Pustular-type drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms due to carbamazepine with systemic muscle involvement.

Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe reaction usually associated with maculopapular eruptions and systemic involvement. Here we report the first case, to our knowledge, of DIHS/DRESS due to carbamazepine with acute generalized pustular bacterid-like (AGPB-like) eruptions and skeletal muscle involvement. Reviewing our case and the published work, we discuss pustular-type DIHS/DRESS which, in most cases, involves acute generalized exanthematous pustulosis (AGEP)-like skin eruptions in response to carbamazepine. Pustular eruptions may appear in relatively few cases of DIHS/DRESS, in particular, when the causative drug is carbamazepine and, even in cases of intractable pustular bacterid-like eruptions, a reaction to a drug should be suspected. Skeletal muscle involvement may be associated with DIHS/DRESS as one of its systemic manifestations.

Dynamic molecular behavior of semi-fluorinated oleic, elaidic and stearic acids in the liquid state.

Ordinary fatty acids such as oleic, elaidic and stearic acids exist as their hydrogen-bonded dimers in their liquids and in non-polar solvents. Infrared (IR) and nuclear magnetic resonance (NMR) spectroscopy have revealed that semi-fluorinated (SF) acids containing a perfluorooctyl group (C8F17) as a terminal segment exist also as hydrogen-bonded dimers, which are the units of inter- and intramolecular movements in their liquids and CCl4. The dynamic molecular properties, such as self-diffusion coefficients and intramolecular movements of SF-oleic, SF-elaidic, and SF-stearic acids were compared with those of corresponding ordinary fatty acids (H-acids). From the high equilibrium spreading pressures (ESPs) for SF-acids compared with those for their corresponding H-acids, it was expected that the inter-acyl chain interaction is weaker for the SF-acid than for the H-acid: the SF-fatty acids should have higher molecular mobility than the corresponding ordinary H-acids in the liquid state. However, the self-diffusion coefficients obtained for SF-acids were smaller than those for the corresponding H-acids; the apparent activation energies for the self-diffusion process (translational movement) of SF-acids were larger than those for the corresponding H-acids. Namely, the motion of SF-acid molecules in a liquid phase is rather restricted compared with H-acid in spite of lower inter-acyl chain interaction of SF-acid. This unexpected result suggests that the molecular motion of SF-acid in a liquid phase is not directly governed by inter-acyl interaction, but may be interpreted as a reptation movement of an acid molecule, which is related to intramolecular movement. In fact, low intramolecular movements for SF-acid were confirmed by ¹³C-NMR T1 measurements.