,8%) presentaron eosinófilos en la histopatología y 21 pacientes (87,5%) fueron tratados con corticoides. La mortalidad fue 11,1% (2 pacientes, por causas distintas a DRESS). DISCUSIÓN: DRESS es una reacción adversa a medicamentos severa con variados hallazgos clínicos y analíticos que requieren de su conocimiento para no retrasar el diagnóstico y su tratamiento.

INTRODUCCIÓN: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare disease that can be lethal. OBJECTIVE: To describe the clinical, laboratory and histopathological findings in patients with DRESS. MATERIALS AND METHODS: Retrospective study of clinical records of patients with DRESS between 2007 and 2017 with RegiSCAR score greater than or equal to probable case. RESULTS: 24 patients were studied: 14 were women (58.3%), 2 had autoimmune diseases (8.3%), the average age was 45.04 ± 17.2 years (16-78). The medications frequently implicated were Lamotrigine (33.3%) and Carbamazepine (20.8%). The latency was 28 ± 17.7 days (10-90). The most frequent symptoms were 87.5% pruritus, fever 75%, facial edema 62.5% and lymphadenopathies 45.8%. In the laboratory, the most disturbed were liver tests (70.8%) and eosinophilia (45.8%). 11 patients (45.8%) presented eosino-phils in histopathology and 21 patients (87.5%) were treated with corticosteroids. Mortality was 11.1% (2 patients) due to other causes than DRESS. DISCUSSION: DRESS is an adverse reaction to severe medications with a varied clinical and la-boratory finding, requiring knowledge in order to not to delay diagnosis and treatment.Key words: DRESS; Eosinophilia; ADR, Drug rash

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome complicated with central nervous system vasculitic-like presentation:a case report / 天津医药

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a serious adverse drug reaction, characterized with rash, fever, lymphadenectasis, eosinophilia and visceral involvement. This article describes the clinical case of a patient with renal insufficiency after receiving sensitizing drugs,which resulted in limb weakness and cognitive impairment of center nervous system characterized by vasculitis imaging and responded well to glucocorticoid treatment-DRESS syndrome.

An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia.

Background: The prevalence, clinical patterns, and causative drugs of cutaneous adverse drug reactions (cADR) vary among the different populations previously studied. Aim: To determine the prevalence, the clinical patterns of drug eruptions, and the common drugs implicated, particularly in severe cADR such as Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms (DRESS) in our population. Methods: We analyzed the database established for all cADR seen by the department of Dermatology from January 2001 till December 2010. Results: A total of 362 cADR were seen among 42 170 new clinic attendees, yielding an incidence rate of 0.86%. The most common reaction pattern seen was maculopapular eruption (153 cases) followed by SJS/TEN (110 cases) and DRESS (34 cases). Antibiotics was the most commonly implicated drug group (146 cases) followed by anticonvulsants (81 cases) and antigout drugs (50 cases). The most frequently implicated drug was allopurinol (50 cases). Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 21.8%, 20.9%, and 12.7%, respectively, of the 110 cases seen, whereas DRESS was mainly caused by allopurinol (15 cases). Mortality rates for TEN, SJS, and DRESS were 28.6%, 2.2%, and 5.9%, respectively Conclusions: The low rate of cADR with a high proportion of severe reactions observed in this study was probably due to referral bias. Otherwise, the reaction patterns and drugs causing cADR in our population were similar to those seen in other countries. Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN in our population.

<b>A Case of Acute Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Successfully Treated with Saikokeishito Administration </b> / 日本東洋医学雑誌

We report a case of acute chronic obstructive pulmonary disease (COPD) exacerbation caused by bacterial pneumonia infection, which was successfully resolved using saikokeishito. An 86-year-old woman with COPD presented with fever. Chest radiography and computed tomography (CT) confirmed bacterial pneumonia and she was admitted. Antibiotic therapy was started, but it had to be discontinued shortly thereafter because the patient developed drug rash. Oral saikokeishito was administered, as an alternative medicine, after which the patient showed dynamic improvements in pneumonia, and other general complaints such as respiratory dysfunction, fever, delirium, and appetite loss.<br>Saikokeishito is known to trigger various biomedical effects such as stimulation of anti-inflammatory and antipsychotic functions and autoimmune regulation.<br>Although antibiotic therapy is, without doubt, the most efficient treatment for acute bacterial pneumonia, in cases where antibiotic treatment is not possible, Kampo therapy may be used as an alternative treatment method for improving the condition and other complaints.<br>In future, more sequential case reports showing the use of Kampo therapy in acute respiratory medicine would be necessary to establish conclusive evidence for the use of this therapy as an alternative treatment method.

