scholarly journals Phenobarbitone Induced Toxic Epidermal Necrosis in a Young Patient - A Rare Clinical Presentation: A Case Report and Brief Review of the Literatures

2021 ◽  
Author(s):  
Biniyam A. Ayele ◽  
Kemal Ali ◽  
Eliyas Mulatu
Keyword(s):  
Case Report ◽  
Asthmatic Patient ◽  
Wound Care ◽  
Tube Feeding ◽  
Whole Body ◽  
Stevens Johnson Syndrome ◽  
Low Grade ◽  
First Case ◽  
Epidermal Necrosis ◽  
New Onset

Abstract Background: Toxic epidermal necrolysis (TEN)/ Stevens-Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, Ig E mediated hypersensitivity reaction; universally related to different drugs. Phenobarbitone is known to cause hypersensitivity reactions with benign pattern; ranging from a mild to moderate rashes but not life-threatening reactions such as TEN/SJS. Little is known about TEN in asthmatic patient. To the best of our knowledge, this is the first case of Phenobarbitone-induced TEN in a young asthmatic patient from the sub Saharan African. Case report: We report a 14-year-old right handed asthmatic male patient who presented with extensive blister skin eruptions involving the whole body including mouth ear canal later followed by skin exfoliation associated with low grade fever, sore throat, and dysphagia. The hypersensitivity skin reaction developed two weeks after initiation of Phenobarbitone of 100mg twice daily for a new onset generalized tonic clonic seizure. The exfoliation also involved oral and Conjunctival mucosa; with estimated 65% body surface area involvement; hence the diagnosis of Toxic epidermal necrosis was made. The Laboratory investigations were relevant for mild leucocytosis, prolonged prothrombin time, and reduced albumin. Phenobarbitone was discontinued and replaced with clonazepam; and the patient was managed with fluids replacement, IV antibiotics, twice daily wound care, analgesics, and naso gastric tube feeding. On subsequent days in intensive care unit (ICU), the patients’ clinical condition started improving; the skin lesion also started to heal and exfoliate in most of the affected skin surface areas, and the patient was discharges improved after ten days of ICU care.Conclusion: In summary, the present case describes, a 14-years-old young child with history of allergy in a form of asthma and new onset seizure disorder; and developed toxic epidermal necrosis following exposure to Phenobarbitone. This case also highlighted the benign prognosis observed in paediatrics population with TEN.

scholarly journals Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Biniyam A. Ayele ◽  
Kemal Ali ◽  
Eliyas Mulatu
Keyword(s):  
Case Report ◽  
Wound Care ◽  
Pediatric Population ◽  
Tube Feeding ◽  
Skin Surface ◽  
Clonic Seizure ◽  
Stevens Johnson Syndrome ◽  
Low Grade ◽  
Patient Reported ◽  
Epidermal Necrosis

Abstract Background Toxic epidermal necrolysis (TEN)/Stevens–Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, T-cell mediated delayed type IV hypersensitivity reaction and universally related to different drugs. Phenobarbitone is known to cause hypersensitivity reactions with benign pattern; ranging from a mild to moderate rashes but not life-threatening reactions such as TEN/SJS. Case report We report a 14-year-old asthmatic male patient admitted to a local hospital for an acute exacerbation of asthma, after he presented with shortness of breath, cough, and fever. He was treated with bronchodilator and antibiotics. On subsequent days, the patient developed new onset generalized tonic clonic seizure in the hospital for which he was started on phenobarbitone of 100 mg twice daily. Two weeks after initiation of phenobarbitone, the patient developed extensive blistering skin eruptions; which subsequently exfoliated unevenly. Associated with the hypersensitivity skin reaction, the patient reported low grade fever, sore throat, and dysphagia. The exfoliation also involved oral and conjunctival mucosa; with estimated 65% body surface area involvement. The laboratory investigations were relevant for mild leucocytosis, prolonged prothrombin time, and reduced albumin. Phenobarbitone was discontinued and replaced with clonazepam; and the patient was managed with fluids replacement, IV antibiotics, twice daily wound care, analgesics, and naso gastric tube feeding. On subsequent days the patients’ clinical condition started improving; the skin lesion also started to heal and exfoliate in most of the affected skin surface areas, and the patient was discharged improved after ten days of intensive care unit. Conclusion In summary, the present case describes, a 14-years-old young child with history of asthma and seizure disorder; and developed toxic epidermal necrosis following exposure to Phenobarbitone. This case also highlighted the better prognosis observed in pediatric population with TEN.

