scholarly journals Dapsone induced DRESS syndrome: a rare fatal complication

2020 ◽  
Vol 7 (7) ◽  
pp. 1638
Author(s):  
Komalatha Choppari ◽  
Soma Santosh Kumar ◽  
Mamatha Pakala
Keyword(s):  
Emergency Department ◽  
Liver Failure ◽  
Skin Eruption ◽  
Skin Rash ◽  
Failure Diagnosis ◽  
Dress Syndrome ◽  
Fatal Complication ◽  
Threatening Condition ◽  
Life Threatening ◽  
Author Report

DRESS syndrome is a serious life threatening condition characterized by skin eruption, haematological abnormalities and multi organ involvement that can be fatal if unrecognized especially in patients with liver failure. Diagnosis may be difficult because it is rarely seen in children and it can mimic many different conditions. Author report a case of 12 year old female presented to this emergency department with moderate grade fever, skin rash and jaundice following dapsone ingestion. She was evaluated and was diagnosed as DRESS syndrome and successfully treated with steroids.

scholarly journals A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Bertram K. Woitok ◽  
Shawki Bahmad ◽  
Gregor Lindner
Keyword(s):  
Supportive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Multiorgan Failure ◽  
Heat Stroke ◽  
Exertional Heat Stroke ◽  
Hypoxic Hepatitis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10  km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

Methaemoglobinaemia from Vagisil creme in a 50-year-old woman

2021 ◽  
Vol 14 (3) ◽  
pp. e239697
Author(s):  
Sarah Cheyney ◽  
Zachary Field ◽  
Jacqueline Kropf ◽  
Steve Carlan
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Topical Anaesthetic ◽  
Over The Counter ◽  
Perimenopausal Woman ◽  
Threatening Condition ◽  
Life Threatening

Methaemoglobinaemia is a life-threatening condition that results from increased methaemoglobin production. As methaemoglobin is unable to reversibly bind to oxygen potentially lethal hypoxia and functional anaemia can occur. Benzocaine can be used as a topical anaesthetic and can be found in many nonprescription preparations marketed for self-application. It is known to cause methaemoglobinaemia in rare cases but most reports describe the complication occurring during endoscopy procedures. Methaemoglobinaemia occurring after topical benzocaine use on the perineum of a perimenopausal woman is exceedingly rare. A 50-year-old woman with methaemoglobinaemia secondary to the perineal application of over-the counter Vagisil (benzocaine 20% and resorcinol 3%- an antiseptic and disinfectant, respectively) presented to the emergency department. She had been using Vagisil for severe, chronic vaginal itching. While methaemoglobinaemia secondary to excessive use of over-the-counter medications such as Vagisil creme is exceedingly rare, it should be included in the differential diagnosis.

scholarly journals Spontaneous Heterotopic Pregnancy: Case Report and Literature Review

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 365 ◽  
Author(s):  
Miglė Černiauskaitė ◽  
Brigita Vaigauskaitė ◽  
Diana Ramašauskaitė ◽  
Mindaugas Šilkūnas
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Laboratory Tests ◽  
Heterotopic Pregnancy ◽  
Fallopian Tubes ◽  
Lower Abdomen ◽  
Healthy Baby ◽  
Extrauterine Pregnancy ◽  
Threatening Condition ◽  
Life Threatening

Heterotopic pregnancy is defined as a condition when intrauterine and extrauterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. We present a case of a 28-year-old primigravida female who conceived spontaneously and at her seventh week of gestation and was presented to the emergency department with weakness and acute pain in lower abdomen. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy. Urgent laparoscopic salpingotomy was chosen as a treatment option. The ectopic pregnancy was successfully removed with the preservation of the intrauterine embryo and fallopian tubes. The course of pregnancy after the surgery was without complications, and a healthy baby was delivered at the 39th week of gestation. When treated properly and on time, a heterotopic pregnancy can result in live childbirth with favorable outcomes for both the child and the mother.

Aggressive Treatment of Life-Threatening Hypophosphatemia During Recovery From Fulminant Hepatic Failure: A Case Report

2017 ◽  
Vol 33 (6) ◽  
pp. 375-379 ◽  
Author(s):  
Brittany D. Bissell ◽  
Jason E. Davis ◽  
Alexander H. Flannery ◽  
David A. Adkins ◽  
Melissa L. Thompson Bastin
Keyword(s):  
Liver Failure ◽  
Continuous Infusion ◽  
Liver Enzymes ◽  
High Dose ◽  
Fulminant Liver Failure ◽  
Aggressive Approach ◽  
Hepatocyte Regeneration ◽  
Threatening Condition ◽  
Life Threatening ◽  
Safe Approach

