1. J Korean Med Sci. 2020 Apr 13;35(14):e93. doi: 10.3346/jkms.2020.35.e93.
The First Reported Case of Infant Botulism in Korea: Treatable Infantile
Neuromuscular Disease.
Jang HG(1), Jang J(1), Jung HJ(1), Jung DE(2).
Author information:
(1)Department of Pediatrics, Ajou University Hospital, Ajou University School of
Medicine, Suwon, Korea.
(2)Department of Pediatrics, Ajou University Hospital, Ajou University School of
Medicine, Suwon, Korea. j978005@naver.com.
Botulism is a rare neuromuscular disorder caused by neurotoxins produced by
Clostridium botulinum. The diagnosis of infant botulism may be obscured or
delayed, as its presentation is similar to that of infantile neuromuscular
disorders. We report the first Korean case of infant botulism in an acute
progressive floppy infant with poor sucking and a weak cry. No abnormalities were
found in all blood, cerebrospinal fluid, genetic test, nerve conduction study,
and imaging studies. A stool-toxin test was finally performed under suspicion of
infant botulism, and the result was positive. The patient was immediately treated
with heptavalent botulism antitoxin. Follow-up after 3 months showed normal
development with a complete resolution of all symptoms. Therefore, clinical
suspicion of infant botulism, which is a treatable infantile neuromuscular
disease, is essential for early diagnosis and prompt treatment in the
differential diagnosis of a floppy infant.
© 2020 The Korean Academy of Medical Sciences.
DOI: 10.3346/jkms.2020.35.e93
PMCID: PMC7152530
PMID: 32281313 [Indexed for MEDLINE]
Conflict of interest statement: The authors have no potential conflicts of
interest to disclose.
2. Acta Med Port. 2020 Apr 1;33(4):284-287. doi: 10.20344/amp.11567. Epub 2020 Apr
1.
[A Potentially Fatal Aphrodisiac: Cantharidin Poisoning].
[Article in Portuguese; Abstract available in Portuguese from the publisher]
Diaz P(1), Carneiro A(1), Montes V(2), Alves S(3).
Author information:
(1)Serviço de Medicina Interna. Hospital de Cascais. Cascais. Portugal.
(2)Serviço de Neurologia. Hospital de Cascais. Cascais. Portugal.
(3)Serviço de Medicina Interna. Hospital Fernando Fonseca. Amadora. Portugal.
Cantharidin is a toxin extracted from coleoptera beetles, commonly known as
'Spanish fly'. Traditionally it was used as an aphrodisiac, a vesicant or as an
abortifacient. Intoxication by this substance has been widely reported, generally
associated with gastrointestinal complications, such as digestive hemorrhage, and
genitourinary disorders, such as hematuria and acute kidney injury. The authors
describe the case of a 51-year old male patient who developed severe cantharidin
poisoning after ingesting a preparation ('tea formulation') containing the
substance. The patient reported a burning sensation in his oral cavity, diarrhea
and hematuria, having sustained acute kidney injury and atypical neurological
symptoms. Due to the lack of an antidote, the available treatment options are
reduced to supportive measures. This case strengthens the need for a thorough
medical history to ascertain the use of 'natural' products and medicinal herbs
(i.e. of unregulated origin), and the importance of educating the community to
their potential toxicity.
Publisher: A cantaridina é uma toxina extraída de coleópteros, comummente
conhecidos como ‘Spanish fly’. Historicamente utilizada como
afrodisíaco, vesicante e abortivo. A intoxicação por este agente encontra-se
amplamente descrita, tipicamente com envolvimento das mucosas gastrointestinal,
com hemorragia digestiva, e genitourinária, com hematúria e lesão renal aguda. Os
autores apresentam o caso de um doente do sexo masculino, com 51 anos que
desenvolveu um quadro de intoxicação aguda por cantaridina, após ingestão de
uma preparação (‘chá’) desta substância, com ardor na cavidade oral, diarreia,
disúria, hematúria, lesão renal aguda e com um quadro neurológico atípico. A
toxicidade pela cantaridina é sistémica, contudo, o envolvimento neurológico é
raro. Dada ausência de um antídoto, preconiza-se a terapêutica de suporte. Este
caso reforça a importância de uma anamnese detalhada, incluindo a utilização de
produtos ‘naturais’ ou de ervanária (i.e. de origem não controlada), e da
necessidade de alertar os doentes para a sua potencial toxicidade.
DOI: 10.20344/amp.11567
PMID: 32238244 [Indexed for MEDLINE]
3. Nursing. 2020 Apr;50(4):32-38. doi: 10.1097/01.NURSE.0000657056.57969.11.
Neuroleptic malignant syndrome: A case report.
Ruth-Sahd LA(1), Rodrigues D, Shreve E.
Author information:
(1)Lisa A. Ruth-Sahd is a professor at the York College of Pennsylvania in York,
Pa., and Georgetown University in Washington, D.C. Darris Rodrigues is a nurse at
St. Luke's University Health Network in Fountain Hill, Pa. Elizabeth Shreve is a
nursing student at York College of Pennsylvania.
Electroconvulsive therapy (ECT) is an increasingly popular treatment for
drug-resistant depression that may have utility for some patients with
neuroleptic malignant syndrome (NMS) who are unresponsive to pharmacotherapy.
Using a case study as an example, this article discusses the diagnosis of a
patient with NMS, the use of ECT as a treatment for NMS, and the importance of
nursing care for these patients.
DOI: 10.1097/01.NURSE.0000657056.57969.11
PMID: 32195873 [Indexed for MEDLINE]
4. Rev Soc Bras Med Trop. 2020 Mar 16;53:e20190285. doi:
10.1590/0037-8682-0285-2019. eCollection 2020.
First report of scorpionism caused by Tityus serrulatus, described by Lutz and
Mello, 1922 (Scorpiones, Buthidae), a species non-native to the state of Pará,
Brazilian Amazon.
Costa GG(1), Serejo LFM(1), Coelho JS(2), Cândido DM(3), Gadelha MADC(1), Pardal
PPO(1)(2).
Author information:
(1)Universidade Federal do Pará, Hospital Universitário João de Barros Barreto,
Centro de Ciências da Saúde, Belém, PA, Brasil.
(2)Universidade Federal do Pará, Núcleo de Medicina Tropical, Laboratório de
Entomologia médica e Artrópodes Peçonhentos, Belém, PA, Brasil.
(3)Instituto Butantan, Laboratório de Artrópodes, São Paulo, SP, Brasil.
This reports a case of scorpionism caused by Tityus serrulatus. A male adult was
stung while unloading bananas at the supply center in Belém, Pará, Brazil. The
bananas originated in another state (Bahia) and were brought to Belém by truck.
The patient presented with pain, edema, and erythema at the sting site, and was
classified as low-risk. The specimen was identified as T. serrulatus and
symptomatic treatment and clinical observation were advised. The patient was
discharged later without further complications. This is the first known
envenomation caused by T. serrulatus, a non-native species to Pará, in the
Brazilian Amazon.
DOI: 10.1590/0037-8682-0285-2019
PMCID: PMC7094041
PMID: 32187336 [Indexed for MEDLINE]
5. Zhonghua Nei Ke Za Zhi. 2020 Mar 1;59(3):253-256. doi:
10.3760/cma.j.issn.0578-1426.2020.03.020.
[The 477th case: muscular spasms, alopecia, diarrhea].
[Article in Chinese; Abstract available in Chinese from the publisher]
Xiong YY(1), Lyu G(1), Wang LY(1), Zhu LM(1), Cui LY(2), Qian JM(1).
Author information:
(1)Department of Gastroenterology, Peking Union Medical College Hospital, Peking
Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730,
China.
(2)Department of Neurology, Peking Union Medical College Hospital, Peking Union
Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Diarrhea is a common digestive symptom. Here, we reported a case of young patient
admitted with diarrhea caused by lead poisoning and cytomegalovirus infection.
Through informative medical history and multi-disciplinary team discussion,
Satoyoshi syndrome was finally diagnosed.
Publisher:
患者为28岁女性，以腹泻、全身性脱发为突出表现，通过详细询问病史及多学科讨论，最终诊断为Satoyoshi综合征。患者原发病罕见，同时合并巨细胞病毒感染、铅中毒，
诊断较为棘手。.
DOI: 10.3760/cma.j.issn.0578-1426.2020.03.020
PMID: 32146759 [Indexed for MEDLINE]
6. S D Med. 2020 Mar;73(3):106-110.
Coma and Respiratory Failure in a 2-Year-Old Child After Accidental Overdose of
Baclofen.
Dasgupta K(1)(2), Nielson S(3).
Author information:
(1)Pediatric Critical Care, Avera McKennan Children's Hospital and University
Health Center, Sioux Falls, South Dakota.
(2)Department of Pediatrics, University of South Dakota Sanford School of
Medicine, Sioux Falls, South Dakota.
(3)Avera Mckennan Children's Hospital and University Health Center, Sioux Falls,
South Dakota.
Baclofen (Lioresal) is a derivative of gamma-aminobutyric acid and is used in
both adults and children mainly for symptomatic treatment of muscle spasticity.
It is absorbed completely from the gastrointestinal tract, metabolized minimally
in the liver and is excreted almost unchanged by the kidneys. Being lipophilic it
can cross the blood-brain barrier easily. Baclofen overdose can result in life
threatening complications such as respiratory failure, metabolic encephalopathy,
seizures, deep coma and autonomic instability leading to hypertension and
bradycardia.1-5 The literature on oral baclofen overdose in young children is
very sparse. Here we report a 2-year-old-girl who was found by her parents after
an accidental ingestion of her father's baclofen. The child presented with
respiratory failure, coma, hypotonia and bradycardia. The patient was managed
conservatively; mechanically ventilated for 16 hours and was discharged home
after 48 hours with no sequelae.
Copyright© South Dakota State Medical Association.
PMID: 32142228 [Indexed for MEDLINE]
7. Rev Assoc Med Bras (1992). 2020 Feb 27;66(1):12-17. doi:
10.1590/1806-9282.66.1.12. eCollection 2020.
Flucloxacillin-Induced Hepatotoxicity - Association with HLA-B*5701.