scholarly journals Case report: a 5-year-old with new onset nephrotic syndrome in the setting of COVID-19 infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kelsi M. Morgan ◽  
Peace D. Imani
Keyword(s):  
Nephrotic Syndrome ◽  
Case Report ◽  
Pediatric Patient ◽  
Corticosteroid Therapy ◽  
Clinical Remission ◽  
Laboratory Findings ◽  
Case Presentation ◽  
The Third ◽  
First Case ◽  
New Onset

Abstract Background This is a case report of an asymptomatic SARS-CoV-2 infection associated with new-onset nephrotic syndrome in a pediatric patient. This is the third case of new-onset nephrotic syndrome in children associated with SARS-CoV-2 infection, but is the first case report describing a new-onset nephrotic syndrome presentation in a patient who had asymptomatic COVID-19 infection. Case presentation This is a case of a previously healthy 5 year old female who presented with new-onset nephrotic syndrome in the setting of an asymptomatic COVID-19 infection. She presented with progressive edema, and laboratory findings were significant for proteinuria and hypercholesterolemia. She was treated with albumin, diuretics, and corticosteroid therapy, and achieved clinical remission of her nephrotic syndrome within 3 weeks of treatment. Though she was at risk of hypercoagulability due to her COVID-19 infection and nephrotic syndrome, she was not treated with anticoagulation, and did not develop any thrombotic events. Conclusions Our case report indicates that SARS-CoV-2 infection could be a trigger for nephrotic syndrome, even in the absence of overt COVID-19 symptoms.

scholarly journals Spinal Intradural, Extramedullary Ependymoma with Astrocytoma Component: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Gene M. Weinstein ◽  
Knarik Arkun ◽  
James Kryzanski ◽  
Michael Lanfranchi ◽  
Gaurav K. Gupta ◽  
...  
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Lower Back Pain ◽  
Low Grade ◽  
Review Of The Literature ◽  
Pathologic Evaluation ◽  
Lower Back ◽  
Spinal Lesions ◽  
First Case ◽  
Intradural Extramedullary

Ependymomas are common spinal lesions, with the vast majority arising in an intramedullary location. Several cases have been described in the literature of ependymomas in an intradural, extramedullary location. The authors present a case of a 56-year-old female who presented with several weeks of lower back pain and weakness. MRI revealed an intradural, extramedullary enhancing mass at L1-L2. The mass was successfully resected surgically. Pathologic evaluation revealed a low grade glioma with components of both ependymoma and pilocytic astrocytoma with MUTYH G382D mutation. Extramedullary ependymomas are very rare tumors. To the authors’ knowledge, this is the first case of ependymoma/astrocytoma collision tumors described in an extramedullary location.

scholarly journals Gastric mixed adenoneuroendocrine carcinoma case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1982891
Author(s):  
Miguel Angel Moyón Constante ◽  
Fernando Xavier Moyón Constante ◽  
Jorge Fernando Tufiño ◽  
Andres Cárdenas Patiño ◽  
Gabriel Alejandro Molina ◽  
...  
Keyword(s):  
Case Report ◽  
World Health ◽  
Low Grade ◽  
Radical Gastrectomy ◽  
Upper Endoscopy ◽  
Mixed Adenoneuroendocrine Carcinoma ◽  
First Case ◽  
The World ◽  
Medical Teams ◽  
Health Organization

Mixed adenoneuroendocrine carcinomas are rare tumors that contain both an exocrine and an endocrine component. Since the latest classification by the World Health Organization and with the aid of immunostaining, more mixed adenoneuroendocrine carcinomas are now identified and diagnosed. Nonetheless, our knowledge of these tumors is still limited, notably concerning gastric variants, as the cases reported in the literature are very limited. The clinical and surgical treatment, including the chemotherapy schemes, the prognosis, and recurrence still represent challenges for the medical teams. We present the case of a 62-year-old woman. After an upper endoscopy revealed multiple polyps and a low-grade neuroendocrine tumor, a D2 radical gastrectomy was performed. A low output esophageal anastomotic leak was discovered in the postoperative period and successfully managed. Pathology revealed a gastric mixed adenoneuroendocrine carcinoma, the first case of this kind reported in Ecuador. Patient is doing well and under constant surveillance up until her 13th postoperative month.