Acute liver failure secondary to acetaminophen overdose can be a life-threatening condition, characterized by severe electrolyte derangements. Hepatocyte regeneration is associated with phosphorous utilization and is a known complication of liver recovery following injury. We report the case of profound, life-threatening hypophosphatemia following recovery from acute fulminant liver failure. As the liver enzymes normalized, serum phosphorous levels plummeted. Our patient required an aggressive, individualized phosphorus replacement regimen, which resulted in a continuous infusion of intravenous (IV) sodium phosphate, titrated to a maximum rate of 30 mmol/h or 0.5 mmol/kg/h. The patient required over 400 mmol of total IV and oral phosphorous over the course of 48 hours. An aggressive approach to phosphorous replacement was done safely and effectively. Traditional replacement protocols are not adequate to sustain patients with this degree of hypophosphatemia. This is the first report to utilize a continuous infusion of phosphate with a maximum reported rate (0.5 mmol/kg/h). Our report summarizes a novel and safe approach for clinicians to maximally support these patients through high-dose, continuous infusion phosphorous administration.

scholarly journals Plasma Exchange as a Rescue Therapy for Acute Liver Failure

2021 ◽  
Author(s):  
Nupur B Patel ◽  
Anand Sharma ◽  
Itish Patnaik ◽  
Ashok Kumar
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Plasma Exchange ◽  
Resource Constraints ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Liver Function Tests ◽  
Threatening Condition ◽  
Life Threatening

Acute Liver Failure (ALF) is a life-threatening condition and often necessitates Liver Transplantation (LT). However, LT is not available to most patients in developing countries due to resource constraints. Here, authors presents a case of 30-year-old female with ALF and fulfilled the criteria for LT. The aetiology of ALF could not be diagnosed in her. Due to the lack of LT facilities, she was offered plasma exchange as a therapeutic option, which resulted in improvement in sensorium and Liver Function Tests (LFT) {bilirubin, International Normalised Ratio (INR), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT)} over a period of two weeks. She was discharged and was doing well during follow-up. Plasma exchange is a less studied but potential treatment option for ALF when LT is not feasible.

scholarly journals Atraumatic hemopericardium in a patient receiving warfarin therapy for a pulmonary embolus

CJEM ◽  
2005 ◽  
Vol 7 (03) ◽  
pp. 168-170
Author(s):  
Peter G. Katis
Keyword(s):  
Emergency Department ◽  
Pulmonary Embolism ◽  
Cardiac Tamponade ◽  
Pulmonary Embolus ◽  
Warfarin Therapy ◽  
Pericardial Tamponade ◽  
Thromboembolic Disease ◽  
Threatening Condition ◽  
Life Threatening ◽  
Echocardiographic Evidence

ABSTRACT Acute pericardial tamponade is a potentially life-threatening condition that requires immediate treatment. This report describes a patient who presented to the emergency department with an acute hemopericardium and echocardiographic evidence of cardiac tamponade following the initiation of warfarin therapy for a recently diagnosed pulmonary embolism. The association between cardiac tamponade, oral anticoagulation and pulmonary thromboembolic disease is briefly discussed.

scholarly journals Acute abdomen due to an infarction of wandering spleen: case report

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Ragheb Assaf ◽  
Baraa Shebli ◽  
Ayham Alzahran ◽  
Ahmad Rami Rahmeh ◽  
Ali Mansour ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Acute Abdomen ◽  
Rare Condition ◽  
Wandering Spleen ◽  
Ectopic Spleen ◽  
Threatening Condition ◽  
Life Threatening ◽  
Displaced Spleen

Abstract Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all spleen ligaments that fixate the spleen in the left upper quadrant. Many different terms refer to wandering spleen like dislocated spleen, ectopic spleen and displaced spleen. We report in this case a 13-year-old Syrian girl presented to the emergency department complaining of acute generalized abdominal pain with fever, anorexia and vomiting started 2 days prior to presentation. A splenectomy was performed, with uneventful postsurgical follow-up. Wandering spleen is prone to torsion and infarction resulting in acute abdomen and a life-threatening condition with high mortality rate reaching 50%. We advise the investigation of any recurrent episodes of chronic pain keeping up within mind this diagnosis.

scholarly journals Efficacy and safety of liver support devices in acute and hyperacute liver failure: a systematic review and network meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna Kanjo ◽  
Klementina Ocskay ◽  
Noémi Gede ◽  
Szabolcs Kiss ◽  
Zsolt Szakács ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Meta Analysis ◽  
Liver Support ◽  
Therapeutic Modalities ◽  
Molecular Adsorbent Recirculating System ◽  
Effective Option ◽  
Threatening Condition ◽  
Life Threatening ◽  
Liver Support Devices