Teixeira M(1), Macedo S(1), Batista T(1), Martins S(1), Correia A(2), Matos
LC(3)(4).
Author information:
(1). Internal Medicine Physician with Specific Training in Internal Medicine,
Tondela-Viseu Hospital Center, Viseu, Portugal.
(2). Hospital Assistant Physician in Internal Medicine, Tondela-Viseu Hospital
Center, Viseu, Portugal.
(3). Hospital Assistant Physician Graduated on Internal Medicine, Tondela-Viseu
Hospital Center, Viseu, Portugal.
(4). Faculty of Health Sciences of the University of Beira Interior, Covilhã,
Portugal.
Drug-induced liver injury (DILI) to flucloxacillin is rare and is classified as
idiosyncratic, as it is dependent on individual susceptibility, unpredictable,
and dose-independent. The authors present the case of a 74 - year - old man with
a history of monoclonal gammopathy under investigation and alcoholic habits of 24
g/day, with asthenia, anorexia, nausea, abdominal discomfort, and fever with
three days of evolution. He was treated with two courses of antibiotic therapy
with flucloxacillin to erysipelas previously (3 months and 2 weeks before
admission). Lab tests showed serum AST levels of 349 U/L, ALT 646 U/L, alkaline
phosphatase 302 U/L, GGT 652 U/L, total bilirubin 3.3 mg/dL and direct bilirubin
2.72 mg/dL. Infectious, autoimmune, and metabolic causes were ruled out. Magnetic
resonance cholangiopancreatography showed normal results. Liver biopsy showed
mild multifocal (predominantly microvesicular) steatosis; marked changes in the
centrilobular areas (sinusoidal dilatation, marked congestion, hemorrhage, and
multifocal hepatocyte collapse); expansion of the portal areas with the formation
of bridges; proliferated bile ducts and inflammatory infiltrate of variable
density, predominantly mononuclear type. The HLA-B*5701 screening test was
positive. Hepatic biochemical tests remain abnormal with a significative increase
in total bilirubin, which reached levels of 24.1 mg/dL, with the development of
jaundice, pruritus, and choluria. DILI was assumed, and the patient was treated
with ursodeoxycholic acid. There was favorable evolution, without evidence of
blood coagulation dysfunction or encephalopathy. The analytic normalization was,
however, slow, with evolution to chronicity. The authors present this case to
remind the possibility of moderate/severe drug-induced liver injury to
flucloxacillin, an antibiotic commonly used in clinical practice and association
with the HLA-B * 5701 allele reported in the literature.
DOI: 10.1590/1806-9282.66.1.12
PMID: 32130375 [Indexed for MEDLINE]
8. J Biol Regul Homeost Agents. 2020 Jan-Feb;34(1 Suppl. 1):1-11.
Treatment with novel HYBENX® root canal cleanser suggests biofilms blocked
healing of human wounds: case series.
DENTAL SUPPLEMENT, Gitterle M(1).
Author information:
(1)Wound & Hyperbaric Medicine, Christus Santa Rosa, New Braunfels, TX, USA.
Pathogenic biofilms are considered a potential major obstacle to healing chronic
wounds. The six-month evaluation period in this study assessed the effect of a
single treatment of the HYBENX® (HYB) Root Canal Cleanser on chronic wounds,
especially its ease of use, safety, potential for shortening duration of
Inflammatory Phase, and promotion of granulation. HYB gel was applied to the
wound bed and periwound skin for 10 seconds. Gel was removed by cotton gauze pads
and low-pressure saline rinsing. Standard wound dressings based on wound
etiology, location, and exudate characteristics were applied. Duration of these
seven HYB-treated wound cases (two pressure ulcers, one surgical wound, four
lower extremity ulcers-a venous reflux-associated calf ulcer, one diabetic foot
ulcer, and two animal-induced wounds-brown recluse spider and bovine bite) ranged
from 12 days to 10 years. Three cases had sinus tracts. After HYB application,
sinus tract closure occurred at 7, 16, and 21 days. The 10-year recalcitrant
wound from brown recluse spider bite healed in 97 days. Diabetic foot ulcer
responded to HYB treatment plus additional strategies and healed in six months.
These data support the hypotheses that pathogenic biofilm actively prevents the
healing of chronic wounds, and biofilm can be disrupted with a single HYB
treatment.
Copyright 2020 Biolife Sas. www.biolifesas.org.
PMID: 32064830 [Indexed for MEDLINE]
9. Anticancer Res. 2020 Feb;40(2):865-871. doi: 10.21873/anticanres.14019.
Postoperative Exacerbation of Oxaliplatin-induced Neurotoxicity in
Gastrointestinal Cancers: A Case Series.
Gonzalez A(1), Walker EJ(2)(3), Van Loon K(2)(3), Cinar P(2)(3), Atreya CE(4)(3).
Author information:
(1)School of Medicine, University of California San Francisco, San Francisco, CA,
U.S.A.
(2)Department of Medicine, Division of Hematology and Oncology, University of
California San Francisco, San Francisco, CA, U.S.A.
(3)UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA,
U.S.A.
(4)Department of Medicine, Division of Hematology and Oncology, University of
California San Francisco, San Francisco, CA, U.S.A. chloe.atreya@ucsf.edu.
BACKGROUND/AIM: Oxaliplatin-induced neurotoxicity (OIN) can be severe and
dose-limiting with clinically significant symptoms that persist for years. Few
published reports have described postoperative exacerbation of OIN and more
longitudinal data are needed to better characterize the phenomenon.
PATIENTS AND METHODS: We identified 13 patients diagnosed with colon (n=7),
rectal (n=4) or pancreatic (n=2) cancer who experienced postoperative OIN
exacerbation at our medical center. Charts were reviewed for demographic and
clinical data regarding OIN.
RESULTS: OIN exacerbation was documented 0.5-7.0 months after the first surgery
following oxaliplatin exposure, with a median duration of 10.6 months
(range=1.4-86.1 months). OIN exacerbation persisted in 3/13 patients at last
follow-up, and improved to pre-operative levels in 6/13 patients (with complete
resolution in 4/13) within a median of 3.6 months from initial exacerbation.
CONCLUSION: Given the widespread use of oxaliplatin in neoadjuvant and first-line
treatment for gastrointestinal cancers, further study is warranted to
prospectively and systematically define risks for postoperative OIN exacerbation.
Copyright© 2020, International Institute of Anticancer Research (Dr. George J.
Delinasios), All rights reserved.
DOI: 10.21873/anticanres.14019
PMID: 32014930 [Indexed for MEDLINE]
10. BMC Infect Dis. 2020 Feb 3;20(1):100. doi: 10.1186/s12879-020-4760-2.
A rare case of purulent meningitis caused by Capnocytophaga canimorsus in the
Czech Republic - case report and review of the literature.
Prasil P(1), Ryskova L(2), Plisek S(1), Bostik P(3)(4).
Author information:
(1)Department of Infectious Diseases, Charles University School of Medicine and
Faculty Hospital, Hradec Kralove, Czech Republic.
(2)Department of Clinical Microbiology, Charles University School of Medicine and
Faculty Hospital, Hradec Kralove, Czech Republic.
(3)Department of Infectious Diseases, Charles University School of Medicine and
Faculty Hospital, Hradec Kralove, Czech Republic. bostikp@lfhk.cuni.cz.
(4)Faculty of Military Health Sciences, University of Defense, Trebesska 1575,
50001, Hradec Kralove, Czech Republic. bostikp@lfhk.cuni.cz.
BACKGROUND: Invasive infections caused by Capnocytophaga canimorsus are rare.
Immunocompromised patients, who report being bitten by or having a close contact
with an animal, represent a high-risk group for this infection. There are only
few dozens of infections by this bacteria manifesting as purulent meningitis
reported worldwide. The reported case is a first reported case of purulent
meningitis caused by by Capnocytophaga canimorsus in Czech Republic with only a
limited risk factor history.
CASE PRESENTATION: The patient, a 74 years old man, was referred to the
infectious diseases department of a teaching hospital with clear signs of
developing purulent meningitis. His anamnestic data did not show any unusual
findings. He was treated for compensated diabetes mellitus type II. The blood
cultures were negative and the etiological agent did not grow from the
cerebrospinal fluid (CSF) on common media. Eventually, it was identified by
detecting pan-bacterial DNA and DNA sequencing. Subsequently, the pathogen was
confirmed by anaerobic cultivation from CSF. Only after then the patient recalled
being bitten by his German shepherd puppy during play. The patient was
successfully treated intravenously by ceftriaxone.
CONCLUSIONS: Purulent meningitis caused by Capnocytophaga spp. is a rare disease,
but it needs to be considered in patients at risk with pre-existing conditions,
who report close contact with or being bitten by an animal. It is important to
test for this microbe in cases with negative microbiological results for the more
common agents.
DOI: 10.1186/s12879-020-4760-2
PMCID: PMC6998360
PMID: 32013874 [Indexed for MEDLINE]
11. Am J Trop Med Hyg. 2019 Sep;101(3):476-477. doi: 10.4269/ajtmh.19-0321.
Hemorrhagic Blisters, Necrosis, and Cutaneous Ulcer after Envenomation by the
Niquim Toadfish.
Haddad V(1), Lopes-Ferreira M(2), Mendes AL(3).
Author information:
(1)Department of Dermatology, Faculty of Medicine, Sao Paulo State University,
Botucatu, Brazil.
(2)Immunoregulation Unit of the Special Laboratory of Applied Toxinology,
Butantan Institute, São Paulo, Brazil.
(3)Department of Internal Medicine, São Paulo State University, São Paulo,
Brazil.
DOI: 10.4269/ajtmh.19-0321
PMCID: PMC6726955
PMID: 31971140 [Indexed for MEDLINE]
12. Rev Inst Med Trop Sao Paulo. 2020 Jan 17;62:e1. doi: 10.1590/S1678-9946202062001.
eCollection 2020.
Rabies encephalitis and extra-neural manifestations in a patient bitten by a
domestic cat.
Soler-Rangel S(1), Jiménez-Restrepo N(2), Nariño D(1), Rosselli D(3).
Author information:
(1)Pontificia Universidad Javeriana, Hospital Universitario San Ignacio,
Departamento de Neurociencias, Bogotá, Colombia.