scholarly journals Eosinophilic pneumonia induced by lettuce: A case report

2021 ◽  
Author(s):  
Reina Sekiya ◽  
Tatsuya Nagano ◽  
Tatsuya Moriyama ◽  
Aki Kawaguchi ◽  
Takafumi Fukui ◽  
...  
Keyword(s):  
Case Report ◽  
Ground Glass Opacity ◽  
Lavage Fluid ◽  
Immunoblot Analysis ◽  
High Serum ◽  
Eosinophilic Pneumonia ◽  
Low Grade ◽  
Lung Field ◽  
First Case ◽  
Igg Binding

Abstract Background: Lettuce (Lactuca sativa) belongs to the Composite family and is a vegetable widely consumed globally. Although lettuce is extensively cultivated and consumed, lettuce-associated occupational allergy is rarely reported. Herein, we are reporting a case of eosinophilic pneumonia induced by lettuce for the first time.Case presentation: A 56-year-old female lettuce farmer was admitted to the hospital with a low-grade fever, worsening cough, and dyspnoea. A blood test revealed eosinophilia and a high serum IgE concentration. A chest X-ray taken on admission showed an infiltrative shadow in the upper lung field. Chest CT revealed patchy ground glass opacity on the upper lung field and thickening of the bronchial wall. The bronchoalveolar lavage fluid contained 8% eosinophils. The IgG-binding proteins that reacted with the patient’s sera were identified by immunoblot analysis. She was diagnosed as lettuce induced eosinophilic pneumonia and was treated with prednisolone, and her symptoms and radiological findings improved. Wearing a mask and reducing the amount of the crop improved her symptoms the following year.Conclusions: This is the first case report about lettuce-induced eosinophilic pneumonia which occurred in a lettuce farmer. The avoidance from antigen is quite useful in this patient.

Ichthyosis Uteri: A Case Report and Review of the Literature

2005 ◽  
Vol 129 (5) ◽  
pp. e124-e125
Author(s):  
Chhanda Bewtra ◽  
Qing M. Xie ◽  
William J. Hunter ◽  
William Jurgensen
Keyword(s):  
Case Report ◽  
Squamous Metaplasia ◽  
Endometrial Adenocarcinoma ◽  
Low Grade ◽  
Review Of The Literature ◽  
Endometrial Polyps ◽  
Chronic Endometritis ◽  
Squamous Cells ◽  
First Case

Abstract Squamous metaplasia of endometrium is mostly manifested by morules or nodules of benign nonkeratinizing squamous cells intimately mixed with benign or malignant endometrial glands. It has been described with low-grade adenocarcinoma of the endometrium, as well as with various benign conditions, including hyperplasia, chronic endometritis, and endometrial polyps. However, extensive plaquelike, keratinizing squamous change is distinctly uncommon. To our knowledge, we describe the first case of extensive benign squamous keratinization with underlying endometrial adenocarcinoma.

scholarly journals Primary thyroid-like low-grade nasopharyngeal papillary adenocarcinoma in a 11-year-old male patient: The first case report in Indonesia

2020 ◽  
Vol 21 ◽  
pp. 200392
Author(s):  
Emilia Theresia ◽  
Ery Kus Dwianingsih ◽  
Hanggoro Tri Rinonce ◽  
Rita Cempaka ◽  
Camelia Herdini ◽  
...  
Keyword(s):  
Case Report ◽  
Male Patient ◽  
Papillary Adenocarcinoma ◽  
Low Grade ◽  
First Case

scholarly journals Case Report: Response to Intra-arterial Cisplatin and Concurrent Radiotherapy Followed by Salvage Surgery in a Patient With Advanced Primary Sinonasal Low-Grade Non-intestinal Adenocarcinoma

