Carbamazepine induced transient monoclonal gammopathy and immunodeficiency.

Immune abnormalities have been found in many patients receiving anti-epileptic drugs. However, the effects of carbamazepine are still conflicting. We report the case of a 31-year-old woman who began carbamazepine treatment because of idiopathic epilepsy of adulthood. After three years of treatment she developed arthralgias and malaise. Complete immunologic evaluation showed a total absence of immunoglobulin M with decreased levels of immunoglobulin A, positive antinuclear antibodies and monoclonal paraproteinemia type IgG-kappa. The possibility of B cell lymphoma or myeloma was ruled out. Skin testing was negative. Bone marrow examination was normal. After carbamazepine discontinuation, levels of IgA and IgM increased until reaching normal values over 3 years. The monoclonal gammopathy of undetermined significance also disappeared over this period. During this period of immunodeficiency, the patient did not complain of any infectious complications.

[Anemia secondary to lead poisoning. Our experience with 12 cases]. / Anemia secundaria a intoxicación por plomo. Nuestra experiencia a propósito de 12 casos.

BACKGROUND: A decrease in hemoglobin production is probably the main cause of anemia observed in patients poisoned by lead although hemolysis caused by the effects on membrane or by inhibition of other enzymes such as 5'-pyrimidine nucleotidase may also play a key role. The main lead exposure source comes from lead use in industry; however, outside occupational exposure, food and water consumption is the main cause of lead exposure. MATERIALS AND METHODS: Clinical and analytical characteristics are reported of twelve patients with lead poisoning of food and water source occurred in the last 14 years in two health areas in north Extremadura. RESULTS: The exposure source was wine, vinegar and olives in one case, hand-made brandy in five, water consumption in houses with lead piping, and in two cases the cause was not determined. The clinical picture was similar in all cases with the exception of one female patient who had encephalopathy and hepatic failure. Diagnosis was suggested by regenerative anemia with basophilic stippling of erythrocytes. All patients received oral calcium disodium EDTA. CONCLUSIONS: Lead poisoning in non-industrial areas is a rare entity. Nevertheless, owing to the use of artisanal procedures for wine elaboration and derivatives, its occurrence is increasing. In a patient with symptoms of lead poisoning and regenerative anemia, a peripheral blood smear should be reviewed.

Anemia secundaria a intoxicación por plomo. Nuestra experiencia a propósito de 12 casos / Anemia secondary to lead poisoning. Our twelve-case experience

Introducción. La disminución en la producción de hemo es probablemente la causa principal de la anemia observada en pacientes intoxicados por plomo, si bien la hemólisis provocada por los efectos sobre la membrana o por inhibición de otras enzimas tales como la 5'-pirimidin nucleotidasa también pueden tener una importancia capital. La mayor fuente de exposición al plomo proviene de su utilización en actividades industriales; sin embargo, fuera del ámbito laboral el origen alimentario es la principal causa de contacto con este tóxico. Material y métodos. Presentamos las características clínicas y analíticas de 12 casos de saturnismo de origen alimentario producidos en los últimos 14 años en 2 áreas sanitarias del norte de Extremadura. Resultados. La fuente de exposición fue vino, vinagre y aceitunas en un caso, aguardiente artesanal en 5, en 2 pacientes fue por el consumo de agua canalizada por tuberías de plomo y en 2 no se determinó la causa. El cuadro clínico fue superponible en todos, excepto en 1 paciente con encefalopatía y fallo hepático. La anemia regenerativa con punteado basófilo sugirió el diagnóstico. Todos recibieron tratamiento con ácido etilendiaminotetracético (EDTA) cálcico disódico oral. Conclusiones. La intoxicación por plomo en zonas no industriales constituye una rareza; sin embargo, debido al uso de procedimientos artesanales en la elaboración del vino y sus derivados nuevamente se está incrementando. En un paciente con síntomas de saturnismo y con anemia regrenerativa debe revisarse la extensión de sangre periférica (AU)