(2)Pontificia Universidad Javeriana, Hospital Universitario San Ignacio,
Departamento de Urgencias, Bogotá, Colombia.
(3)Pontificia Universidad Javeriana, Departamento de Epidemiología Clínica y
Bioestadística, Bogotá, Colombia.
Rabies encephalitis is a fatal zoonotic viral disease transmitted to humans
either by domestic animals like dogs and cats or by wild animals like bats,
skunks and raccoons. We present the case of a 25-year-old woman admitted due to
behavioral disorders, generalized paresthesiasand acute respiratory deterioration
compatible with a respiratory distress syndrome (ARDS) requiring orotracheal
intubation, mechanical ventilation and empirical initiation of antibiotic and
antiviral therapy. Chest tomography showed pneumomediastinum and changes
suggestive of pulmonary infection. In the presence of neurological symptoms, a
central nervous system (CNS) infection was suspected and the cerebrospinal fluid
showed no pleocytosis, hiperproteinorrachy without glucose consumption; cranial
CT scan was normal. During hospitalization, the family reported that the patient
was bitten by a cat 30-day prior to the onset of rabies-like symptoms, and the
animal was sacrificed. The patient had an unfavorable clinical evolution, with
electroencephalographic activity dissociation evidenced by video telemetry. The
zoonotic exposure led to the suspected diagnosis of rabies infection. The patient
died and the suspected diagnosis was confirmed by histopathology, with presence
of Negri bodies on cerebellum Purkinje cells and a positive immunofluorescence
test for rabies virus. Both, initial extra-neural manifestations and late
reporting of rabies exposure led to delayed diagnosis.
DOI: 10.1590/S1678-9946202062001
PMCID: PMC6968790
PMID: 31967209 [Indexed for MEDLINE]
13. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2019 Dec 20;37(12):936-937. doi:
10.3760/cma.j.issn.1001-9391.2019.12.015.
[A case of acute carbon tetrachloride poisoning caused by contact with carburetor
cleaning agent].
[Article in Chinese]
Wu D.
DOI: 10.3760/cma.j.issn.1001-9391.2019.12.015
PMID: 31937038 [Indexed for MEDLINE]
14. Medicine (Baltimore). 2020 Jan;99(1):e18136. doi: 10.1097/MD.0000000000018136.
Fetal outcomes after intentional ingestion of paraquat: A case report.
Chen J(1)(2), Jian X(1), Yu G(1), Si M(1), Kan B(1).
Author information:
(1)Department of Poisoning and Occupational Diseases, Qilu Hospital of Shandong
University, Jinan, Shandong.
(2)Department of Intensive Care Unite, The Second Affiliated Hospital and Yuying
Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, PR China.
RATIONALE: Despite the fact that treatment of paraquat poisoning in pregnant
women and their fetuses is challenging and raises ethical issues, it is rarely
reported in the literature. We report the case of a pregnant woman who took
paraquat intentionally.
PATIENT CONCERNS: A 36-year-old woman at 38 weeks gestational age, in an apparent
suicide attempt, drank 1 mouthful (about 20 ml) of paraquat solution. Ten hours
later, her urine dithionate test showed light blue color with a plasma paraquat
concentration of 0.547 μg/ml. Six hours after admission, a male infant, whose
plasma paraquat concentration was 0.761 μg/ml, together with 0.673 μg/ml in the
amniotic fluid measured by high-performance liquid chromatography, was delivered
but the woman's lung, liver, and kidney function declined rapidly.
DIAGNOSIS: INTERVENTIONS:: Because of placenta previa and multiple organ failure,
emergency cesarean section, and panhysterectomy were performed for the pregnant
woman. Intravenous injection of antibiotic to prevent infection and dexamethasone
30 mg once a day were administered. Mechanical ventilation was performed for the
infant and meropenem and penicillin injection was administered.
OUTCOMES: The infant died 33 hours after birth while the mother died on the 3rd
day after ingestion.
LESSONS: Paraquat can enter the fetus through the placenta and the amniotic fluid
via fluid exchange. The pathological changes of fetal organs may relate to
gestational age, and the prognosis was very poor in both the mother and the
fetus.
DOI: 10.1097/MD.0000000000018136
PMCID: PMC6946536
PMID: 31895766 [Indexed for MEDLINE]
15. Medicine (Baltimore). 2019 Dec;98(52):e18295. doi: 10.1097/MD.0000000000018295.
Intoxication with 3-MeO-PCP alone: A case report and literature review.
Berar A(1)(2), Allain JS(2)(3), Allard S(4), Lefevre C(4), Baert A(1), Morel
I(4)(5), Bouvet R(1)(6), Gicquel T(4)(5).
Author information:
(1)CHU Rennes, Department of Forensic Medicine.
(2)CHU Rennes, Department of Internal Medicine and Clinical Immunology.
(3)CIC-P 1414 Clinical Investigation Center, Inserm.
(4)CHU Rennes, Department of Forensic Toxicology.
(5)Université de Rennes, INRA, Inserm, Institut NuMeCan - UMR_A 1341, UMR_S 1241.
(6)Université de Rennes, IDPSP - EA 4640, Rennes, France.
RATIONALE: 3-Methoxyphencyclidine (3-MeO-PCP) is a new psychoactive substance
derived from phencyclidine. Although it can lead to severe intoxications, the
main manifestations and optimal management have not been well characterized.
Here, we report 2 cases of 3-MeO-PCP intoxication in the same patient, and
summarize the manifestations of this intoxication reported in literature.
PATIENT CONCERNS: A 17-year-old male purchased a bag of 3-MeO-PCP on the Internet
but took an oral dose (200 mg) that corresponds to the less active isomer
4-MeO-PCP. He developed high blood pressure (158/131 mm Hg), tachycardia (100
bpm), and neurological manifestations (confusion, hypertonia, nystagmus, and then
agitation). A maculopapular rash appeared, although this may have been related to
the administration of midazolam. Hyperlactatemia (2.6 mmol/L) was the main
laboratory finding. Seven days later, he returned to the emergency department
after sniffing 50 mg of 3-MeO-PCP. High blood pressure, tachycardia, and
neurological manifestations (psychomotor impairment and dysarthria) were present
but less severe than after the first intoxication.
DIAGNOSIS: In the first intoxication, the blood and urine 3-MeO-PCP
concentrations were, respectively, 71.1 ng/mL and 706.9 ng/mL. Conventional
toxicity tests were all negative. In the second intoxication, biological samples
were not available.
INTERVENTIONS: In the first intoxication, treatment consisted of intravenous
hydration and midazolam. The patient was transferred to an intensive care unit
for monitoring. After the second intoxication, he was monitored for 12 hours.
OUTCOMES: The patient's condition improved quickly in both cases.
LESSONS: These cases provide additional information on the manifestations of
3-MeO-PCP intoxication. These manifestations are mainly cardiovascular (high
blood pressure, tachycardia) and neurological. The fact that second (50 mg)
intoxication was less severe than the first (200 mg) is suggestive of a
dose-effect relationship for 3-MeO-PCP. The first case also emphasizes the risk
of dosing errors caused by the similarity between the names "3-MeO-PCP" and
"4-MeO-PCP."
DOI: 10.1097/MD.0000000000018295
PMCID: PMC6946333
PMID: 31876705 [Indexed for MEDLINE]
16. Rev Med Chil. 2019 Jul;147(7):935-939. doi: 10.4067/S0034-98872019000700935.
[Severe hyponatremia secondary to Phyllomedusa bicolor (Kambó frog) poisoning.
Report of one case].
[Article in Spanish]
Campodónico J, Aedo P, Montané MI, Rojas A, Aveiga A(1), Silva L(1), Ríos JC(2),
Solís I(3).
Author information:
(1)Unidad de Tratamiento Intermedio, Clínica Dávila, Santiago, Chile.
(2)Centro de Información Toxicológica, Pontificia Universidad Católica de Chile,
Santiago, Chile.
(3)Departamentos de Medicina Interna y Endocrinología, Clínica Dávila, Santiago,
Chile.
Phyllomedusa bicolor or Kambo is a frog that lives in the Amazon rainforest. It
can release through its skin a substance used in healing rituals that are common
among South-American tribes, as well as in urban people of America and Europe. We
report a 41-year-old female patient who, during a healing ritual consumed
ayahuasca (a drink obtained from the mixture of Banisteriopsis caapi, Psychotria
viridis and Mimosa hostilis) and 12 hours later received the poison of Kambo Frog
(Phyllomedusa bicolor) on superficial right shoulder skin burns. The ritual
included a minimum of six-liter water intake over a few hours period. She evolved
with clouding of sensorium, motor agitation, frequent vomiting, and generalized
tonic-clonic seizures. She presented lethargic to the emergency room, with a weak
pupillary light reflex, generalized stiffness, moving all four limbs. Laboratory
showed severe hyponatremia (120 mEq/L) and a creatine kinase level of 8,479 UI/L,
that increased 107,216 IU/L within few days. An admission CT Brain scan was
normal. The toxicological screening did not identify the presence of other
substances. During hospitalization the patient developed severe psychomotor
agitation controlled by a dexmedetomidine infusion, hyponatremia, low plasma
osmolality (248 mOsm/kg), and disproportionately high urinary osmolality (448
mOsm/kg), suggestive of inappropriate antidiuretic hormone secretion syndrome
(SIADH). With correction of hyponatremia, the patient gradually recovered
consciousness. Rhabdomyolysis was assumed to be secondary to seizure and managed
by volume and bicarbonate infusions with a positive response.
DOI: 10.4067/S0034-98872019000700935
PMID: 31859994 [Indexed for MEDLINE]
17. Rev Soc Bras Med Trop. 2019 Dec 20;53:e20190328. doi:
10.1590/0037-8682-0328-2019. eCollection 2019.
A rare cause of vertebral osteomyelitis: the first case report of rat-bite fever
in Portugal.
Pena E(1), Jordão S(1), Simões MJ(2), Oleastro M(2), Neves I(1).
Author information:
(1)Matosinhos Local Health Unit, Infectious Diseases Department, Matosinhos,
Porto, Portugal.
(2)National Health Institute Doutor Ricardo Jorge (INSA), Infectious Diseases
Department, Lisboa, Portugal.
Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus
moniliformis . Although this disease is distributed worldwide, there have been
few cases reported in Europe. Here, we report a case of vertebral osteomyelitis
and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese
patient previously bitten by a rat. Laboratory diagnosis was performed using
molecular identification. This is the first case report of rat-bite fever in
Portugal. The case described here serves as a reminder for physicians to consider
this diagnosis in patients who have developed fever syndromes after being in
contact with rodents.
DOI: 10.1590/0037-8682-0328-2019
PMCID: PMC7083378
PMID: 31859955 [Indexed for MEDLINE]
18. Unfallchirurg. 2020 Mar;123(3):247-250. doi: 10.1007/s00113-019-00755-9.
[Flawed initial treatment of dog bite injury].
[Article in German]
Landeg M(1), Bogner-Flatz V(2), Neuhof T(3).
Author information:
(1)Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der
LMU, Nussbaumstr. 20, 80336, München, Deutschland. M.Landeg@campus.lmu.de.
(2)Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der
LMU, Nussbaumstr. 20, 80336, München, Deutschland.
(3)Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern,
Hans-Böckler-Allee 3, 30173, Hannover, Deutschland.
A 73-year-old male patient suffered multiple dog bites to the left hand and lower
arm. The initial treatment in hospital consisted of conservative treatment with
wound closure strips and bandages. For further treatment the patient was referred
to the general practitioner who found a discharge of pus below the wound closure
strips 2 days later. On the 3rd day the patient was admitted to a different
hospital where surgical treatment with débridement, placement of vacuum bandages
and subsequent flap plasty was conducted on admission. An examination 1 year
later revealed stabbing pain over the carpometacarpal joint radiating into the
thumb, hypoesthesia of the back of the hand, numbness of the thumb on the ulnar
side, reduced range of movement in the wrist and thumb and suspected development
of a neuroma. In the subsequent arbitration procedure, the patient criticized the
initial treatment and claimed that the bite wounds were not cleansed and were
then closed with wound closure strips without antibiotic treatment. This was
assumed to have caused extensive infection, which required surgical treatment and
caused lasting complaints. The arbitration board report determined an
insufficient initial clinical assessment and a faulty wound care resulting in,
among other things, reduced range of movement of all fingers of the left hand.
DOI: 10.1007/s00113-019-00755-9
PMID: 31858166 [Indexed for MEDLINE]
19. J Opioid Manag. 2019 Sep/Oct;15(5):428-432. doi: 10.5055/jom.2019.0531.
Fentanyl analogue overdose: Key lessons in management in the synthetic opioid
age.
Raheemullah A(1), Andruska N(2).
Author information:
(1)Department of Psychiatry, Stanford University School of Medicine, Stanford,
California.
(2)Department of Internal Medicine, University of Illinois College of Medicine,
Chicago, Illinois.
Fentanyl overdoses are growing at an alarming rate. Fentanyl is often mixed into
heroin and counterfeit prescription opioid pills without the customer's knowledge
and only detected upon laboratory analysis. This is problematic because fentanyl
analogues like carfentanil are 10,000 times more potent than morphine and pose
new challenges to opioid overdose management. A 62-year-old male with an overdose
from a rare fentanyl analogue, acrylfentanyl, was given two doses of intranasal 2
mg naloxone with improvements in respiratory rate. In lieu of more naloxone, his
trachea was intubated and he was admitted to the intensive care unit. He
subsequently developed ventilator-associated pneumonia and then a pulmonary
embolism. He did not receive any opioid use disorder treatment and returned back
to the emergency department with an opioid overdose 21 days after discharge. We
are encountering an unprecedented rise in synthetic opioid overdose deaths as we
enter the third decade of the opioid epidemic. Thus, it is imperative to be aware
of the features and management of overdoses from fentanyl and its analogues. This
includes protecting against occupational exposure, administering adequate doses
of naloxone, and working with public health departments to respond to fentanyl
outbreaks. Additionally, fentanyl overdoses represent a critical opportunity to
move beyond acute stabilization, start buprenorphine or methadone for opioid use
disorder during hospitalization, link patients to ongoing addiction treatment,
and distribute naloxone into the community to help curb the overdose epidemic.
DOI: 10.5055/jom.2019.0531
PMID: 31849033 [Indexed for MEDLINE]
20. Biochem Med (Zagreb). 2020 Feb 15;30(1):010802. doi: 10.11613/BM.2020.010802.
Epub 2019 Dec 15.
An unconscious man with profound drug-induced hypoglycaemia.
Schiemsky T(1), Vundelinckx G(2), Croes K(3), Penders J(4), Desmet K(1), Pauwels
S(1), Vermeersch P(1).
Author information:
(1)Laboratory Medicine, University Hospitals Leuven; Department of cardiovascular
Medicine, University of Leuven, Leuven, Belgium.
(2)Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
(3)Laboratory medicine, AZ Groeninge Hospital, Kortrijk, Belgium.
(4)Laboratory medicine, Ziekenhuis Oost-Limburg, Genk, Belgium.
Introduction: Hypoglycaemia has been reported as an unusual complication of
tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is
not known.
Case description: An ambulance crew was dispatched to an unconscious 46-year old
man. A glucometer point-of-care measurement revealed a profound hypoglycaemia
(1.9 mmol/L). Treatment with intravenous glucose was started and the patient was
transported to the hospital. The patient had several episodes of pulseless
electrical activity requiring cardiopulmonary resuscitation in the ambulance and
upon arrival in the hospital. Despite continuous glucose infusion the
hypoglycaemia was difficult to correct during the next few hours and the patient
developed hypokalaemia. Further investigation to identify the cause of
hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A
toxicological investigation revealed the presence of tramadol and its metabolites
in lethal concentrations. Also acetaminophen, ibuprofen and lormetazepam were
present. Ethanol screening was negative (< 0.1 g/L) and no sulfonylurea were
detected. The patient developed multiple organ failure, but eventually recovered.
What happened: The hypoglycaemia was caused by inappropriate stimulation of
insulin secretion in a patient intoxicated with tramadol. The sudden hypokalaemia
was caused by a massive intracellular shift of potassium in response to the
hyperinsulinemia, triggered by the intravenous administration of glucose.
Main lesson: To our knowledge, we are the first to document a significant rise in
endogenous insulin production in a hypoglycaemic patient presenting with tramadol
intoxication. Our observation suggests that hyperinsulinemia could be the cause
of the hypoglycaemia associated with tramadol use.
Croatian Society of Medical Biochemistry and Laboratory Medicine.
DOI: 10.11613/BM.2020.010802
PMCID: PMC6904963
PMID: 31839727 [Indexed for MEDLINE]
Conflict of interest statement: Potential conflict of interest: None declared.
21. Am J Case Rep. 2019 Dec 15;20:1874-1878. doi: 10.12659/AJCR.919545.
Neonate Death Due to Marijuana Toxicity to the Liver and Adrenals.
Bao C(1), Bao S(1).
Author information:
(1)Champaign County Coroner's Office, Urbana, IL, USA.
BACKGROUND Marijuana is the considered the most widely available and used drug
across the world. Up to this time, there have been no reports of human death
directly caused by acute marijuana toxicity in adults, fetuses, or newborn
neonates. CASE REPORT We report a death of an 11-day-old white female neonate due
to acute marijuana toxicity. She died of extensive necrosis and hemorrhage of the
liver and adrenals due to maternal use of marijuana. CONCLUSIONS This case is
unique in that other possible causes of death can be eliminated. With growing use
of marijuana by pregnant women and increases in newborn drug screening of
umbilical cord homogenate, more cases of neonatal death due to acute marijuana
toxicity could be discovered.
DOI: 10.12659/AJCR.919545
PMCID: PMC6930694
PMID: 31838485 [Indexed for MEDLINE]
22. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2019 Nov 20;37(11):855-857. doi:
10.3760/cma.j.issn.1001-9391.2019.11.015.
[Clinical analysis of 5 cases of acute poisoning by inhalation of hydrochlogen
chloride].
[Article in Chinese; Abstract available in Chinese from the publisher]
Xia ML(1), Lou YF(1), Ma WJ(2).
Author information:
(1)Department of Pulmonary Medicine, Hangzhou Hospital of Traditional Chinese
Medicine, Hangzhou 310007, China.
(2)Pulmonary and Critical Care Medicine, the First Affiliated Hospital of
Zhejiang University, Hangzhou 310003, China.
Objective: To analyze the clinical characteristics caused by acute poisoning by
inhalation of hydrogen chloride (HCl) and to raise awareness and treatment level
of the disease. Methods: The clinical manifestations, imaging features,
diagnosis, treatment and prognosis of 5 patients with acute HCl poisoning were
analyzed retrospectively. Results: Among the 5 cases of HCl poisoning, 2 cases
were severe poisoning, 3 cases were moderate poisoning. All patients were treated
with corticosteroids and symptomatic treatment, one of them was treated with
venovenous extracorporeal membrane oxygenation (VV-ECMO) . All patients were
recovered and discharged from hospital. Conclusion: The lung damage of acute
poisoning by inhalation of HCl is rapidly progressing, early detection and timely
medical treatment can obtain a better prognosis.
Publisher: 目的： 分析吸入盐酸（Hydrochloric acid，HCl）烟雾中毒病例的临床特点，提高对该病的诊治水平。 方法：
2019年3月回顾分析我院2018年7月6日至2018年7月9日收治的5例吸入氯化氢吸入致中毒病例临床资料，对其临床表现、影像学特征、诊断、治疗及预后进行总结。
结果： 5例患者中，2例诊断为重度中毒，3例为中度中毒。5例均予糖皮质激素及对症支持治疗，其中1例予静脉-静脉体外膜肺氧合（Venovenous
extracorporeal membrane oxygenation，VV-ECMO）治疗，所有患者均痊愈出院。 结论：
吸入盐酸烟雾中毒患者肺部损害可在短期内明显进展，早期发现、及时就医可获得较好预后。.
DOI: 10.3760/cma.j.issn.1001-9391.2019.11.015
PMID: 31826555 [Indexed for MEDLINE]
23. Continuum (Minneap Minn). 2019 Dec;25(6):1785-1806. doi:
10.1212/CON.0000000000000807.
