Uncommon vancomycin-induced side effects

Vancomycin has been used with increased frequency during the past 15 years and the most common toxicity with this drug is the red man syndrome . Other adverse effects include neutropenia, fever, phlebitis, nephrotoxicity, ototoxicity, thrombocytopenia, interstitial nephritis, lacrimation, linear IgA bullous dermatosis, necrotizing cutaneous vasculitis and toxic epidermal necrolysis. Only two cases of vancomycin-induced Stevens-Johnson syndrome and one case of pancytopenia have been reported in the medical literature. The treatment for both situations is based on cessation of the vancomycin therapy; in cases of Stevens-Johnson syndrome, antihistamine and/or steroid agents can be used. This article reports a case of pancytopenia and a case of erythema major associated with neutropenia.

Developmental milestones of vertically HIV infected and seroreverters children: follow up of 83 children

The aim of the study was to detect neurological abnormalities in human immunodeficiency virus (HIV) infected children. This was achieved by a prospective evaluation, from November/1995 to April/2000, of 43 HIV infected children (group I) and 40 HIV seroreverters children (group II) through neurological exam and neurodevelopmental tests: Denver Developmental Screening Test (DDST) and Clinical Adaptive Test / Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). A control group (III), of 67 children, were evaluated by CAT/CLAMS. Hyperactivity, irritability and hypotonia were the findings on neurological examination, without statistical differences between group I and II. On CAT/CLAMS, the group I developmental quotient (DQ) was significantly lower than the other groups. The same occurred in DDST, with group I presenting significantly more failures than group II. Nineteen HIV children of group I had brain computed tomographic scan, with abnormalities in three of them (basal ganglia calcification, white matter hypodensity and asymmetry of lateral ventricles). We conclude that in HIV infected children a neurodevelopment delay occur early in the disease, and it can be detected by screening tests

Insuficiência aguda hepática associada ao ácido valpróico na infância: relato de três casos / Acute hepatic failure associated with valproic acid in children: report of 3 cases

Relatamos três casos da insuficiência aguda hepática associada ao uso de ácido valpróico (AVP) em crianças epilépticas. A idade variou de 2 anos e 8 meses a 5 anos e 1 mês. Todos os pacientes apresentavam epilepsia de difícil controle e dois deles tinham desenvolvimento psicomotor severamente comprometido. O AVP foi usado em associaçao com outros antiepilépticos (carbamazepina em dois, fenobarbital em um). Todos os pacientes apresentaram sinais clínicos de insuficiência hepática. Vômitos, edema e icterícia foram os sinais iniciais. Febre ocorreu em dois pacientes. Os exames laboratoriais mostraram transaminases pouco aumentadas (inferiores a 194 U/l) e níveis de bilirrubina entre 5,5 e 19,8 mg por cento. Um dos pacientes usava a droga há 12 meses e os dois outros, há menos de 6 meses. Dois pacientes apresentaram resoluçao do quadro hepático após a retirada da droga e um faleceu. Com este relato, salientamos a toxicidade do AVP em crianças epiléptica mesmo acima de dois anos de idade, principalmente em uso de politerapia, com comprometimento neurológico, e que o quadro pode ser reversível com a retirada da droga.