AbstractAcute liver failure (ALF) is a potentially life-threatening condition. Liver support therapies can be applied as a bridging-to-transplantation or bridging-to-recovery; however, results of clinical trials are controversial. Our aim was to compare liver support systems in acute and hyperacute liver failure with network meta-analysis. After systematic search, randomized controlled trials (RCT) comparing liver support therapies in adults with acute or hyperacute liver failure were included. In-hospital mortality was the primary outcome, the secondary outcomes were hepatic encephalopathy and mortality-by-aetiology. A Bayesian-method was used to perform network meta-analysis and calculate surface under the cumulative ranking curve (SUCRA) values to rank interventions. Eleven RCTs were included. BioLogic-DT and molecular adsorbent recirculating system (MARS) resulted in the lowest mortality (SUCRAs: 76% and 73%, respectively). In non-paracetamol-poisoned patients, BioLogic-DT, charcoal hemoperfusion and MARS may be equally efficient regarding mortality (SUCRAs: 53%, 52% and 52%, respectively). Considering hepatic encephalopathy, extracorporeal liver assist device (ELAD) may be the most effective option (SUCRA: 78%). However, in pairwise meta-analysis, there were no statistically significant differences between the interventions in the outcomes. In conclusion, MARS therapy seems to be the best available option in reducing mortality. Further research is needed on currently available and new therapeutic modalities. (CRD42020160133).

scholarly journals The diagnostic accuracy of multi-organ point-of-care ultrasonography for life-threatening conditions: The case of cancer patients who visit the emergency department: retrospective observational study

2021 ◽  
Author(s):  
Yun Ang Choi ◽  
Min Sung Lee ◽  
Tae Kwon Kim ◽  
Jae Yun Jung ◽  
Ki Hong Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Positive Predictive Value ◽  
Cancer Patients ◽  
Predictive Value ◽  
Pulmonary Thromboembolism ◽  
Point Of Care ◽  
Threatening Condition ◽  
Life Threatening ◽  
Point Of Care Ultrasonography

Abstract Background The number of cancer patients visiting the emergency department (ED) is increasing globally, and this has highlighted the importance of diagnosing and coping with related life-threatening complications early. There may be efficacy in employing multi-organ point-of-care ultrasonography (M-PoCUS) for this purpose; however, there has been no study on the usefulness of this diagnostic tool for cancer patients only. The aim of this study was to evaluate the diagnostic accuracy of M-PoCUS for a life-threatening condition in cancer patients who visited the ED.Methods We conducted a retrospective observational study in one tertiary university hospital ED in Seoul, Republic of Korea. We selected three emergency medicine specialists to perform a protocolized M-PoCUS evaluation of cancer patients according to the requests of emergency physicians since the SARS-CoV-2 pandemic began. We enrolled 94 cancer patients in the study. The M-PoCUS diagnosis was then compared with an audit diagnosis. The primary outcomes measured were the sensitivity, specificity, positive predictive value, and negative predictive value of M-PoCUS in the above-described diagnosis.Results The M-PoCUS showed a sensitivity of 83% (95% CI, 61-95), specificity of 96% (95% CI, 88-99), positive predictive value of 86% (95% CI, 65-97), and negative predictive value of 94% (95% CI, 85-97). M-PoCUS produced 4 false negative (4.3%) pulmonary thromboembolism diagnoses and 3 false positive (3.2%) pleural effusion diagnoses. Conclusions M-PoCUS was useful in ruling out a life-threatening condition among the cancer patients. However, pulmonary thromboembolism was hard to distinguish using M-PoCUS due to pre-existing diseases scattered in cancer patients’ thorax.

scholarly journals Lamotrigine Induced DRESS Syndrome in a Child: A Case Report and Literature Review

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1063
Author(s):  
Chien-Heng Lin ◽  
Sheng-Shing Lin ◽  
Syuan-Yu Hong ◽  
Chieh-Ho Chen ◽  
I-Ching Chou
Keyword(s):  
Drug Reaction ◽  
Case Report ◽  
Skin Rash ◽  
Stable Condition ◽  
Anticonvulsant Drug ◽  
Dress Syndrome ◽  
Life Threatening ◽  
History Of ◽  
History Of Epilepsy ◽  
Systemic Symptoms

Lamotrigine is an important anticonvulsant drug. Its use, however, has been limited by the risk of potentially life-threatening dermatological reactions, such as a drug reaction with eosinophilia and systemic symptoms (DRESS). Here, we report the case of a 7-year-6-month-old girl with a history of epilepsy who developed a skin rash with dyspnoea after 2 weeks of lamotrigine treatment, with DRESS ultimately being diagnosed. After discontinuation of the offending drug and the initiation of systemic glucocorticosteroids, the DRESS symptoms were relieved and the patient was discharged in a stable condition. Anticonvulsant drugs such as lamotrigine are among the factors that induce DRESS in children. When a patient displays skin rash and systemic organ involvement following the initiation of an anticonvulsant drug, DRESS should not be overlooked as a diagnosis, and immunosuppressant drugs should be considered as an option for treating DRESS patients.

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