What obstetricians should be aware of: serious side effects of antibiotic toxoplasmosis treatment in pregnancy

Infection with Toxoplasma gondii is usually an asymptomatic or oligosymptomatic, self-limiting disease in immunocompetent individuals. However, during the pregnancy, primary infection can lead to transplacental vertical transmission resulting in congenital toxoplasmosis with possible severe sequelae. The efficacy of systematic screening remains controversial and the effect of antibiotic treatment is unclear. Although main side effects of antibiotic drugs used for toxoplasmosis are well known, mostly from malaria treatment, there is a lack of information about occurrence in pregnant woman treated for toxoplasmosis. We report a case of a healthy pregnant woman with primary toxoplasmosis infection in the second trimester, who developed a severe adverse reaction in form of hypersensitivity pneumonia after antibiotic treatment with pyrimethamine and sulfadiazine and discuss the literature.

Kambô-Induced Systemic Inflammatory Response: A Case Report of Acute Disease Progression of Cholangiocarcinoma

Kambô is a cleansing ritual involving the application of a toxin produced by the giant leaf frog ( Phyllomedusa bicolor). The Kambô ritual has increasingly been adopted among cancer patients in Europe. Accumulating data indicate various adverse effects. We report another severe adverse reaction to Kambô, a systemic inflammatory response syndrome mimicking disease progression in a patient with cholangiocarcinoma. We describe a systemic reaction to Kambô, manifested as tachycardia, tachypnea, impaired liver cholestatic enzymes, and enlargement of lymphadenopathy mimicking disease progression. The clinical features and onset of symptoms, the rapid reaction, and the lack of other identified causes make the diagnosis of Kambô-induced SIRS highly probable. This case report calls for future studies examining standard oncological care such as chemotherapy, radiotherapy, and immunotherapy in conjunction with alternative therapy. Additionally, greater awareness and physician education should be promoted, encouraging inquiry of oncology patients’ administration of alternative, complementary, and integrative medicine.

Randomized trial: corticoids versus placebo in severe bronchiolitis. COTHEB study.

Background: Corticosteroids as modulation the inflammatory response is a controversial issue in the treatment of bronchiolitis. This study aimed to assess whether corticoid therapy influenced the inflammatory and clinical response of critically ill infants. Methods: Prospective, randomized, double blind placebo-controlled trial of glucocorticoids (GCT) in infants of less than 12 months with severe or moderate bronchiolitis. Patients were randomized to receive corticoid therapy or placebo. The main outcomes were: a) levels of lymphocyte; b) levels of IL-2, IL-12, and IFNγ as pro-inflammatory factors, and c) levels of IL-4 and IL-10 as anti-inflammatory response. Secondary outcomes related with the clinical response were also analyzed. Results: 97 patients were randomized. Evolution of lymphocyte subsets was similar in both groups. Pro-inflammatory interleukins and interferon decreased, but without differences. Antiinflammatory interleukins showed a significant decrease from baseline to the end of the study, and IL-10 values were significantly lower in the GCT group. GCT group showed a lower time of mechanical ventilation and of hospitalization, but without statistically significant differences No cases of severe adverse reaction to steroids were detected. Conclusions: administration of systemic GCT did not modify the inflammatory not the clinical response of patients with severe bronchiolitis, except for IL-10 levels that were significantly lower in the GCT group. Trial registration: Glucocorticoid Therapy Impact on the Inflammatory Response and Clinical Evolution in Patients With Severe Bronchiolitis, NCT02571517. ClinicalTrials.gov registration number: 2011-000337-36. Date of registration: 30 june 2012 (retrospectively registered).

Severe Adverse Reaction to Vemurafenib in a Pregnant Woman with Metastatic Melanoma

Targeted therapies have drastically changed the management of metastatic melanoma and have shown encouraging results on tumour progression but are also known for their high rates of adverse reactions. In general, targeted therapies are contraindicated during pregnancy due to concerns about teratogenesis. For the BRAF V600 inhibitor vemurafenib, the available literature about the effects on human pregnancy is limited to a single case report. In patients with metastatic melanoma that wish to continue their pregnancy, targeted therapies like vemurafenib offer the only possibility of improving maternal outcome. In this article, we report on a pregnant woman with metastatic melanoma who was treated with vemurafenib during pregnancy and experienced a fatal adverse reaction.

Diagnosis and Therapy for Lewy Body Dementia

Almost undistinguished some 30 years ago, dementia with Lewy bodies is now shown to be the second most common neurodegenerative cause of dementia in the elderly. A host of neuroinflammatory mechanisms are attributed to Lewy bodies and their component alpha synuclein, a common pathology shared by Parkinson disease and Parkinson disease with dementia. Accurate diagnosis of patients is essential, as they show unique impairment patterns, which differ from other forms of dementia and show severe adverse reaction to neuroleptic medication, a common treatment in other degenerative diseases.

Temporary Henna Tattooing: a Case of Contact Dermatitis

A case of a temporary henna tattoo is presented in which red henna containing p-phenylenediamine (PPD) caused a severe adverse reaction. The eruption began three days after its application and patient experienced itching and mild pain at the tattoo site along with an erythematous, papular lesion. The topic is discussed with pictures of this eruption.