Lambert-Eaton Myasthenic Syndrome, Botulism, and Immune Checkpoint
Inhibitor-Related Myasthenia Gravis.
Guidon AC.
PURPOSE OF REVIEW: This article reviews the pathophysiology, epidemiology,
clinical presentation, diagnosis, and treatment of Lambert-Eaton myasthenic
syndrome (LEMS) and of botulism, and immune-related myasthenia gravis (MG)
occurring in the context of immune checkpoint inhibitor therapy for cancer.
RECENT FINDINGS: The suspicion that LEMS is rare but also likely underdiagnosed
is supported by recent epidemiologic data. A validated, LEMS-specific scale now
exists to assess and monitor disease, and symptomatic and immunomodulatory
treatments are available. As presynaptic disorders of neuromuscular transmission,
LEMS and botulism share electrodiagnostic abnormalities but have important
distinguishing features. Knowledge of the clinical features of botulism is
needed, particularly with continued cases of infant botulism, the opioid epidemic
increasing the incidence of wound botulism, and medical use of botulinum toxin,
which may cause iatrogenic botulism. Foodborne botulism remains rare. Prompt
recognition of botulism and administration of antitoxin can improve outcomes. MG
may be exacerbated or may present de novo in the context of immune activation
from immune checkpoint inhibitor therapies for cancer. Immune-related MG commonly
overlaps with myositis and myocarditis. Corticosteroids typically result in
improvement. However, immune-related MG can be more fulminant than its idiopathic
counterpart and may cause permanent disability or death.
SUMMARY: The diagnosis of LEMS, botulism, or immune-related MG can generally be
made from the patient's history, supplemented with directed questions, a physical
examination designed to demonstrate abnormalities, and laboratory and
electrodiagnostic testing. Early diagnosis and carefully selected treatment not
only improve outcomes of the neuromuscular disease but can affect the prognosis
of underlying malignancy, when present.
DOI: 10.1212/CON.0000000000000807
PMID: 31794471 [Indexed for MEDLINE]
24. Neurology. 2019 Dec 3;93(23):1012-1013. doi: 10.1212/WNL.0000000000008578.
Antitubercular therapy-induced psychosis.
Singanamala B(1), Saini L(2), Madaan P(1), Singh P(1), Vaidya PC(1), Sahu JK(1).
Author information:
(1)From the Pediatric Neurology Unit, Department of Pediatrics, Advanced
Pediatrics Centre (B.S., L.S., P.M., P.C.V., J.K.S.), and Department of
Radiodiagnosis (P.S.), Post Graduate Institute of Medical Education & Research,
Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi,
India.
(2)From the Pediatric Neurology Unit, Department of Pediatrics, Advanced
Pediatrics Centre (B.S., L.S., P.M., P.C.V., J.K.S.), and Department of
Radiodiagnosis (P.S.), Post Graduate Institute of Medical Education & Research,
Chandigarh; and Council of Scientific and Industrial Research (P.M.), New Delhi,
India. drlokeshsaini@gmail.com.
DOI: 10.1212/WNL.0000000000008578
PMID: 31792104 [Indexed for MEDLINE]
25. Toxicol Lett. 2020 Mar 1;320:109-112. doi: 10.1016/j.toxlet.2019.11.025. Epub
2019 Nov 25.
Acute severe intoxication with cyclopropylfentanyl, a novel synthetic opioid.
Wilde M(1), Sommer MJ(1), Auwärter V(2), Hermanns-Clausen M(3).
Author information:
(1)Institute of Forensic Medicine, Forensic Toxicology, Medical Center,
University of Freiburg, Freiburg, Germany; Hermann Staudinger Graduate School,
University of Freiburg, Freiburg, Germany.
(2)Institute of Forensic Medicine, Forensic Toxicology, Medical Center,
University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of
Freiburg, Freiburg, Germany.
(3)Faculty of Medicine, University of Freiburg, Freiburg, Germany; Poisons
Information Center, Department of General Pediatrics, Adolescent Medicine and
Neonatology, Center for Pediatrics, Medical Center, University of Freiburg,
Freiburg, Germany. Electronic address:
maren.hermanns-clausen@uniklinik-freiburg.de.
BACKGROUND: Since 2016 an increase has been observed in the availability of new
synthetic opioids (NSO) in Europe. Cyclopropylfentanyl is a very potent and
selective μ-opioid agonist, which was reported for the first time in August 2017
in Europe.
METHODS: The case was included in a prospective observational study of patients
treated in emergency departments after the intake of novel psychoactive
substances (NPS). Clinical features were acquired using a structured
questionnaire for physicians. Serum and/or urine samples of ED patients were
analyzed using liquid chromatography-electrospray ionization-tandem mass
spectrometry (LC-ESI-MS/MS) screening methods for NPS.
CASE REPORT: Within 10 min after intranasal intake of fentanyl, a 25-year-old
male developed nausea, profuse sweating and dyspnoe. Because soon afterwards coma
and respiratory insufficiency was noticed, the patient was admitted to hospital.
After administration of naloxone (0.8 mg) breathing stabilized. However, the
patient displayed recurrent decreases of oxygen saturation for 12 h. The intake
of cyclopropylfentanyl was analytically confirmed.
CONCLUSION: The constantly growing diversity of NSO still poses a high risk for
drug users and can be a challenging task for clinicians and forensic
toxicologists. Clinicians treating opioid overdoses should be aware of the
potentially long lasting respiratory depression induced by fentanyl analogs.
Copyright © 2019 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.toxlet.2019.11.025
PMID: 31778775 [Indexed for MEDLINE]
26. Pediatrics. 2019 Dec;144(6). pii: e20191937. doi: 10.1542/peds.2019-1937.
Two Neonates With Postnatally Acquired Tickborne Infections.
Handel AS(1), Hellman H(2), Hymes SR(3).
Author information:
(1)Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New
York; and andrew.handel@stonybrookmedicine.edu.
(2)Hampton Community Healthcare, Southampton, New York.
(3)Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, New
York; and.
Neonatal tick bites place infants at risk for acquiring infections that have
rarely or never been documented in this age group. We describe 2 rare cases of
tickborne infection in neonates. The first patient presented with multiple
erythema migrans and fever, leading to a diagnosis of early disseminated Lyme
disease. The second patient presented with irritability, fever, and worsening
anemia due to babesiosis. Both infants had been bitten by arthropods fitting the
description of ticks before the onset of symptoms. Our cases demonstrate the
clinical course of 2 common tickborne infections occurring at an atypical age,
opening the door to new, complex questions for which little guiding data exists.
As tickborne infections become more prevalent, we expect other clinicians will be
faced with similarly challenging neonatal cases. Providers must use past
experience and a keen eye to identify neonates with tickborne infections and sort
through their optimal diagnosis and management. In this article, we raise some of
the questions we faced and discuss our conclusions.
Copyright © 2019 by the American Academy of Pediatrics.
DOI: 10.1542/peds.2019-1937
PMID: 31776195 [Indexed for MEDLINE]
Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have
indicated they have no potential conflicts of interest to disclose.
27. BMC Gastroenterol. 2019 Nov 27;19(1):199. doi: 10.1186/s12876-019-1122-x.
Drug induced hepatitis mimicking Wilson's disease secondary to the use of complex
naturopathic regimens: a case report.
Pitre T(1), Mah J(2), Vertes J(2), Rebello R(2), Zhu J(2).
Author information:
(1)Michael G. DeGroote School of Medicine (Waterloo Regional Campus), McMaster
University, Hamilton, Canada. Tyler.Pitre@medportal.ca.
(2)Faculty of Medicine, Dalhousie University, Halifax, Canada.
BACKGROUND: Drug induced liver injury (DILI) is an important cause of acute liver
injury and accounts for approximately 10% of all cases of acute hepatitis. Both
prescription and natural health products (NHPs) have been implicated in DILI.
There is a dearth of studies on NHPs induced liver injury.
CASE PRESENTATION: A previously healthy 37-year-old female presented with
subacute hepatitis, in the context of a previous admission to a separate
institution, months prior for undiagnosed acute hepatitis. Importantly, she had
disclosed taking complex regiments of natural health products (NHPs) for months.
Her only other medication was rivaroxaban for her homozygous Factor V Leiden
deficiency. She had an extensive work up for causes of acute and unresolving
hepatitis. She discontinued several but not all of her NHPs after her initial
presentation for acute hepatitis at the first institution and continued taking
NHPs until shortly after admission to our institution. The predominant
pathological features were that of drug induced liver injury, although an
abnormal amount of copper was noted in the core liver biopsies. However, Wilson's
disease was ruled out with normal serum ceruloplasmin and 24-urine copper. After
2 months of stopping all the NHPs, our patient improved significantly since
discharge, although there is evidence of fibrosis on ultrasound at last available
follow up.
CONCLUSION: NHPs are a well-established but poorly understood etiology of DILI.
The situation is exacerbated by the unregulated and unpredictable nature of many
of the potential hepatotoxic effects of these agents, especially in cases of
multiple potential toxic agents. This highlights the importance of acquiring a
clear history of all medications regardless of prescription status.
DOI: 10.1186/s12876-019-1122-x
PMCID: PMC6882359
PMID: 31775657 [Indexed for MEDLINE]
28. BMJ Case Rep. 2019 Nov 24;12(11). pii: e230044. doi: 10.1136/bcr-2019-230044.
Unusual presentation of haemoptysis following accidental inhalation of the
'superwarfarin' rodenticide brodifacoum.
Love RL(1), Sharma N(2), Chong K(3).
Author information:
(1)Department of Respiratory Medicine, East and North Hertfordshire NHS Trust,
Stevenage, UK ryan.love@nhs.net.
(2)Department of Radiology, East and North Hertfordshire NHS Trust, Stevenage,
UK.
(3)Department of Respiratory Medicine, East and North Hertfordshire NHS Trust,
Stevenage, UK.
Haemoptysis is a worrying symptom for patients and can represent a diagnostic
challenge for clinicians. We present the case of a 56-year-old woman who
presented to the emergency department with acute haemoptysis and associated
sudden-onset dyspnoea. The patient remained haemodynamically stable and there was
no demonstrable drop in haemoglobin concentration. Following rigorous
investigations, on further questioning, the patient recalled inadvertent
inhalation of the rodenticide brodifacoum. This exposure was deemed to represent
the cause of their acute haemoptysis, which subsequently fully resolved without
intervention.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and
permissions. Published by BMJ.
