Co-amoxiclav-induced Stevens Johnson Syndrome in a child

Stevens-Johnson Syndrome is an uncommon life threatening disease generally induced by drugs. Antibiotics, mainly sulphonamides, are the most involved drugs in Stevens-Johnson Syndrome in children. Co-amoxiclav is a well tolerated antibiotic. It has never been reported to cause, lonely this syndrome in children. Herein, we report a co-amoxiclav-induced Stevens-Johnson Syndrome occurring in an 18-month-old child. The diagnosis of SJS is often challenging in children and other possible diseases should be ruled out. The etiology of this syndrome is not yet fully understood. It is thought to be mediated by an immunologic mechanism. Management involves early identification, withdrawal of the culprit drug and rapid initiation of supportive therapies.Pan African Medical Journal 2013; 14:3

Online)

ABSTRACT Context Pancreatitis is a very rare adverse effect of tamoxifen with only six cases of tamoxifen-associated pancreatitis reported in the English literature until now. In these cases, rechallenge with tamoxifen was not carried out. Case report We report a case of recurrent severe acute pancreatitis in a 44-year-old female induced by tamoxifen therapy and review the literature with regards to tamoxifen-associated pancreatitis. Conclusion Clinicians should be aware of the risks of developing severe acute pancreatitis when using tamoxifen therapy. If tamoxifen is suspected as the probable causative agent, rechallenge with this drug should be prohibited

Acetaminophen-induced cellulitis-like fixed drug eruption

Acetaminophen is a widely used analgesic drug. Its adverse reactions are rare but severe. An 89-year-old man developed an indurated edematous and erythematous plaque on his left arm 1 day after acetaminophen ingestion. Cellulitis was suspected and antibiotictherapy was started but there was no improvement of the rash; there was a spectacular extension of the lesion with occurrence of flaccid vesicles and blisters in the affected sites. The diagnosis of generalized-bullous-fixed drug eruption induced by acetaminophen was considered especially with a reported history of a previous milder reaction occurring in the same site. Acetaminophen was withdrawn and the rash improved significantly. According to the Naranjo probability scale, the eruption experienced by the patient was probably due to acetaminophen. Clinicians should be aware of the ability of acetaminophen to induce fixed drug eruption that may clinically take several aspects and may be misdiagnosed

Glutathione S-transferase M1 and T1 polymorphisms and the risk of mild hepatotoxicity induced by carbamazepine in a tunisian population study

Abstract Background The aim of this study was to evaluate whether the glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) null alleles may contribute to carbamazepine-induced hepatotoxicity. Methods A cross-sectional prospective study was conducted to identify the frequency distribution of GSTM1 and GSTT1 alleles in 129 Tunisian epileptic patients treated with carbamazepine. Null alleles were determined using a Polymerase Chain Reaction. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured by standard methods. Results Our results showed that the frequencies of GSTM1 (−) null allele and GSTT1 null (−) allele were 74.4 and 17.8% respectively. The ALT and AST levels were elevated in 46 (35.7%) and 33 (25.6%) cases. The mean values of ALT and AST were approximately 1.32 and 3.61 times higher than the upper limit of normal levels, respectively. The values of ALT and AST were significantly higher in GSTM1 (−) allele than in GSTM1 (+) (p = 10−3.and 0.004, respectively). The level of ALT was significantly higher in combination of GSTM1 (−)/T1(−) than in combined GSTM1(−)/T1(+) and combined GSTM1(+)/T1(+) (p = 0.2 and 0.03, respectively), and that of AST was significantly higher in combination of GSTM1(−)/T1(−) and in combination of GSTM1(+)/T1(−) than in combination of GSTM1(+)/T1(+) (p = 10−3 and 10−3, respectively). Conclusions Our findings suggest that the GSTM1 (−) allele may be considered as a key factor for the development of carbamazepine-induced hepatotoxicity. Results related to GSTT (−) allele and elevation in AST levels should be considered with caution as AST may be elevated in other pathophysiological conditions

Vascularite cutanée leucocytoclasique induite par la gabapentine

Nous décrivons le cas d’une patiente ayant développé une vascularite cutanée leucocytoclasique secondaire à la prise de gabapentine

Musculoskeletal ultrasonography of the Achilles tendon and plantar fascia in spondyloarthritis patients

Aim of the work: To assess the frequency and severity of peripheral enthesitis in spondyloarthritis (SpA) patients using musculoskeletal ultrasound (MSKUS) in B mode associated with power Doppler (PD) compared to a group of patients with mechanical low back pain (M-LBP). Patients and methods: The study included 40 SpA patients and 20 M-LBP patients as a control group. Ultrasound (US) in B mode and PD was performed at Achilles tendon (AT) and plantar fascia (PF). Results: The mean age of SpA patients was 41.9 ± 14.3 years and disease duration 8.4 ± 5.8 years. Axial form was found in 36 cases (90%) and peripheral form in 4 (10%). The mean ESR was 28.3 ± 23.2 mm/1sth and the CRP was 22.9 ± 31.2 mg/l. In SpA patients 109/160 (68.1%) of the assessed entheseal sites were significantly abnormal compared to 27/80 (33.8%) in M-LBP patients (AT p < .0001 and PF p = .02). Compared to the M-LBP patients, a significant difference was found in AT for hypoechogenicity (p = .006) and bone erosion (p = .005) and at both entheses for cortical hypervascularisation (AT: p < .0001 and PF: p = .03). Otherwise, in SpA patients, 60.2% (53/88) of non tender entheses showed at least one ultrasound abnormality compared to 77.8% (56/72) of tender entheses. A significant correlation was identified between clinical and ultrasound assessment (r = 0.4, p = .01). Conclusion: The frequency of enthesitis was high among SpA compared with M-LBP patients and AT was the most affected enthesis. Abnormal vascularization in the cortical bone insertion of entheses was detected especially in SpA patients, and there was great evidence of subclinical enthesitis. Keywords: Enthesis, Spondyloarthritis, Mechanical low back pain, Ultrasonography, Power dopple