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A 27-year-old female presented to us with a short history of fever, jaundice, rash, and worsening hepatic dysfunction subsequent to treatment with intravenous antibiotics and alternative medicine for a urinary tract infection. The eosinophilia, lymphadenopathy, and transaminitis prompted us to consider a diagnosis of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) which can be fatal if not treated. The patient showed improvement in clinical and laboratory parameters after a course of steroids. This case is presented as DRESS syndrome that can prove rapidly fatal if not diagnosed and treated immediately.
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Hepatitis E virus (HEV) infection is most common among acute viral hepatitis (AVH) infections in developed countries. It is an enteric virus which usually causes a self-resolving hepatitis. We report the case of a 9-year old boy who presented with anorexia, fever, pain in abdomen and jaundice. Ultrasound revealed no signs of cholestasis. Laboratory findings revealed conjugated hyperbilirubinemia, transaminitis, and bilirubinuria. There was no evidence of any autoimmune or metabolic disease, and routine viral serology was normal except for immunoglobulin M to HEV suggestive of acute origin of disease. The jaundice resolved slowly after a period of 2 months. Hepatitis E virus RNA was not detectable in the convalescent serum. This case is an example of conjugated hyperbilirubinemia seen in acute phase of viral hepatitis caused by HEV.
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Objective: Anorexia nervosa and eating disorder not otherwise specified (NOS), an eating disorder not fulfilling anorexia nervosa DSM-IV criteria are on a rising trend in Singapore. The aims of this paper were to study the clinical characteristics and features of patients with anorexia and eating disorder NOS in Singapore. Methods: A retrospective cohort analysis of 373 patients between 2003 and 2010 at a tertiary hospital was done. Inclusion criteria included inpatients and outpatients with the age range of 12 years old to 40 years old fulfilling the Diagnostic and Statistical Manual (DSM)-IV criteria for anorexia nervosa and patients with the diagnosis of eating disorder NOS. The subjects are analyzed based on the severity of the eating disorder and the presentation subtypes. Results: An analysis of the overall demographic data revealed the female to the male ratio to be 22.4:1. The Chinese formed the largest ethnic group in the study population with 242 (86.1%) patients, and the bulk of the patients (75.8%) patients were between 12 to 20 years old. Anorexia nervosarestricting subtype was the most common eating disorder (55.2%) and the most common body mass Index (BMI) was between BMI 14.6 – 16.5 (35.2%). Restriction technique (p = 0.01), binge/purge (p = 0.03) and exercise (p < 0.001) are statistically significant to cause transaminitis in patients. Conclusion: There were significant changes in the demographics compared to the study reviewing patients from 1994 and 2002. There was a significant increase in the Caucasian population with changes in the Singapore immigration policy. A detail history taken during first visit can reduce the morbidity and mortality of these patients.
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<p><b>INTRODUCTION</b>Anorexia nervosa (AN) and eating disorders not otherwise specified (EDNOS) are on the rise in Singapore. Abnormal liver function tests have been reported for up to 12.2% of patients with AN. These patients are also known to present with comorbid psychiatric disorders. This study aims to investigate the correlation between body mass index (BMI) and the severity of abnormal liver function tests, and between BMI and the presence of comorbid psychiatric disorders.</p><p><b>METHODS</b>A retrospective cohort analysis of 373 patients diagnosed with AN or EDNOS at a tertiary hospital was performed. The clinical course of transaminitis and comorbid psychiatric disorders was correlated with the patient's BMI.</p><p><b>RESULTS</b>Patients with a BMI of ≥ 16.6 kg/m(2) at their first consult had a significantly lower risk of having comorbid psychiatric disorders (χ(2) = 32.08, p < 0.001). These patients were five times less likely to have comorbid psychiatric disorders as compared to patients from the other BMI groups (odds ratio [OR] 0.21). On the other hand, patients with a BMI of < 14.6 kg/m(2) had a significantly higher risk of having transaminitis (χ(2) = 72.5, p < 0.001). They were 11.1 times more likely to develop transaminitis as compared to patients with a BMI of ≥ 14.6 kg/m(2) (OR 11.05).</p><p><b>CONCLUSION</b>Severity of BMI can be used by clinicians as an indicator to assess for secondary psychiatric comorbidities and/or transaminitis during the first consultation. This could help reduce the morbidity and mortality rates in patients with AN or EDNOS.</p>