DOI: 10.1136/bcr-2019-230044
PMID: 31767603 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
29. Medicine (Baltimore). 2019 Nov;98(47):e18098. doi: 10.1097/MD.0000000000018098.
Three case reports: Temporal association between tyrosine-kinase
inhibitor-induced hepatitis and immune checkpoint inhibitors in renal cell
carcinoma.
Carretero-González A(1), Salamanca Santamaría J(2), Castellano D(1), de Velasco
G(1).
Author information:
(1)Department of Medical Oncology.
(2)Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain.
RATIONALE: Hepatotoxicity is a well-known adverse effect of vascular endothelial
growth factor receptor (VEGFR) tyrosine-kinase inhibitors (TKIs), usually
employed for the treatment of metastatic renal cell carcinoma (mRCC). Immune
checkpoint inhibitors (ICIs) have been shown to improve survival in specific
patients with mRCC, but concerns have arisen over their safety profile,
particularly as regards the risk of liver damage in those patients receiving TKIs
sequentially or concurrently with these new drugs. Here, we report three cases of
hepatitis presentation in patients receiving TKIs after ICIs that should
potentially be considered in current clinical practice, where a combination of
these hepatotoxic drugs is becoming increasingly used.
PATIENTS CONCERNS: All three patients were receiving TKIs therapy and presented
with nonspecific clinical deterioration and liver enzyme elevation in different
time frames according to the start of treatment. All were previously treated with
ICIs.
DIAGNOSES: After performing imaging techniques and complementary laboratory tests
for the differential diagnosis of hepatic injury, the diagnosis of potentially
TKI-induced hepatitis was assumed in all these cases. Hepatic biopsy was
performed only in the first case in order to confirm the diagnosis.
INTERVENTIONS: Potential toxic drugs were interrupted and steroids course with
slow reduction regimen was administered in all these cases because of the
previous use of ICIs.
OUTCOMES: The patients described improved with this conservative treatment
without complications during the following weeks. Only one case presented a new
episode of mild hepatic alteration while on treatment with following treatment.
LESSONS: Taking into account this new therapeutic context, stricter monitoring
for potentially increased/altered adverse events should be indicated. Adequate
patient selection and consideration of the safety profile of the different drugs
used could help to optimize treatment in the near future.
DOI: 10.1097/MD.0000000000018098
PMCID: PMC6882583
PMID: 31764847 [Indexed for MEDLINE]
30. Medicine (Baltimore). 2019 Nov;98(47):e17981. doi: 10.1097/MD.0000000000017981.
Severe hyperammonemia from intense skeletal muscle activity: A rare case report
and literature review.
Taneja V(1), Jasuja H(2).
Author information:
(1)Orlando Regional Medical Center, Orlando, FL.
(2)Materials and Nanotechnology Program, North Dakota State University, Fargo,
ND.
RATIONALE: Adult hyperammonemia is most often the result of hepatic dysfunction.
Hyperammonemia in the setting of normal hepatic function is a much less common
phenomenon and has usually been associated with medications and certain disease
states. Here, we present an unusual case of severe hyperammonemia caused
physiologically by intense muscle activity in a patient lacking any evidence of
liver disease.
PATIENT CONCERNS: A 36-year-old woman was brought to the emergency department for
a suicide attempt after being found covered in Lysol and Clorox germicidal
bleach. She was noted to be in a state of violent psychosis with extreme
agitation and had to be sedated and intubated for airway protection.
DIAGNOSIS AND INTERVENTIONS: Initial labs revealed hyperammonemia, lactic
acidosis, and anion gap metabolic acidosis. Aminotransferases, bilirubin, and
creatine kinase (CK) were normal. Renal function, prothrombin time, activated
partial thromboplastin time, and international normalized ratio were also
unremarkable and remained so at 24 hours. Ethyl alcohol, acetaminophen,
salicylate, and valproic acid were all undetectable in blood. She received 2
doses of lactulose overnight, with a subsequent bowel movement. Next day, her
mentation, serum ammonia level, and lactic acid level were back to normal, and
she was extubated. Aminotransferases and CK levels were elevated but improved
with supportive care. A detailed history and relevant biochemical investigations
were unremarkable for any other etiology of hyperammonemia including the common
inborn errors of metabolism (IEM). The combination of clinical findings of
extreme skeletal muscle activity along with hyperammonemia and lactic acidosis,
and subsequently rhabdomyolysis in the setting of unremarkable history and
otherwise normal hepatic function strongly suggest the myokinetic origin of
hyperammonemia in the patient.
OUTCOME: The patient recovered well with supportive care and was discharged on
day 5.
LESSONS: This unique case illustrates the important role of skeletal muscle in
the human metabolism of ammonia. In our discussion, we also elucidate the
underlying pathophysiology, with the objective of improving clinician
understanding of various differential diagnoses.
DOI: 10.1097/MD.0000000000017981
PMCID: PMC6882587
PMID: 31764807 [Indexed for MEDLINE]
31. BMJ Case Rep. 2019 Nov 21;12(11). pii: e230966. doi: 10.1136/bcr-2019-230966.
Clinical effects from household insecticide: pyrethroid or organophosphate
toxicity?
Basrai Z(1), Koh C(2), Celedon M(2), Warren J(3).
Author information:
(1)Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles,
California, USA zahir.basrai@va.gov.
(2)Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles,
California, USA.
(3)David Geffen School of Medicine, Los Angeles, California, USA.
A 54-year-old man with a history of schizophrenia presented to the emergency room
for weakness with associated lacrimosis, drooling, nausea, emesis, diarrhoea,
diplopia and burning sensation on his skin that began 6 hours after spraying five
cans of Raid on his carpet. He was noted to have miotic pupils and hyperactive
bowel sounds. Given the clinical presentation, the patient was diagnosed with
organophosphate (OP) toxicity. After being admitted, he developed symptoms
associated with his OP toxicity and was successfully treated with atropine and
pralidoxime. Most Raid products contain pyrethroids; however, both OPs and
pyrethroids are available in commercial pesticides and patients may misidentify
ingestions. There are limited data reporting the toxicity of pyrethroid overdose
in humans and to guide its subsequent treatment. It is crucial to keep a low
threshold for diagnosing and treating patients with acute onset of symptoms
suspicious for an OP or pyrethroid toxidrome.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and
permissions. Published by BMJ.
DOI: 10.1136/bcr-2019-230966
PMID: 31753823 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
32. BMJ Case Rep. 2019 Nov 19;12(11). pii: e232791. doi: 10.1136/bcr-2019-232791.
Impressive bullous reaction to mosquito bites.
Mai S(1), Mansouri S(2), Ismaili N(1), Senouci K(1).
Author information:
(1)Dermatology, Chu Ibn Sina, Rabat, Morocco.
(2)Dermatology, Chu Ibn Sina, Rabat, Morocco siham-mnsr@hotmail.fr.
DOI: 10.1136/bcr-2019-232791
PMID: 31748373 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
33. Presse Med. 2019 Nov;48(11 Pt 1):1353-1354. doi: 10.1016/j.lpm.2019.09.002. Epub
2019 Nov 11.
Multiple eruptive dermatofibromas.
Zaouak A(1), Chamli A(2), Khanchel F(3), Hammami H(2), Fenniche S(2).
Author information:
(1)Habib Thameur Hospital, Research Unit "Genodermatoses and cancers LR12SP03",
dermatology department, Tunis, Tunisia. Electronic address:
anissa84zaouak@gmail.com.
(2)Habib Thameur Hospital, Research Unit "Genodermatoses and cancers LR12SP03",
dermatology department, Tunis, Tunisia.
(3)Habib Thameur Hospital, Research Unit "Genodermatoses and cancers LR12SP03",
anatomopathology department, Tunis, Tunisia.
DOI: 10.1016/j.lpm.2019.09.002
PMID: 31727483 [Indexed for MEDLINE]
34. BMJ Case Rep. 2019 Nov 12;12(11). pii: e229946. doi: 10.1136/bcr-2019-229946.
Unexpected neurologic complications following a novel lymphoma treatment
'expected' to give rise to neurologic toxicity.
Kersten MJ(1), van Ettekoven CN(2), Heijink DM(3).
Author information:
(1)Department of Haematology, Amsterdam UMC, University of Amsterdam, Cancer
Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam,
The Netherlands.
(2)Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam,
The Netherlands.
(3)Department of Haematology, Amsterdam UMC, Vrije Universiteit, Cancer Center
Amsterdam, Amsterdam, The Netherlands.
Chimeric antigen receptor (CAR) T-cell therapy is a novel and promising form of
cellular immunotherapy using genetically engineered, tumour-specific autologous T
cells. CD19-specific CAR T-cells have been shown to be very effective as a
treatment for relapsed/refractory B-cell acute lymphoblastic leukaemia and
aggressive B-cell non-Hodgkin's lymphoma. ICANS (immune effector cell-associated
neurotoxicity syndrome) is one of the most frequently occurring toxicities of CAR
T-cell treatment. We describe two cases of patients with neurologic symptoms
following CAR T-cell infusion who were suspected to have ICANS, but in fact had
cerebral toxoplasmosis and venous sinus thrombosis respectively. The focus on CRS
and ICANS after CAR T-cell infusion may lead to less vigilance to the 'normal'
threats faced by intensively pretreated patients with lymphoma such as infections
and thrombosis. Both cases underscore the importance of a broad and thorough
examination of patients if they experience neurologic symptoms after CAR T-cell
treatment.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and
permissions. Published by BMJ.
DOI: 10.1136/bcr-2019-229946
PMID: 31722870 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: MJ Kersten has received
travel support and honoraria for attending advisory boards and presentations for
Kite/Gilead and Novartis. The other authors declare no competing interests.
35. Nihon Shokakibyo Gakkai Zasshi. 2019;116(11):944-951. doi:
10.11405/nisshoshi.116.944.
[Liver injury caused by exposure to silica and 2,2-dichloro-1,1,1-trifluoroethane
(HCFC-123):a case report].