Acute generalized exanthematous pustulosis due to amoxicillin/clavulanate / 대한내과학회지

Acute generalized exanthematous pustulosis (AGEP) was initially named by Beylot to describe a disease entity with sudden- onset amicrobial pustular eruptions accompanied by fever and leukocytosis. Most cases appear to be related to drug reactions, mainly antibiotics, although viral infections and hypersensitivity to mercury also cause AGEP. A 28-year-old woman presented with sudden-onset, multiple, and generally pinhead-sized pustules on an erythematous base scattered on the face and anterior chest wall. The patient had been on amoxicillin/clavulanate for acute pharyngitis. Histopathologically, the skin biopsy specimen revealed subcorneal and subepidermal pustules with neutrophil spongiosis, perivascular neutrophilic infiltration, and karyorrhectic debris. The eruption cleared rapidly after discontinuing the drug and administering systemic corticosteroid therapy.

Cutaneous Adverse Drug Reactions observed in a Dermatology Clinic, Penang General Hospital

Background Cutaneous Adverse Drug Reaction (CADR) is commonly encountered in our daily clinical practice1. Knowledge of the various patterns of CADR and the common offending agents will certainly help the physician in assessing the likelihood of the drug induced eruption as opposed to another dermatological diagnosis. Objectives To improve the understanding of CADRs in Penang General Hospital,To evaluate the incidence of CADR in Dermatology clinic Penang Hospital, to identify the common offending drugs and to describe the characteristics of CADR and to identify the associated risk factors of developing CADR. Materials and Methods This prospective study covers a 12-month period from April 2005 to March 2006. Demographic characteristics, causative drugs, management and treatment outcome were analysed. Results A total of 174 cases were referred to the Dermatology Clinic over 1-year period (Incidence of 4.9% of Dermatology Clinic new case attendees). Chinese comprises of 51.4%, followed by Malay 32.4%, Indian 10.8% and others 5.4%. Male to female ratio was 1.2:1. 74.1 % of CADR occurred between 13 - 59 year age group. The offending drugs included antimicrobials 28.6%, antituberculous 19.7%, analgesics 17.7%, allopurinol 8.4%, anticonvulsants 5.4%, HAART 1.0%, traditional medicines 2.0% and others 17.2%. High proportion of erythema multiforme syndrome cases was observed (23.5%). Toxic epidermal necrolysis has a high mortality rate. It was caused by amoxycillin, sulphonamide and phenytoin. 80.5% of CADR occurred within 2 weeks of drug introduction. Overall mortality rate secondary to CADR was 2.3%. Risk factors identified included poly-pharmacy (37.9%), renal insufficiency (31.0%), personal history of previous drug allergy (19.0%), liver disorder (18.4%), tuberculosis (16.7%), HIV infection (10.3%), autoimmune disorders (6.3%) and hematological malignancy (4.0%). Conclusions Diagnosis of CADR requires a high index of suspicion especially in those having symmetrical eruption within 2 months in relation to initial dose of medication, particularly the high risk groups.

An research about using clinical pathway in the course of holistic nursing for patients with trichloroethylene drug rash / 中国实用护理杂志

Objective To investigate the feasibility and the effects of using clinical pathway in the course holistic nursing for patients with trichloroethylene drug rash. Methods Using case-control study, the clinical pathway were used in the experimental group, and the traditional nursing methods were used in the control group. Compared the curative ratio, the days in hospital, costs of hospitalization and the contentment ratio between these 2 groups. Results [WTBZ]The curative ratio in the experimental group and the control group were 100% and 96% respectively. The average days in hospital of these 2 groups were 72.4?6.6 days and 120.6?15.8 days respectively, and the cost of hospitalization were 62260.7?2963.7RMB and 33060.6?1843.2 RMB respectively. The contentment ratio in experimental group was significant higher than that of in control group. [WTHZ]Conclusion Using clinical pathway during the course of holistic nursing for patients with trichloroethylene drug rash can decrease the cost of hospitalization, shorten the days in hospital, improve the curative ratio and the contentment ratio effectively.

A Case of SIADH Related to Drug-indeced Generalized Maculopapular Rash / 대한내분비학회지

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.