Minocycline hypersensitivity syndrome with hypotension mimicking septic shock.

Minocycline is a semisynthetic tetracycline derivative that is often used in the treatment of acne vulgaris. A serious but rare adverse effect caused by minocycline therapy is a hypersensitivity syndrome (HS), consisting of fever, skin eruption, and internal organ involvement that begins within 8 weeks of therapy initiation. We report a case of minocycline HS with unique features, namely, associated hypotension, and a rebound of the cutaneous eruption upon discontinuation of systemic steroids.

Chronic meningococcemia in childhood: case report and review of the literature.

Chronic meningococcemia is a rare form of meningococcal infection. Most reported cases occur in adults. Only about 10% of reported patients are under 18 years of age. We herein report chronic meningococcemia in a 17-month-old immunocompetent child and review the literature. Our patient had a 4-month history of several episodes of intermittent fever accompanied by widespread erythematous and purpuric, crusted papules and pustules with necrotic centers. Blood cultures were positive for group C Neisseria meningitidis. Histopathology of a skin biopsy specimen revealed leukocytoclastic vasculitis. Because the disease is uncommon and can be confused with other conditions including other infectious processes, vasculitis, and collagen vascular diseases, it is important to have a high degree of suspicion for chronic meningococcemia. This will help avoid a delayed diagnosis and/or inappropriate treatment. The positive blood culture remains the diagnostic sine qua non. Treatment with ceftriaxone was rapidly successful in our patient.

U1RNP positive neonatal lupus erythematosus: association with anti-La antibodies?

Neonatal lupus erythematosus (NLE) is an antibody-mediated disorder most commonly associated with autoantibodies to Ro and/or La antigens. There have been five previous reports describing eight NLE patients with anti-U1RNP antibody in the absence of anti-Ro and anti-La autoantibodies. We report two cases of anti-U1RNP antibody-positive NLE, and briefly review the five previous reports. The diagnosis of NLE was based on physical examination and serological studies by ELISA, immunodiffusion, and immunoblotting. By conventional immunodiffusion and ELISA, our cases were negative for anti-Ro and anti-La antibodies, and positive for anti-U1RNP antibody. However, one of the mothers had anti-La antibody detected by immunoblot assay only. All anti-U1RNP antibody-positive infants had classic cutaneous lesions of NLE, but it is of interest that none had congenital heart block (CHB). Although these infants were negative for anti-Ro and anti-La antibodies with immunodiffusion and ELISA techniques, these antibodies might be detectable by immunoblotting, as was the case in one of the mothers.

Cutaneous polyarteritis nodosa of childhood.

BACKGROUND: The clinical presentation of childhood polyarteritis nodosa (PAN) can range from isolated cutaneous findings to widespread multisystem involvement. Both the systemic and cutaneous forms are known to occur after streptococcal infection. OBJECTIVE: Our purpose was to emphasize the frequent association of childhood cutaneous PAN with antecedent streptococcal infection. METHODS: We discuss four cases of cutaneous PAN that were associated with streptococcal infection and briefly review the pertinent literature. RESULTS: All patients had evidence of preceding streptococcal infection at the onset of their illness. Although mild systemic symptoms were present in all, their course was benign. The use of nonsteroidal antiinflammatory agents or corticosteroids resulted in clinical improvement. Antibiotic therapy was also used in the treatment of these patients. CONCLUSION: In children with PAN, evaluation should include laboratory studies to detect streptococcal infection.

Cutaneous porphyrialike photosensitivity after liver transplantation.

BACKGROUND: Liver disease and cholestasis are often associated with abnormal coproporphyrin levels, but photosensitivity eruptions do not usually occur with these conditions. We present a case of a cutaneous porphyrialike photosensitivity in a liver transplant patient with only mildly elevated coproporphyrin levels. OBSERVATIONS: A 5-year-old girl developed a cutaneous porphyria cutanea tarda-like photosensitivity after liver transplantation for congenital biliary atresia. Her cutaneous eruption consisted of fluid-filled vesicles and crusted erosions involving her face and arms. These lesions eventually healed with atrophic scarring and milia. The patient was in a state of chronic hepatic rejection, but her serum and 24-hour urine specimens contained only mildly elevated levels of coproporphyrin. Results of histopathologic examination and direct immunofluorescence of a skin biopsy specimen resembled those of porphyria. CONCLUSIONS: Although clinically porphyria cutanea tarda was suspected, her porphyrin profile was not consistent with that diagnosis. Liver transplantation has become relatively common, but porphyria cutanea tarda-like clinical and histopathologic findings associated with coproporphyrinemia in a liver transplant patient have not been reported to date.

Control of hypertension among diabetic patients.

We reviewed the data on 100 randomly selected patients who were treated for diabetes as well as hypertension in the Hypertension Clinic of the Zablocki VA Medical Center. We found that, while normal blood pressure (diastolic BP less than 90 mmHg) was achieved in 82% of the patients during the 3-year follow-up, diabetes control (fasting serum glucose less than 140 mg/dL during all follow-up visits) was achieved in only 17% of the patients. Despite extensive and repeated dietary counselling by dietitians, most patients failed to lose weight. The current methods employed to get the patients to lose weight are inadequate. Better methods are needed to achieve weight loss which could accomplish greater control of diabetes as well as hypertension.