Tramadol-induced Stevens-Johnson syndrome

Stevens-Johnson syndrome and toxic epidermal necrolysis are acute and severe life-threatening allergic reactions. Their incidences in Thailand may be underestimated due to a lacking of reports. The etiologies of Stevens-Johnson syndrome/toxic epidermal necrolysis are numerous; drugs are the most important causes. Not only well-known drugs, e.g. antibiotics, antiepileptics and NSAIDs, but also any drugs can be the cause of Stevens-Johnson syndrome/toxic epidermal necrolysis. Hereby we report a 20 years old Thai male presenting with high-grade fever with extensive detachment of epidermis and erosion of mucocutaneous membrane for 3 days. The patient had taken tramadol. The dermatopathology was compatible with Stevens-Johnson syndrome. The serology revealed positive dengue Immunoglobulin G. The final diagnosis was dengue fever with Stevens-Johnson syndrome. We report a case of Stevens-Johnson syndrome from tramadol

Diabetic fetopathy associated with bilateral adrenal hyperplasia and ambiguous genitalia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Many fetal malformations can occur because of maternal diabetes. However, ambiguous genital organs have never been reported as an associated finding in the literature. This is the first report of associated ambiguous genital organ and bilateral adrenal hyperplasia in a case of diabetic fetopathy.</p> <p>Case presentation</p> <p>A 19-year-old Thai primigravida with familial history of diabetes mellitus (DM) was diagnosed as having gestational DM type 2, based on 100 g oral glucose tolerance test, and was poorly controlled with insulin injections. Delayed targeted ultrasonography at 28 weeks gestation revealed multiple fetal anomalies. The woman underwent low transverse cesarean section at 30 weeks gestation due to preterm labor and transverse lie. The newborn with ambiguous genitalia was delivered but expired after birth. Autopsy findings revealed alobar holoprosencephaly, a prominent forehead, hypotelorism, an absent nose, absent bilateral ears, median cleft lip and palate, preaxial polydactyly of the right hand, accessory spleens, single umbilical artery, markedly enlarged adrenal glands and ambiguous external genitalia The subsequent fetal chromosomal study revealed 46,XX.</p> <p>Conclusion</p> <p>We describe a case of diabetic fetopathy with classic facial malformation and preaxial hallucal polydactyly which has been proposed as a marker of diabetic embryopathy. Bilateral adrenal hyperplasia with ambiguous genitalia, an uncommon associated anomaly, was also identified. It is controversial whether adrenal hyperplasia can be a novel feature of diabetic fetopathy or just a coincidental finding. Further observation and adequate investigation are needed in such cases.</p

Placenta-Derived Extracellular Vesicles in Pregnancy Complications and Prospects on a Liquid Biopsy for Hemoglobin Bart's Disease

Extracellular vesicles (EVs) are nano-scaled vesicles released from all cell types into extracellular fluids and specifically contain signature molecules of the original cells and tissues, including the placenta. Placenta-derived EVs can be detected in maternal circulation at as early as six weeks of gestation, and their release can be triggered by the oxygen level and glucose concentration. Placental-associated complications such as preeclampsia, fetal growth restriction, and gestational diabetes have alterations in placenta-derived EVs in maternal plasma, and this can be used as a liquid biopsy for the diagnosis, prediction, and monitoring of such pregnancy complications. Alpha-thalassemia major ("homozygous alpha-thalassemia-1") or hemoglobin Bart's disease is the most severe form of thalassemia disease, and this condition is lethal for the fetus. Women with Bart's hydrops fetalis demonstrate signs of placental hypoxia and placentomegaly, thereby placenta-derived EVs provide an opportunity for a non-invasive liquid biopsy of this lethal condition. In this article, we introduced clinical features and current diagnostic markers of Bart's hydrops fetalis, extensively summarize the characteristics and biology of placenta-derived EVs, and discuss the challenges and opportunities of placenta-derived EVs as part of diagnostic tests for placental complications focusing on Bart's hydrop fetalis