ABSTRACT
Azathioprine hypersensitivity syndrome is a rare but potentially severe side effect of azathioprine use. It has a variable and non-specific presentation making it difficult to distinguish from sepsis or disease relapse. High clinical suspicion is therefore required for recognition and prompt cessation of azathioprine for symptom resolution. Herewith two cases of severe azathioprine hypersensitivity syndrome are described, one in association with Sweet syndrome. Both presented with vague symptoms 2 weeks after commencing azathioprine for antineutrophil cytoplasmic antibody vasculitis. The differentials of sepsis and disease relapse were considered prior to cessation of azathioprine which resulted in a dramatic improvement in both cases. These cases highlight the diagnostic challenge azathioprine hypersensitivity syndrome presents. It should be suspected when there is a temporal relationship to drug initiation, with absence of infection or serological evidence of disease relapse.
Subject(s)
Drug Hypersensitivity Syndrome , Drug Hypersensitivity , Sweet Syndrome , Antibodies, Antineutrophil Cytoplasmic , Azathioprine/adverse effects , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Humans , Immunosuppressive Agents/adverse effects , Sweet Syndrome/chemically induced , Sweet Syndrome/diagnosis , Sweet Syndrome/drug therapyABSTRACT
OBJECTIVE: The aims of this study were to compare distinct brain frontal lobe parcellation methods across 90 brain magnetic resonance imaging scans and examine their associations with cognition in older age. METHODS: Three parcellation methods (Manual, FreeSurfer, and Stereology) were applied to T1-weighted magnetic resonance imaging of 90 older men, aged â¼ 73 years. A measure of general fluid intelligence (gf) associated with dorsolateral frontal regions was also derived from a contemporaneous psychological test battery. RESULTS: Despite highly discordant raw volumes for the same nominal regions, Manual and FreeSurfer (but not Stereology) left dorsolateral measures were significantly correlated with gf (r > 0.22), whereas orbital and inferior lateral volumes were not, consistent with the hypothesized frontal localization of gf. CONCLUSIONS: Individual differences in specific frontal lobe brain volumes--variously measured--show consistent associations with cognitive ability in older age. Importantly, differences in parcellation protocol for some regions that may impact the outcome of brain-cognition analyses are discussed.
