ABSTRACT
The acute toxicity of paraphenylenediamine (PPD) has been associated with several histopathological changes. In humans, acute PPD poisoning is known to cause rhabdomyolisis and particularly myocardial lysis. However, its toxicity for the fetus has never been reported in the literature. We report a case of myocardial lysis in a fetus expelled by a 22-year-old mother after apparent ingestion of an unknown amount of PPD. The patient was admitted to our intensive care unit with acute onset of respiratory distress and rhabdomyolysis. The pelvic ultrasonography on admission showed a normally progressing pregnancy of 23-24 weeks. On day 9 post-ingestion, the patient spontaneously expelled a non-viable fetus. The fetal examination did not show any external or macroscopic abnormalities. However, the histopathological exam showed an important heart and lung congestion. There was also some interstitial edema and inflammation at the base of the lingua, in addition to a chorionic villus thrombosis and abruptio placentae. The histopathology of the myocardium showed lysis of the cardiac muscle. This observation suggests that the PPD was most likely responsible for the myocardial injury in the fetus.
Subject(s)
Abortion, Criminal , Coloring Agents/adverse effects , Fetal Diseases/chemically induced , Heart/drug effects , Myocarditis/chemically induced , Phenylenediamines/adverse effects , Administration, Oral , Adult , Fatal Outcome , Female , Fetal Diseases/pathology , Gestational Age , Heart/embryology , Humans , Maternal Exposure , Maternal-Fetal Exchange , Myocarditis/embryology , Myocarditis/pathology , Myocardium/pathology , PregnancyABSTRACT
INTRODUCTION: Acute pancreatitis is rarely seen in systemic lupus erythematous. CASE REPORT: A 28-year-old woman without significant past medical history, was hospitalized for sepsis and diagnosed with acute pancreatitis, which was found to be the initial presentation of a newly diagnosed systemic lupus erythematous. DISCUSSION: Acute pancreatitis as an initial presentation of systemic lupus erythematous is rare and is reported in only 10 cases in the literature. Multiple factors are involved in the pathogenesis. The role of corticosteroids in its apparition or resolution is still a subject of controversy.