2020 ◽  
Vol 7 ◽  
Author(s):  
Hirohiko Tachino ◽  
Hiromasa Takakura ◽  
Hideo Shojaku ◽  
Michiro Fujisaka ◽  
Katsuichi Akaogi ◽  
...  
Keyword(s):  
Case Report ◽  
Salvage Surgery ◽  
Histopathological Examination ◽  
Locally Advanced ◽  
Middle Turbinate ◽  
Lymphocytic Infiltration ◽  
Low Grade ◽  
Fractionated Radiotherapy ◽  
First Case ◽  
Positron Emission

Background: The clinical usefulness of concurrent chemoradiotherapy before surgery in the treatment of primary, locally advanced sinonasal low-grade, non-intestinal type adenocarcinoma (LG non-ITAC) is unclear.Methods: We present the first case report of the efficacy of super-selective intra-arterial cisplatin (CDDP) infusion concurrent with conventional fractionated radiotherapy (RT) for LG non-ITAC in a Japanese patient.Results: A white, rugged-marginal mass that was histopathologically diagnosed as LG non-ITAC occupied the right nasal cavity. Based on the imaging findings, including computed tomography, magnetic resonance imaging, and positron emission tomography, the tumor was diagnosed as T4aN0M0, stage IVa. After treatment, the nasal tumor disappeared leaving only a small bulge in the medial wall of the middle turbinate. The patient also underwent right transnasal ethmoidectomy performed as salvage surgery. A histopathological examination revealed that the lesion was replaced by granulation tissue with lymphocytic infiltration and hemosiderin-laden macrophages, and no viable tumor cells remained. In the seven years after treatment, the patient has not experienced any local recurrence or regional or distant metastasis.Conclusions: Super-selective intra-arterial CDDP infusion concurrent with conventional fractionated RT followed by salvage surgery might be useful for the management of sinonasal LG non-ITAC.

scholarly journals “String of pearls sign” on FDG PET imaging in two patients with PUO of diverse etiologies and rare associations

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Shrinivas Yuvan ◽  
Shanmuga Sundaram Palaniswamy ◽  
Padma Subramanyam
Keyword(s):  
Fdg Pet ◽  
Kinase Inhibitor ◽  
Diagnostic Yield ◽  
Past History ◽  
Subcutaneous Tissue ◽  
Whole Body ◽  
Low Grade ◽  
Nodal Disease ◽  
First Case ◽  
String Of Pearls

Abstract Background Pyrexia of unknown origin (PUO) may be related to several pathologies that need to be identified for proper treatment. PET is found to have highest diagnostic yield in identifying various causes of PUO. The aim of this study is to highlight and justify the use of 18F FDG PET (Fluorine Fluorodeoxyglucose Positron Emission Tomography) imaging as a whole body screening tool in two unique cases of febrile illness with lymphadenopathy but with diverse etiologies based on PET-guided biopsy. The unique arrangement of PET positive nodal disease as a “string of pearls sign” helps in easy identification of nodal disease. Case presentation The first case presented with fever and headache (past history of meningitis), high ferritin level, leukopenia, anemia, and raised inflammatory markers. CSF cell count was high, with mildly elevated protein and low glucose levels. PET positive nodes were biopsied; Kikuchi Fujimoto disease was confirmed with unexpected FDG avid pachymeningeal enhancements on PETMR indicating associated (active) meningitis which would have been missed if CT or MR was done as a standalone imaging. Lumbar puncture confirmed aseptic meningitis. The patient was treated with anti-inflammatory drugs, inj. methylprednisolone, and immunoglobulin together with hydroxychloroquine. The patient improved on follow-up. The second case presented with low-grade fever, pruritis, and nodular swellings in extremities, anemia, and pancytopenia. Based on PETCT findings, biopsy was attempted from FDG avid axillary nodes. Mantle cell lymphoma with rare nodular involvement of cutaneous and subcutaneous tissue was confirmed. Chemotherapy and tyrosine kinase inhibitor therapy was initiated, and the patient is doing well clinically. Conclusion The clinical impact of PET is twofold in both cases. It has accurately identified the nodal involvement even those subcentimetric in size by exhibiting a unique sign on PET resembling a “string of pearls” in the neck and chest with unrelated diverse etiologies. Secondly, additional findings of meningitis in the first case and cutaneous/subcutaneous nodular lymphomatous deposits in the second patient were possible only with whole body FDG PETMR/CT imaging. The rate of additional disease detection by PET is found to be greater than other conventional imaging modalities due to the functional basis of investigation.

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