Hair loss in a female patient after administration of fluoxetine: a case report and review of the literature.

OBJECTIVE: Fluoxetine is a pharmacological agent that has been widely used to determine the neurotransmission of serotonin in the central nervous system. It is the drug of choice in the treatment of depression due to its safer profile, fewer side effects, and greater tolerability. PATIENTS AND METHODS: This is a case of a 30 year-old woman suffering from mild depression according to the DSM-V criteria who had been prescribed and administered fluoxetine in a dose of 20 mg p.o./per day. RESULTS: Six weeks after the initiation of the medication, the patient reported hair loss in the frontal area of the skull. CONCLUSIONS: Since fluoxetine is a widely used antidepressant, clinicians should be aware of the skin complications in patients treated with antidepressants. There is further need for therapeutic monitoring in everyday clinical practice and before the prescription of an antidepressant agent, the specific guidelines, side-effect profile, drug-drug interactions and most current indications should always be taken into consideration.

Acute transverse myelitis and antiphospholipid antibodies in lupus. No evidence for anticoagulation.

Current views suggest that prothrombotic properties of antiphospholipid antibodies (aPL) have a role in the development of acute transverse myelitis (ATM) in patients with systemic lupus erythematosus (SLE). Consequently, empiric anticoagulation may be included in these patients' treatment. We performed a systemic review of the literature to explore the clinical value of the presence of aPL in patients with lupus myelitis and the possible effectiveness of anticoagulation. We analyzed clinical and laboratory data extracted from published cases of SLE-associated ATM, fulfilling the Transverse Myelitis Consortium Working Group diagnostic criteria, that provided information on aPL. We report on a total of 70 patients. aPL, detected upon ATM onset in 54% of patients, neither predicted the involvement of the thoracic part of the spine, which has been postulated to reflect a predominantly thrombosis-induced injury, nor correlated with relapsing ATM, additional lupus CNS manifestations, or worse clinical outcome. An unfavorable outcome could be predicted by paralysis (P=0.02) and abnormal CSF findings at presentation (P=0.02). Whilst all patients received major immunosuppressive regimens, severe neurologic impairment (estimated Expanded Disability Status Scale score>7) was found primarily in aPL-negative patients (P=0.03). Anticoagulation was more frequently applied in aPL-positive patients (P=0.04), but any additional therapeutic effect was not evident. Detection of circulating aPL at ATM onset appears unreliable to suggest a thrombotic cause and perhaps not enough to dictate therapeutic anticoagulation. Registry creation of ATM in patients with SLE is needed to obtain more definite answers on the role of aPL in this condition.

Possible epileptic origin of symptoms in a case exemplifying the sleeper kind of 'limbic psychotic trigger reaction'.

Limbic psychotic trigger reaction (LPTR) includes paroxysmal, motiveless, unplanned felonies, all committed during flat affect, autonomic arousal and a fleeting de novo psychosis. It is considered as a form of non-convulsive behavioural seizures (NCBS). A transient limbic hyperactivation is probably implicated that impairs prefrontal monitoring but preserves memory for the acts. LPTR may, however, not be limited to felonies which have attracted forensic attention. There may exist many more 'merely' social misbehaviours, undetected and untreated as a 'sleeper' case. This kind of possible undetected LPTR cases, exemplified by a patient who suffers from paroxysmal hallucinations triggering her to attempt to commit infanticide, is presented herein. Our patient had repetitive occurrence of episodes and remission of the symptomatology after the administration of oxcarbazepine, facts that support the epileptic origin of the disorder.

Central nervous system involvement in HCV-related mixed cryoglobulinemia.

An involvement of the peripheral nervous system is frequent in patients with HCV-related mixed cryoglobulinemia (HCV-MC), whereas central nervous system (CNS) impairment has been rarely reported. To investigate the possible CNS involvement in MC, we evaluated 18 patients by neurophysiological, neuroradiological and neuropsychological methods. Three patients (16.7%) had clinically evident neurological central signs, ten (55.5%) complained of mild symptoms, possibly indicative of CNS impairment, and five (27.8%) did not have any CNS symptom. Evoked potentials (EPs) were abnormal in 83% of the cases (SSEPs in 72%, VEPs in 44%, MEPs in 39% and BAERs in 22%). Brain magnetic resonance imaging (MRI) showed abnormal findings in 83% (small T2-weighted hyperintense lesions in 72%, focal or diffuse atrophy in 50%). Cognitive impairment was detected in 22% of the patients. A mild or subclinical CNS involvement is frequent in MC patients. Neuropsychological, neurophysiological and neuroradiological examination are useful to detect CNS involvement also in asymptomatic subjects.