[Article in Japanese]
Fukushima H(1), Kubo Y(1), Matsugaki S(1), Sakemi R(1), Sakakibara S(1),
Morimitsu Y(2).
Author information:
(1)Department of Gastroenterology, Tobata Kyoritsu Hospital.
(2)Division of Pathology, Tobata Kyoritsu Hospital.
This case report presents two males with drug-induced liver injury acquired from
working at a glass factory dealing with silica and
2,2-dichloro-1,1,1-trifluoroethane (HCFC-123). Within one month of work, both
patients presented with fever, icterus with liver dysfunction, and eosinophilia.
Case 1 had experienced recurrence of symptoms twice while working and showed
positive results for the drug-induced lymphocyte stimulation test (DLST).
Meanwhile, case 2 was diagnosed by liver biopsy and clinical course but was
negative for DLST. Hazard of exposure to non-crystalline silica is low, but
drug-induced liver injury after exposure to HCFC-123 has been reported. Allergic
liver injury is also caused by chemical substances;however, the insight into
whether this injury is caused by exposure to silica or HCFC-123 remains unclear.
Further studies are required to examine the influence of silica and HCFC-123 on
drug-induced liver injury among glass-factory employees.
DOI: 10.11405/nisshoshi.116.944
PMID: 31708507 [Indexed for MEDLINE]
36. Wilderness Environ Med. 2019 Dec;30(4):446-449. doi: 10.1016/j.wem.2019.06.015.
Epub 2019 Nov 5.
Presumed Copperhead Snakebite and Antivenom Administration in the Third
Trimester.
Yano J(1), Zerden M(2), German B(3).
Author information:
(1)Family Medicine, WakeMed Health & Hospitals, Raleigh, NC. Electronic address:
jessica.yano@pihhealth.org.
(2)Family Medicine, WakeMed Health & Hospitals, Raleigh, NC.
(3)Emergency Medicine, WakeMed Health & Hospitals, Raleigh, NC.
Snake envenomation during pregnancy is an uncommon emergency with several
potential complications associated with the poisoning and its treatment. This
case discusses a 27-y-old gravida 3, para 1102 (3 total pregnancies, 1 term
birth, 1 premature birth, 0 abortions, 2 living births, twins) at 36 wk gestation
who was bitten by a presumed Agkistrodon contortrix (copperhead snake). She had
worsening pain and swelling in the right lower limb. Crotalidae polyvalent immune
Fab was administered. The patient felt significantly better with improvement in
swelling. She had a reactive nonstress test and reassuring coagulation studies.
She gave birth to a healthy female infant 12 d later. This case supports the use
of Crotalidae polyvalent immune Fab for venomous snakebites in pregnant patients
to prevent possible maternal and fetal morbidity and mortality.
Copyright © 2019 Marketing EDGE.org. Published by Elsevier Inc. All rights
reserved.
DOI: 10.1016/j.wem.2019.06.015
PMID: 31699647 [Indexed for MEDLINE]
37. MMWR Morb Mortal Wkly Rep. 2019 Nov 8;68(44):1008-1009. doi:
10.15585/mmwr.mm6844a3.
Notes from the Field: Botulism Type E After Consumption of Salt-Cured Fish - New
Jersey, 2018.
Ganapathiraju PV, Gharpure R, Thomas D, Millet N, Gurrieri D, Chatham-Stephens K,
Dykes J, Luquez C, Dinavahi P, Ganapathiraju S, Roger S, Abbasi D, Higgins N,
Loftus F, Trivedi M.
DOI: 10.15585/mmwr.mm6844a3
PMCID: PMC6837475
PMID: 31697653 [Indexed for MEDLINE]
Conflict of interest statement: All authors have completed and submitted the
International Committee of Medical Journal Editors form for disclosure of
potential conflicts of interest. No potential conflicts of interest were
disclosed.
38. Trop Doct. 2020 Jan;50(1):83-84. doi: 10.1177/0049475519884419. Epub 2019 Nov 6.
Broken thermometer in foot: a source of mercury poisoning.
Erfantalab P(1), Zamani N(1)(2), Hassanian-Moghaddam H(2)(3).
Author information:
(1)Assistant Professor, Department of Clinical Toxicology, Loghman Hakim
Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran.
(2)Social Determinants of Health Research Center, Shahid Beheshti University of
Medical Sciences, Tehran, Iran.
(3)Associate Professor, Department of Clinical Toxicology, Loghman Hakim
Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran.
A 17-year-old boy was referred after jumping from a ladder onto the ground,
crushing a medical thermometer with his right foot. Some days later, he
complained of loss of appetite and weakness. A radiograph of the affected foot
demonstrated radiopaque densities. Blood and 24-h urine assays for mercury
demonstrated toxic levels. Chelation therapy cured the patient dramatically.
DOI: 10.1177/0049475519884419
PMID: 31694474 [Indexed for MEDLINE]
39. J Med Case Rep. 2019 Nov 5;13(1):327. doi: 10.1186/s13256-019-2234-1.
Heroin overdose masquerades as methomyl poisoning: a case report.
Amornlertwatana Y(1), Narongchai P(2), Narongchai S(1).
Author information:
(1)Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University,
Chiang Mai, 50200, Thailand.
(2)Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University,
Chiang Mai, 50200, Thailand. paitoon.narongchai@cmu.ac.th.
BACKGROUND: Methomyl is the most common cause of suicidal death but heroin is the
most common cause of accidental death. The problem is to determine the exact
cause and manner of death between methomyl or heroin toxicity. The evidence from
autopsy includes crime scene investigation, toxicological analysis by liquid
chromatography with mass spectrometry, and knowledge of methomyl and heroin
intoxication.
CASE PRESENTATION: A 35-year-old Thai man and a 30-year-old Thai woman were found
showing evidence of cyanosis, with a fine froth around the nose and mouth.
Postmortem interval time was 24 hours. According to the police's and hotel
owner's records, the couple stayed together for 1 day before being found dead in
bed, naked, with a foul and a fine froth around the nose and mouth. A methomyl
insecticide sachet and a plastic box containing white powder form of heroin were
found at the scene. Laboratory tests of the male corpse identified the presence
of methomyl in the blood of the stomach and morphine, codeine, methadone, and
tramadol in the systemic blood. Blood cholinesterase enzyme activity and morphine
concentration was 3416 U/L or 53% (normal 6400 U/L) and 0.058 μg/ml respectively.
Laboratory test of the female corpse identified the presence of methomyl in the
stomach and blood, and cholinesterase enzyme activity was 1965 U/L or 30.7%.
CONCLUSIONS: Cause of death of the male corpse was deemed to be due to heroin
intoxication as the blood concentration of morphine was more than the lethal
concentration with a morphine/codeine ratio of more than 1:1. Methomyl
intoxication of the male corpse was unlikely to be the cause of death because
methomyl systemic blood concentration was found to be very low, < 2.5 μg/ml, and
cholinesterase enzyme levels did not indicate lethal activity (< 10-15% of
normal). The main problem regarding an insurance claim is that the policy will
not pay out in the case of heroin-associated deaths, as it is an addictive drug.
The policy would pay out on death by suicide with methomyl insecticide, which was
not prohibited by the insurance company after 1 year of insurance. So, it is not
clear whether or not the family will receive money from the insurance company.
DOI: 10.1186/s13256-019-2234-1
PMCID: PMC6829933
PMID: 31690350 [Indexed for MEDLINE]
40. Int J Infect Dis. 2020 Jan;90:167-169. doi: 10.1016/j.ijid.2019.10.042. Epub 2019
Nov 2.
A rickettsia infection from Saudi Arabia.
Elzein FE(1), Aloteibi M(2), Alanazi W(2), Alsaeed M(3), Almaghaslah M(3).
Author information:
(1)Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh,
Saudi Arabia. Electronic address: fatehielzein@gmail.com.
(2)Department of Neurology, PSMMC, Riyadh, Saudi Arabia.
(3)Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh,
Saudi Arabia.
We here present a young patient who developed fever, headache, maculopapular skin
rash and an eschar 3 days following a tick bite. Serology for Rickettsia was
consistent with acute spotted fever group (SFG) infection. He had a dramatic
response to doxycycline. Vectors for rickettsia transmission are shown in a
number of studies from Saudi Arabia while human serological studies from Oman
revealed that these infections are common among the rural population.
Surprisingly, despite the existence of potential vectors, this disease is rarely
reported from the Arab Gulf countries. To the best of our knowledge this is the
first case report of SFG acquired within Saudi Arabia. SFG should be considered
in the differential diagnosis of febrile illness and exposure history.
Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.
DOI: 10.1016/j.ijid.2019.10.042
PMID: 31689527 [Indexed for MEDLINE]
41. J Clin Psychopharmacol. 2019 Nov/Dec;39(6):677-678. doi:
10.1097/JCP.0000000000001119.
Severe Extrapyramidal Symptoms in a Patient with Niemann-Pick Type C Disease
After a Long-Acting Injection of Risperidone.
Fuchs PA(1), Isaacs DA, Schiff M, Miller L, Stovall J.
Author information:
(1)Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
paul.a.fuchs@vumc.org Department of Neurology, Vanderbilt University Medical
Center, Nashville, TN Department of Psychiatry, Vanderbilt University Medical
Center, Nashville, TN Department of Pharmacy Practice, Lipscomb University
College of Pharmacy, Nashville, TN and Department of Pharmaceutical Services,
Vanderbilt University Medical Center, Nashville, TN Department of Psychiatry,
Vanderbilt University Medical Center, Nashville, TN.
DOI: 10.1097/JCP.0000000000001119
PMID: 31688387 [Indexed for MEDLINE]
42. Adv Emerg Nurs J. 2019 Oct/Dec;41(4):316-321. doi: 10.1097/TME.0000000000000266.
Encephalopathic Presentation of West Nile Virus Neuroinvasive Disease Confounded
by Concomitant History of Acute Alcohol Withdrawal.
Profita A(1), Haglund K.
Author information:
(1)Medical College of Wisconsin, Milwaukee (Dr Profita); College of Nursing,
Marquette University, Milwaukee, Wisconsin (Dr Haglund); and Froedtert & Medical
College of Wisconsin, Milwaukee (Dr Haglund).
