Topiramate-induced delusional parasitosis.

A 48-year-old woman with temporal lobe epilepsy and no prior history of psychiatric illness was started on topiramate (TPM). The dose was titrated up to 150 mg twice daily over 14 weeks and led to a significant reduction in seizure frequency. Upon reaching this dose, she developed intense pruritus and the firm belief that her skin was infected by parasites. She was diagnosed with delusional parasitosis (DP). Consequently, her TPM was weaned off and her DP settled completely without the use of antipsychotic medication. DP is characterized by the unshakeable conviction that small organisms infest the body despite the absence of confirmatory medical evidence. DP can occur in a wide variety of organic and psychiatric disorders or as an isolated delusional disorder. Rarely DP can be drug-induced. While psychiatric symptoms are a well recognized side-effect of TPM, this is, to our knowledge, the first reported case of TPM-induced DP.

A study of clinical and aetiological factors and possible associations of lichen sclerosus in males.

Lichen sclerosus is a chronic skin condition with a predilection for the genital area. In the present study, 35 male patients with lichen sclerosus were interviewed and examined. Blood screens were performed and histology was requested if not already performed. The findings indicate that lichen sclerosus in males exists as a spectrum of disease, ranging from a mild form with white plaques and few symptoms to a severe form with inflammation, atrophy and scarring with possible urological consequences. In many areas it differs from the condition in females; the association with autoimmune disease is weaker and there is less perianal and extragenital involvement. The association with malignancy in males is of lesser significance than initially believed.

The role of phospholipase C in arginine vasopressin secretion by rat hypothalami in vitro.

The role of phosphatidylcholine (PC) and phosphatidylinositol (PI) specific phospholipase C (PLC) enzymes in the release of immunoreactive arginine vasopressin (ir-AVP) from rat hypothalami in vitro was examined. PC-PLC (0.05-01 U ml-1) increased ir-AVP release but PI-PLC (0.01-0.5 U ml-1) did not. The response to a submaximal concentration of PC-PLC (0.075 U ml-1) was inhibited by the protei kinase C (PKC) inhibitor Ro 31-8220 (40 microM) and by removal of extracellular Ca2+ but was unaffected by the nitric oxide (NO) precursor L-arginine (1 mM), the NO synthase inhibitor N omega-nitro-L-arginine benzyl ester (1 mM) and the phospholipase A2 (PLA2) inhibitors quinacrine (100 microM) and dexamethasone (1 microM). The results suggest that PC-PLC plays an important role in AVP secretion. The responses to PC-PLC appear to be mediated by PKC but not by changes in NO synthase or PLA2 activity.

[3H]L-arginine transport and nitric oxide synthase activity in foetal hypothalamic cultures.

[3H]L-arginine uptake and the conversion of [3H]L-arginine to [3H]citrulline were characterized in foetal hypothalamic cultures. [3H]L-arginine uptake was reduced by L-ornithine (10 microM-1 mM), high extracellular K+ (56 mM), L-glutamate (100 microM) and removal of extracellular Ca2+, but was increased by the nitric oxide synthase inhibitor, Nw-nitro-L-arginine benzyl ester (L-NABE; 1 mM). [3H]citrulline formation was inhibited by L-NABE (1 mM), increased by high extracellular K+ (56 mM) and unaffected by L-glutamate (100 microM). Removal of extracellular Ca2+ reduced [3H]citrulline formation by mixed (neurones and glia) and neurone-enriched cultures but not by glial-enriched cells. The results suggest that [3H]L-arginine uptake into hypothalamic cultures is mediated by the system y+ transporter and is dependent on extracellular Ca2+. [3H]citrulline production in hypothalamic neuronal, but not glial, cells is also dependent on extracellular Ca2+.

The clinical significance of partial lipoatrophy and C3 hypocomplementaemia: a report of two cases.

Partial lipoatrophy often presents with a characteristic 'cadaveric' facial appearance but may also present with manifestations of immune deficiency and renal disease. We present two cases illustrating all these features.

Pyoderma gangrenosum, erythema elevatum diutinum and IgA monoclonal gammopathy.

A patient with erythema elevatum diutinum (EED) developed pyoderma gangrenosum (PG). Investigation revealed an IgA kappa monoclonal gammopathy. Previous reports of PG in association with EED are reviewed and the spectrum of the neutrophilic dermatoses discussed.

Observations on the role of tumor necrosis factor-alpha in a murine model of shock due to Streptococcus pyogenes.

OBJECTIVE: To examine the effect of a monoclonal antibody to tumor necrosis factor-alpha (TNF-alpha) in a murine model of shock due to Streptococcus pyogenes. DESIGN: Prospective, multiexperimental, randomized, controlled trial. SETTING: University hospital research laboratory. INTERVENTIONS: An LD90 murine model of Gram-positive shock using S. pyogenes, associated with the presence of significant concentrations of TNF-alpha in the circulation. Prophylactic administration of antibody with concomitant saline controls. A 500-micrograms TN3-19.12 (hamster monoclonal antibody to recombinant murine TNF), or saline, by intravenous injection was administered. MEASUREMENTS AND MAIN RESULTS: Administration of 0.3 mL of 6 x 10(8) colony-forming units/mL of S. pyogenes H250 to mice resulted in 90% to 100% mortality rates in 72 hrs. Serum TNF-alpha concentrations peaked at 2 hrs after bacterial challenge and were 67.7 +/- 18.6 ng/mL. Treatment with anti-TNF-alpha monoclonal antibody abolished the serum TNF-alpha concentrations but did not affect the mortality rate. Serum endotoxin concentrations were < 50 pg/mL before challenge and at 0.5, 1, 2, 5, and 24 hrs after challenge. CONCLUSIONS: Pretreatment with an anti-TNF monoclonal antibody was not protective in this model of S. pyogenes sepsis, despite the presence of significant amounts of TNF in the circulation. These data suggest that TNF-alpha may not play such a crucial role in the pathogenesis of shock due to S. pyogenes.