ABSTRACT
Cytarabine is an antimetabolite used in the treatment of acute myeloid leukemia which acts by inhibiting DNA synthesis and subsequently cell division. It works on rapidly dividing cells, for that reason, it affects cancer cells, bone marrow and skin cells. Cytarabine has variable cutaneous side effects, the most common one is palmar-plantar erythema which usually presents with a tingling sensation around 5-7 days after cytarabine initiation, followed by erythema and tenderness. Auricular erythema is a rare subtype involving bilateral ears which often presents as ear redness and tenderness as described in the presented case. It is unclear if the skin side effects are related to cytarabine dose or plasma concentration. Most cases of auricular erythema have a benign course and resolve spontaneously. Treatment is mainly conservative. Steroids and antihistamines can be used to speed up recovery given that the pathophysiology is thought to be immediate or due to a delayed hypersensitivity reaction to cytarabine.
ABSTRACT
Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve any organ system, exhibiting great diversity in presentation. Cardiac tamponade as the initial presentation of childhood onset SLE (cSLE) is rare. We report the case of a 10 year old Afro-Caribbean female who presented with complaints of chest pain, shortness of breath and fever over 4 days. Clinical examination strongly suggested cardiac tamponade which was confirmed by investigations and treated with pericardiocentesis. After a thorough investigation, the underlying diagnosis of SLE was confirmed using the Systemic Lupus International Collaborating Clinics (SLICC) criteria and high dose corticosteroid therapy initiated. A review of recent studies shows that common initial presentations of cSLE include constitutional symptoms, renal disease, musculoskeletal and cutaneous involvement. In presenting this case and reviewing the literature we emphasize the importance of cSLE as a differential diagnosis when presented with pericarditis in the presence or absence of cardiac tamponade. In these patients early diagnosis and treatment is desired and in this regard we also discuss the sensitivity of the SLICC criteria in cSLE.
Subject(s)
Cardiac Tamponade/diagnosis , Cardiac Tamponade/etiology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Adrenal Cortex Hormones/therapeutic use , Cardiac Tamponade/drug therapy , Child , Diagnosis, Differential , Dose-Response Relationship, Drug , Echocardiography , Electrocardiography , Female , Humans , Lupus Erythematosus, Systemic/drug therapy , Pericarditis/diagnosis , Pericarditis/drug therapy , Pericarditis/etiology , Treatment OutcomeABSTRACT
OBJECTIVES: To study the relationship of dyslipidemia and serum uric acid with the risk of myocardial infarction among the hypertensive type 2 diabetic and non-diabetic patients of Trinidad. METHODS: Data were obtained from the hospital records of 672 adults who were treated for hypertension in public health clinics in Trinidad. RESULTS: The prevalence of myocardial infarction was 25.45% in the sample. Males accounted for 52.63% while females accounted for 47.37%. Hypertensive type 2 diabetics with dyslipidemia had greater occurrence of MI (23.93%) than non-diabetic hypertensive patients (7.67%) (p=0.008). Useful predictors of MI included: diabetes mellitus, altered lipid profile, family history of any cardiac conditions. On further analysis, hypertension class (p=0.003) and serum uric acid quartile (p=0.029) were also significant predictors of MI. CONCLUSIONS: The results suggest that there is a greater prevalence of MI in hypertensive type 2 diabetic patients with dyslipidemia than in non-diabetic hypertensive patients in Trinidad.
