Recurrent Leflunomide-Induced Drug Reaction With Eosinophilia and Systemic Symptom (DRESS) Syndrome Despite Prolonged Steroid Taper: A Case Report.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characterized primarily by nonspecific systemic symptoms such as fever, a classical rash, and eosinophilia. While this is an adverse reaction more often related to medications such as anticonvulsants, many drugs have been reported to be implicated in this event. We report a case of a 35-year-old male who developed DRESS syndrome within one month of beginning leflunomide therapy. Despite treatment with a prolonged steroid taper, he developed a flare-up with transaminitis less than two months after his initial hospitalization. Our patient was managed with steroid pulse therapy and cyclosporine, which resulted in an improvement of symptoms and transaminitis. To our knowledge, only nine previous cases of leflunomide-induced DRESS syndrome have been previously reported.

A Case Report and 31-Case Study: Does Takotsubo Cardiomyopathy in Myasthenia Gravis Patients Have a High Mortality Rate?

Myasthenia gravis is an autoimmune disorder in which antibodies are formed against post-synaptic nicotinic acetylcholine receptors that lead to impeded muscle contraction and commonly affects the oculomotor muscles. Takotsubo cardiomyopathy (TTC) is a dilated cardiomyopathy that can mimic a myocardial infarction and causes reversible systolic dysfunction. This is a case of a 66-year-old Caucasian male with a known history of ocular myasthenia gravis that presented to the emergency room with worsening dyspnea secondary to a myasthenic crisis. One day, following admission, his shortness of breath failed to improve and was found to meet the diagnostic criteria for takotsubo cardiomyopathy. A brief review of 31 previous cases summarizes the current case reports, patterns, and mortality associated with the myasthenic crisis associated with TTC.

Unusual Case of Recurrent Pneumothorax in Granulomatosis With Polyangiitis.

Granulomatosis with polyangiitis is a small vessel vasculitis that manifests as multisystemic inflammation predominantly affecting the lungs, upper respiratory tract, and the kidneys. Granulomatosis with polyangiitis commonly presents with elevated inflammatory markers and has a strong association with cytoplasmic antinuclear antibodies. Pulmonary manifestations of the disease include nodules, alveolar hemorrhage, and respiratory failure. The prevalence of pleural involvement is low, but can present as pleural effusion, wall thickening, and rarely pneumothorax. We describe the first report of recurrent pneumothorax secondary to presumed granulomatosis with polyangiitis.