Clinical Features of Adverse Drug Reactions in a Tertiary Care Hospital in Korea

Background: Clinical features of adverse drug reactions (ADR) are different and the incidence is increasing. However, there have been only a few data on the clinical features of ADR in Korea. Method: We prospectively collected ADR cases at Severance Hospital between October 2003 and April 2006, analyzed the clinical features. Result: Three hundred and fifty-seven ADR cases were reported. The most common causative drugs were radiocontrast media and nonsteroidal anti-inflammatory drugs (NSAIDs), followed by anticonvulsants, such as lamotrigine, carbamazepine, theophyllines and cephalosporins. Most of the causative radiocontrast media were nonionic, low molecular and iodinated. The leading clinical features were skin eruptions and urticaria. Nine cases of serious ADR were induced by general medication, including 1 case of mortality due to allopurinol-induced toxic epidermal necrolysis. ADR cases induced by contrast media were 245. Conclusion: The most common causative drugs which induced adverse drug reactions were NSAIDs and radiocontrast media. The leading clinical features were skin eruptions and urticaria. Among radiocontrast media, nonionic low molecular iodinated contrast media mainly induced adverse drug reactions. Further epidemiologic studies will validate our study and help reveal the incidence of ADR in Koreaope

A Case of Successful Treatments of Venous Leg Ulcers in Secondary Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune disorder characterized by recurrent arterial or venous thrombosis, and pregnancy loss. A 57-year-old woman was admitted for aggravation of both leg ulcers. Venogram showed chronic venous obstructions at both lower extremities, and chest x-ray and computed tomography revealed serositis in pericardium and pleura. The laboratory tests revealed pancytopenia, and positive tests for antinuclear antibody, anti-dsDNA antibody, lupus anticoagulant and anticardiolipin antibody, which led to a diagnosis of antiphospholipid syndrome secondary to systemic lupus erythematous. After medical treatments by anticoagulation and immunosuppression, and surgical managements including subtotal skin graft and local flap surgery, leg ulcers had been successfully treated without recurrence. Recognition of antiphospholipid syndrome as a cause of venous ulcer and the treatment plans including anticoagulation and surgical management is important in proper managementsope

Comparison of the Naranjo and WHO-Uppsala Monitoring Centre criteria for causality assessment of adverse drug reactions

Background/Aims : Several criteria have been proposed to increase the objectivity, reliability and validity of causality assessment of adverse drug reactions (ADR). We compared the Naranjo probability scale and the World Health Organization- Uppsala Monitoring Centre (WHO-UMC) causality categories to evaluate the validity and clinical usefulness of these criteria. Methods : We evaluated 100 ADR cases with the Naranjo probability scale and the WHO-UMC causality categories. The Spearman rank coefficient was used to determine the correlation of these criteria. The evaluation of the ADR was categorized into four groups for the Naranjo system: definite, probable, possible, and doubtful, and six groups for the WHO‐UMC: certain, probable, possible, unlikely, conditional/unclassified, and unassessable. Results : The criteria used form these two systems showed some differences when compared with the same ADR cases. The Spearman rank coefficient was 0.519 (p<0.001) and the agreement was 55% between the Naranjo probability scale and the WHO-UMC causality categories. The Naranjo probability scale includes measurements for drug concentration, objective evidence of ADR, ADR to previous exposures, responses to placebo, and the dose adjustment of drugs. However, few cases were evaluated for all of these measures. Conclusions : The Naranjo probability scale may be helpful for assessing unexpected ADRs and useful for evaluators with little experience. However, some of the items are not utilized and there are discrepancies when compared with the WHO-UMC causality criteriaope

Kikuchi-Fujimoto`s Disease with Adult Onset Still`s Disease

Kikuchi-Fujimoto`s disease (KFD), or histiocytic necrotizing lymphadenitis, is a rare benign and self-limiting disease. KFD are confused with systemic autoimmune disease as they present with localized lymphadenopathy, fever, fatigue, arthritis, leukopenia. Furthermore as KFD can occur associated with other autoimmune disease, we need to diagnose carefully. Here, we describe a case of 27-year-old female patient, diagnosed as KFD, who subsequently developed adult onset Still`s disesase (AOSD). As far as we know, this is the first case of KFD with AOSD in Korea.ope

Predictive factors related to progression toward rheumatoid arthritis in Korean patients with undifferentiated arthritis

Some patients with undifferentiated arthritis (UA) experience spontaneous remission; however, one-third of patients progress to rheumatoid arthritis (RA) in the final process of the disease. This study evaluated clinical variables in order to find a prediction model that could predict the development of RA in patients with UA. The medical records of 164 patients, who were initially diagnosed with undifferentiated arthritis in Yonsei University Medical Center from January 2004 to December 2007, were retrospectively reviewed. They were followed up for at least 6 months. The clinical variables related to the development of RA were identified by univariate analyses. Using logistic regression analysis, the prediction model was made and the diagnostic performance of the model was evaluated. Thirty-two patients of the 164 total patients progressed to RA during the follow-up period. The prediction model was composed of clinical factors including the duration of morning stiffness, the number of tender joints, the number of swollen joints, C-reactive protein level, rheumatoid factor, anti-cyclic citrullinated peptide antibody, and erosive change on baseline X-ray. The prediction score ranged from 0 to 10. All of the patients with a higher prediction score greater than five experienced RA progression. The area under the curve value for the prediction rule was 0.976. The prediction model could predict progression to RA in patients with UA. It especially helps the clinician to decide on a management plan for patients with a high prediction score.ope