WARFARIN-INDUCED ALOPECIA: A RARE CASE REPORT

  As new drugs are developed everywhere worldwide to combat many diseases, side effects due to drugs are always a matter of concern. Warfarin is indicated for the treatment of venous thromboembolism over many decades and it is always associated with many side effects ranging from bleeding complications, gastrointestinal disturbances to skin necrosis. Hair fall with oral anticoagulants had always been a matter of debate and concern and so far, only very few case reports have been published on warfarin-induced hair loss. Hence, we report a case of warfarin-induced alopecia in a 39-year-old male in a tertiary care hospital in Southern India

CEFUROXIME-INDUCED THROMBOCYTOPENIA: IT'S JUST NOT IN THE RING??

Beta lactams are one of the most commonly used antibiotic groups in clinical practice, owing to their relatively superior safety profile, when weighed against other available antibiotics. Cephalosporins have overgrown over the years, now extending across five generations of drugs. Older cephalosporins are still commonly used, chiefly because of their low cost and minimal adverse effects. However, no drug is entirely free of adverse effects. Cephalosporins (especially those with a methylthiotetrazole ring) have been associated with bleeding manifestations due to hypoprothrombinemia and thrombocytopenia in susceptible subsets of the global population. This case report concerns the use of a cephalosporin that does not have this ring in its structure, but has still caused a rare instance of thrombocytopeniaKeywords: Beta lactam, Cefuroxime, Platelets, Bleeding, Methylthiotetrazole

CLOPIDROGEL INDUCED LEUKOCYTOCLASTIC VASCULITIS

Cutaneous adverse drug reactions are very common in a hospital setting while treating patients. Drug-induced vasculitis is a very common form of vasculitis affecting all age groups, and many drugs have been implicated in causing vasculitis. Clopidogrel is an antiplatelet drug used in the management as well as prevention of coronary artery disease. It is known to cause various side effects ranging from bleeding, gastrointestinal disturbances, to skin rashes. Leukocytoclastic vasculitis is a form of hypersensitivity vasculitis and is very rarely seen with clopidogrel. Hence, we report a case of clopidogrel-induced leukocytoclastic vasculitis in an old male patient after coronary stenting.Â

A RARE INSTANCE OF LEVOSULPIRIDE–INDUCED GALACTORRHOEA

Antipsychotics are well known to affect prolactin secretion, resulting in hyperprolactinemia and its consequent manifestations like amenorrhoea, galactorrhoea, gynaecomastia, etc. Levosulpiride is a novel antipsychotic drug with additional antidepressant, antiemetic and antidyspeptic actions. The authors report a case of levosulpiride-induced hyperprolactinemia, presenting as galactorrhoea in a female patient with dyspepsia at Kasturba Hospital, Manipal, in South India.Keywords: Hyperprolactinemia, Prolactin, Dyspepsia, Antipsychotic, Dopamin

BRONCHOCONSTRICTION SECONDARY TO USE OF TOPICAL TIMOLOL IN A NON-ASTHMATIC PATIENT

Ophthalmic application of a non-selective beta blocker like timolol maleate is known to produce bronchoconstriction in asthmatic individuals or patients with obstructive lung diseases. Timolol-induced bronchoconstriction in a previously healthy young adult without any pulmonary disease is rare. We report a case of a young adult who developed bronchoconstriction following ocular instillation of timolol maleate ophthalmic solution when he was treated for open-angle glaucoma

ACENOCOUMAROL OR WARFARIN: WHICH IS THE CLINICIAN'S ALLY?

