Hand and foot syndrome secondary to capecitabine.

A 55-year-old woman on treatment with capecitabine and paclitaxel for breast carcinoma presented with history of a tingling sensation in her hands and feet with a progressive burning sensation. She also noted discomfort, minimal pain and stiffness while holding objects. On examination, there was patchy hyperpigmentation of both the palms and soles, and the dorsa of hands and feet. This was accompanied by a thickening of the skin more over the knuckles and toes. In addition there was a moist desquamation around the toes and over the palmar creases and a bluish discoloration of the lunulae of both thumbnails. She was diagnosed with hand and foot syndrome and started on pyridoxine and emollients. The finding of keratoderma noted in our patient is not seen commonly in hand and foot syndrome.

Report of a human accident caused by Conus regius (Gastropoda, Conidae) / Relato de um acidente em ser humano causado por Conus regius (Gastropoda, Conidae)

Conus regius is a venomous mollusc in the Conidae family, which includes species responsible for severe or even fatal accidents affecting human beings. This is the first report on a clinical case involving this species. It consisted a puncture in the right hand of a diver who presented paresthesia and movement difficulty in the whole limb. The manifestations disappeared after around twelve hours, without sequelae.

Conus regius é um molusco venenoso da família Conidae, que inclui espécies responsáveis por acidentes graves ou mesmo fatais em humanos. Os autores relatam pela primeira vez um caso clínico envolvendo a espécie, que inclui uma punctura na mão direita de um mergulhador submarino, que apresentou parestesias e dificuldade de movimentação do membro todo. O quadro desapareceu em cerca de doze horas, sem seqüelas.

Thallium poisoning presenting as paresthesias, paresis, psychosis and pain in abdomen.

Due to involvement of multiple systems, thallium poisoning is notorious for complexity and seriousness as symptoms of toxicity are non-specific and diverse. Alopecia and painful neuropathy are its cardinal features, others being gastrointestinal disturbances, encephalopathy, tachycardia, ataxia, hepatorenal and cardiac damage etc. We report a case of thallium poisoning who presented initially with gastrointestinal symptoms and later developed neurological features (peripheral neuropathy and delirium). Various diagnoses were entertained in this case and thallium poisoning was suspected only after he developed alopecia and neuropsychosis. He made a significant recovery by conservative management in spite of delay in diagnosis. We conclude that a high level of suspicion should be kept for thallium poisoning, especially in patients with painful, peripheral neuropathy and gastrointestinal symptoms which appear earlier than alopecia, since prognosis is more rewarding with early diagnosis, leading to complete recovery.

Chemotherapy-induced palmer planter erythrodysesthesia.

We report a case of palmar plantar erythrodysesthesia (PPE) in a case of acute lymphoblastic leukemia treated with VALP regime. The treating physician must be aware of this uncommon complication of chemotherapeutic agents to avoid unnecessary investigations.

Puffer fish poisoning: clinical features and management experience in 25 cases.

Between 1989 and 1999, 25 cases of puffer fish poisoning (PFP) were admitted to the medical service of Chon Buri Hospital. The severity of the poisoning was classified into four stages based on clinical signs and symptoms of PFP. Of the 25 patients, 23 were males and 2 were females. Three patients were in stage 1, four were in stage 2 and eighteen were in stage 4. Paresthesia was the early presenting complaint of all patients. Paresthesia consisting of either numbness or tingling of lips, tongue, around the mouth, hands, and feet. Muscle weakness, dizziness, vertigo, nausea and vomiting were common complaints. Eighteen patients developed acute flaccid paralysis and respiratory failure requiring ventilatory support. All patients received symptomatic and supportive treatment and general supportive care, including gastric lavage and intravenous fluid. Intubation and mechanical ventilation was considered especially when paralysis was progressing rapidly. Most were taken off the respirator 12-48 hours later. All patients completely recovered without any sequelae. Clinical features of PFP, toxicity of puffer fish and management were discussed.

A case of amiodarone and neuromyopathy

La amiodarona es utilizada frecuentemente en el control de las arritmias cardíacas a pesar de sus múltiples efectos colaterales. Se reporta el caso de un varón de 38 años con diagnóstico de taquicardia ventricular que después de un año de uso crónico de amiodarona, presentó fatiga muscular, parestesias y temblor fino fistal en extremidades. Un aumento en la dosis de amiodarona por recidiva de la arritmia fue seguido de una elevación sostenida de los niveles séricos de la fracción MM de creatín fosfocinasa. Una electromiografia reveló neuropatía periférica sensitivo-motora, y una biopsia del cuadriceps, atrofia muscular de tipo neuropático, que se correlacionó con la presencia de depósitos intralisosomales e importante degeneración axonal en el nervio sural. Ambas alteraciones fueron dosis/tiempo dependiente. El caso ilustra la conveniencia de investigar intencionadamente estas alteraciones en pacientes que reciben este fármaco por periodos prolongados

Cisplatinum neuropathy with Lhermitte's sign.

A case of cisplatinum induced neuropathy is reported because of its unusual presentation. Withdrawal of the drug resulted in improvement.