A Case of Fatal DRESS Syndrome Caused by Dapsone in a Patient with Behcet's Syndrome / 대한류마티스학회지

Dapsone has been used for several dermatological conditions such as immunobullous disease and ulticarial vasculitis. Dapsone is very useful drug for treating the mucocutaneous manifestations of Behcet's disease. The widely recognized side effects of dapsone are headache, methemoglobinemia and hemolysis. The severer, but rarer side effect of dapsone is known as dapsone hypersensitivity syndrome, which consists of exfoliative dermatitis, hepatitis, lymphadenopathy and hemolytic anemia. When this is associated with eosinophilia, we can diagnose and treat this drug reaction with eosinophilia and systemic symptoms (DRESS). DRESS is a syndrome of fever, rash, and internal organ involvement that's secondary to administering the offending medication. We describe here a 47-year-old woman who was hospitalized with fever, skin rash, hemolytic anemia, lymphadenopathy, eosinophilia, pleural effusion and life threatening hepatitis, which could lead to hepatic failure, within three weeks of starting of dapsone therapy for controlling her oral and genital ulcers. We diagnosed the woman as suffering with DRESS syndrome and we started treatment with corticosteroid. Three weeks after starting therapy, her symptoms almost completely resolved and she was discharged.

Lymphocytic infundibuloneurohypophysitis presenting with central diabetes insipidus: a case report and review of previous Korean cases / 대한내과학회지

Lymphocytic infundibuloneurohypophysitis is a neuroendocrine disorder characterized by autoimmune inflammation of the pituitary stalk and neurohypophysis. Clinical findings such as acute onset central diabetes insipidus and the regression of characteristic magnetic resonance imaging (MRI) findings allow for the possible diagnosis of this disease. Three cases of lymphocytic infundibuloneurohypophysitis have been previously reported in Korea. Here we report a case in a 66-year-old woman, along with a review of previously reported occurrences in Korea. A woman presented with abrupt-onset central diabetes insipidus. Sella MRI showed thickening of the pituitary stalk and loss of high T1 signals that are associated with a normal neurohypophysis. Basal pituitary hormone levels were normal with the exception of growth hormone, which was low. The patient refused transsphenoidal pituitary biopsy and we thus chose to continue close clinical and radiologic follow-up after desmopressin nasal spray application. The need for desmopressin decreased slightly over time and MRI obtained after 6 months showed regression of the pituitary stalk lesion.

A Case of Isoniazid Induced Systemic Lupus Erythematosus / 대한류마티스학회지

Many drugs have been known to induce lupus-like syndrome, composing approximately 10% of all SLE cases. Isoniazid-induced lupus erythematosus affects either sex equally and the most common presenting feature is arthralgia or arthritis with anemia. Fever and pleuritis occur in approximately half of the cases, and pericarditis in approximately 30% of cases. We discribe a 28-year-old woman receiving antituberculous medications including isoniazid for one month. She was hospitalized with fever, arthralgia and newly developed pleural effusion The analysis of pleural fluid and serum revealed an elevated level of antinuclear antibody. We suspected of drug induced lupus and stopped isoniazid medication. After discontinuation of isoniazid and short course of prednisolone treatment, her symptoms and pleural effusion disappeared. This case is to our knowledge, the fist report of isoniazid induced SLE in Korea.