ABSTRACTWarfarin and acenocoumarol are commonly prescribed oral anticoagulant drugs that are used in the prevention and treatment of thromboembolicdisorders across the world. Although both these drugs act by a similar mechanism, there are significant differences between them, especially in termsof their half-lives, and more importantly, in their variability in response pharmacogenetically. This case report highlights an instance wherein warfarinproved to provide a much more stable anticoagulant cover, as compared to that provided by acenocoumarol.Keywords: Thrombosis, Bleeding, Antiphospholipid antibody syndrome, Anticoagulant, International normalized ratio

CLINICAL AND BIOCHEMICAL PROFILE OF STEROID-INDUCED DIABETES

ABSTRACTObjective: To study the clinical and biochemical profile of patients who develop steroid-induced diabetes (SID) and its predisposing factors.Methods: Non-diabetic patients aged ≥18 years started on steroids were considered eligible for the study. In every case after detailed examination,fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), glycated hemoglobin, fasting insulin were measured prior to starting steroids andwas repeated in 1 week (day 3/4) after starting steroid according to standard guidelines. FPG and PPG were repeated periodically during follow-upof the patients. The utility of Indian diabetic risk score (IDRS) score in predicting the risk for SID was also assessed.stResult: Steroid-induced diabetes was found to be more in females than in males. IDRS is not useful in predicting the risk factors of SID. 97% of patientshad an elevation of post-prandial sugars with or without fasting hyperglycemia, but only 3% of patients had isolated elevation of fasting blood sugar.84% of patients developed SID during the 1 week of therapy. 33% of the cases SID persisted even after 1 month of stopping steroids and on a minimaldosage of steroids.stConclusion: Unlike type 2 diabetes, there were no significant risk factors such as age, family history of diabetes to develop SID and IDRS may not be asensitive tool for predicting risk factors of SID. Monitoring of post-prandial sugars as compared to fasting sugars is essential for the screening of SID.Cumulative dose of steroid may not be important to precipitate steroid diabetes.Keywords: Glucocorticoids, Diabetes, Post-prandial glucose, Indian Diabetic Risk Score

HEMICHOREA: AN UNUSUAL MANIFESTATION OF THYROTOXICOSIS

ABSTRACTChorea is usually associated with neurological diseases. However, it can also be seen in patients with systemic lupus erythematosus (SLE), rheumaticfever (Sydenham's chorea), polycythemia vera, and thyrotoxicosis. Here, we report an interesting case of hemichorea in a 32-year-old lady, whopresented with acute onset of jerky, non-repetitive involuntary movements of the left upper and lower limbs. After detailed evaluation, she was foundto have thyrotoxicosis. Thyroid Tc-scan showed diffuse uptake suggesting Grave's disease. A magnetic resonance imaging of the brain was normal.Other causes of chorea like SLE and rheumatic fever were excluded. She was started on carbimazole. On follow-up after 6 weeks of therapy, there wasthe complete disappearance of chorea, and her thyroid hormone levels were normal.Keywords: Extrapyramidal syndrome, Hyperthyroidism, Corpus striatum, Dancing movements

PHENYTOIN-INDUCED ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS

ABSTRACTPhenytoin is the first line antiepileptic for generalized tonic-clonic seizures. It is still the go to†drug despite the availability of newer antiepileptics,chieflybecause of its lowcost and highefficacy.Phenytoinis associatedwith toxicitiesinvolvingmultiple organsystemssuch asbrain,blood, and skin. One of the most common adverseeffectsis the developmentof skin rashes.It can rangefrommild tolife-threateningskineruptions.This is a case reportof a younggirlwhodevelopedacutegeneralizedexanthematouspustulosis followingphenytointherapyforposttraumaticseizures.Keywords: Drug-induced rash, Anti-epileptic, Type-4 hypersensitivity, Hydantoi

THORACIC EPIDURAL ABSCESS DUE TO COMMUNITY-ACQUIRED METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

ABSTRACTA spinal epidural abscess threatens the spinal cord or cauda equina by compression and also by vascular compromise. If left untreated, an expandingsuppurative infection in the spinal epidural space can impinge on the spinal cord, producing sensory symptoms and signs, motor dysfunction, andultimately paralysis, followed by death. Hence, early intervention undoubtedly improves the outcome. The authors report a case of a 27-year-oldfemale patient, who presented with paraplegia, and was found to have thoracic epidural abscess due to community-acquired methicillin-resistantStaphylococcus aureus.Keywords: Spinal cord, Cauda equina, Infection, Laminectomy, Drainage