West Nile neuroinvasive disease (WNND) is a rare and severe manifestation of West
Nile virus (WNV) infection that occurs in less than 1% of infected persons. It
should be considered in patients who present with fever, neurological symptoms,
and a history of recent outdoor activity where mosquitoes were active. This
article highlights a case of a 55-year-old man whose history and symptoms of WNND
were confounded with an alternate diagnosis, acute alcohol withdrawal. An
overview of WNV infections, and important historical clues and objective findings
characteristic of neuroinvasive disease, is discussed to increase readers'
knowledge of WNV and awareness of when to consider WNND in the diagnostic
differential.
DOI: 10.1097/TME.0000000000000266
PMID: 31687995 [Indexed for MEDLINE]
43. Tidsskr Nor Laegeforen. 2019 Oct 30;139(16). doi: 10.4045/tidsskr.18.0987. Print
2019 Nov 5.
A woman in her fifties with trismus and muscle spasms.
[Article in English, Norwegian]
Olsen BC, Stubhaug TT, Berild JD.
DOI: 10.4045/tidsskr.18.0987
PMID: 31686491 [Indexed for MEDLINE]
44. J Med Case Rep. 2019 Nov 4;13(1):326. doi: 10.1186/s13256-019-2260-z.
Eucalyptus oil poisoning: two case reports.
Ittyachen AM(1), George GR(2), Radhakrishnan M(2), Joy Y(2).
Author information:
(1)Department of Medicine, M.O.S.C Medical College & Hospital, Kolenchery,
Ernakulam District, Kerala State - 682311, India. abyliz@rediffmail.com.
(2)Department of Medicine, M.O.S.C Medical College & Hospital, Kolenchery,
Ernakulam District, Kerala State - 682311, India.
BACKGROUND: Eucalyptus oil poisoning is rare in adults but is not that uncommon
in children. The common side effects in children include depression in the level
of consciousness, ataxia, seizures, and vomiting. Unlike in children, seizures
are unusual in adult patients with eucalyptus oil poisoning. We report the cases
of two patients with eucalyptus oil poisoning, both adults who unintentionally
took eucalyptus oil and presented to the emergency room of our institution with
seizures.
CASE PRESENTATION: Two adult Indian men who unintentionally consumed eucalyptus
oil presented to the emergency room of our institution with seizures. In both
patients, arterial blood gas analysis showed the presence of severe metabolic
acidosis. Both the patients were managed in the intensive care unit and received
standard supportive care. Metabolic acidosis was corrected with intravenous
bicarbonate infusion. They were successfully discharged on the fourth day.
CONCLUSIONS: All physicians should be aware of the toxic effects of eucalyptus
oil, which is used often in daily life in India. Supportive care in an intensive
care unit, including rapid correction of metabolic acidosis and adequate
maintenance of hemodynamic parameters, will lead to a rapid recovery. Warning
labels should be made mandatory on all products that contain eucalyptus oil.
DOI: 10.1186/s13256-019-2260-z
PMCID: PMC6827225
PMID: 31685016 [Indexed for MEDLINE]
45. BMC Infect Dis. 2019 Nov 4;19(1):927. doi: 10.1186/s12879-019-4492-3.
Infective endocarditis caused by Capnocytophaga canimorsus; a case report.
Sakai J(1)(2)(3), Imanaka K(4), Kodana M(5), Ohgane K(5), Sekine S(6), Yamamoto
K(2), Nishida Y(2), Kawamura T(5), Matsuoka T(4), Maesaki S(3), Oka H(2), Ohno
H(7).
Author information:
(1)Department of Infectious Disease and Infection Control, Saitama Medical
Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550,
Japan.
(2)Department of General Internal Medicine, Saitama Medical Center, Saitama
Medical University, Saitama, Japan.
(3)Department of Infectious Disease and Infection Control, Saitama Medical
University Hospital, Saitama Medical University, Saitama, Japan.
(4)Department of Cardiovascular Surgery, Saitama Medical Center, Saitama Medical
University, Saitama, Japan.
(5)Department of Laboratory Medicine, Saitama Medical University Hospital,
Saitama Medical Hospital, Saitama, Japan.
(6)Department of Clinical Laboratory, Saitama Medical Center, Saitama Medical
University, Saitama, Japan.
(7)Department of Infectious Disease and Infection Control, Saitama Medical
Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550,
Japan. hohno@saitama-med.ac.jp.
BACKGROUND: Capnocytophaga canimorsus is a gram-negative bacterium and an oral
commensal in dogs and cats, but occasionally causes serious infections in humans.
Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus
infection is often difficult mainly because of its very slow growth. C.
canimorsus infective endocarditis (IE) is rare and is poorly understood. Since
quite a few strains produce β-lactamase, antimicrobial susceptibility is pivotal
information for adequate treatment. We herein report a case with C. canimorsus IE
and the results of drug susceptibility test.
CASE PRESENTATION: A 46-year-old man had a dog bite in his left hand 3 months
previously. The patient was referred to our hospital for fever (body
temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed
aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and
we initially administered cefazolin and gentamycin assuming frequently
encountered microorganisms and the patient underwent aortic valve replacement. C.
canimorsus was detected in the aortic valve lesion and blood cultures. It was
also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and
continued because disk diffusion test revealed the isolate was negative for
β-lactamase and this case had cerebral symptoms. The patient successfully
completed antibiotic treatment following surgery.
CONCLUSIONS: We diagnosed C. canimorsus sepsis and IE by extended-period blood
cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and
successfully identified its drug susceptibility.
DOI: 10.1186/s12879-019-4492-3
PMCID: PMC6827180
PMID: 31684875 [Indexed for MEDLINE]
46. Undersea Hyperb Med. 2019 Sep - Dec - Fourth Quarter;46(5):719-722.
Toxic inoculation associated with a presumptive stingray injury.
Do R(1), Lu LQ(2), Strauss MB(1).
Author information:
(1)Long Beach Memorial Medical Center.
(2)VA Tibor Rubin Medical Center at Long Beach.
Introduction: Stingray spine injuries are among the most common marine animal
injuries in humans. While most resolve with immersion in warm water, a few become
infected and require antibiotics. We present a case report of a presumptive
stingray injury that evolved to a major slough and which required prolonged
healing in a patient with diabetes mellitus. Our literature review was unable to
find a similarly reported case.
Materials: A co-author was asked to evaluate and manage an ominous-appearing
wound on the right foot of a diabetic. The problem developed after the individual
had been wading in shallow ocean beach water. The patient's diabetic sensory
neuropathy obscured the immediate association of the problem with a stingray
injury, but this became the presumptive diagnosis when pain developed and
necessitated that he seek medical care.
Findings/Clinical Course: After an initial urgent care visit, increasing pain and
worsening appearance of the patient's foot necessitated a visit to our emergency
department. The patient was admitted the next day due to symptoms of systemic
sepsis. On the fourth hospital day, a large bulla on the lateral side of the
right foot was excised. This unroofed a full-thickness slough to the periosteum
level of the underlying bones. Not until the 16th hospital day had enough
improvement occurred to discharge the patient. Over the next 16 weeks, the wound
improved, developed a vascular base and epithelialized.
Conclusion: With a dearth of literature about stingray injuries in patients with
diabetes mellitus reported, our case is unique: The patient's wound course more
closely resembled a toxic inoculation than the typical puncture wound-cellulitis
presentations associated with stingray injuries.
Copyright© Undersea and Hyperbaric Medical Society.
PMID: 31683373 [Indexed for MEDLINE]
Conflict of interest statement: The authors of this paper declare no conflicts of
interest exist with this submission.
47. Am J Trop Med Hyg. 2019 Dec;101(6):1442-1445. doi: 10.4269/ajtmh.19-0611.
Case Report: Spherocytic Hemolytic Anemia after Envenomation by Long-Nosed Viper
(Vipera ammodytes).
Liapis K(1), Charitaki E(2), Psaroulaki A(3).
Author information:
(1)Department of Clinical Hematology, Georgios Gennimatas Hospital, Athens,
Greece.
(2)Department of Nephrology, Aghios Georgios Hospital, Chania, Greece.
(3)Department of Clinical Microbiology and Microbial Pathogenesis, Unit of
Zoonoses and Geographic Medicine, School of Medicine, University of Crete,
Heraklion, Greece.
Snakebite envenoming is a major health issue in many parts of the world,
especially in rural areas. Vipera ammodytes is the commonest cause of snakebite
in Greece. We report our experience with a patient bitten by such a snake, who
developed massive intravascular hemolysis characterized by a spherocytic rather
than microangiopathic hemolytic picture. This case illustrates the potential of
snakebite envenoming to cause spherocytic hemolytic anemia associated with
hemoglobinuria and acute renal failure, and represents the first report of V.
ammodytes in this context. Another important point is that antivenom was rapidly
effective in reversing spherocytic hemolytic anemia, even though several hours
had elapsed since the bite.
DOI: 10.4269/ajtmh.19-0611
PMCID: PMC6896858 [Available on 2020-12-01]
PMID: 31674297 [Indexed for MEDLINE]
48. Wilderness Environ Med. 2019 Dec;30(4):454-460. doi: 10.1016/j.wem.2019.08.002.
Epub 2019 Oct 28.
Intestinal Evisceration in Children From the Bite of the Domestic Pig, Sus scrofa
domesticus: A Report of Two Cases.
Mazingi DS(1), Mutambanengwe P(2), Zimunhu T(3), Gwatirisa T(3), Mbuwayesango
BA(3), Munanzvi K(2), Muparadzi C(2), Moyo M(2), Mwanza Y(2).
Author information:
(1)College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital,
Avondale, Harare, Zimbabwe. Electronic address: dennis.mazingi@gmail.com.
(2)College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital,
Avondale, Harare, Zimbabwe.
(3)College of Health Sciences, University of Zimbabwe, Parirenyatwa Hospital,
Avondale, Harare, Zimbabwe; College of Surgeons of East Central and Southern
Africa, Arusha, Tanzania.
Pig bite injuries are an infrequently described consequence of human-animal
conflict. The domestic pig is thought to be a placid animal not given to
unprovoked aggression. We report 2 separate cases of children managed at our
institution who sustained abdominal injuries after attack by domestic pigs in
rural Zimbabwe. Both incidents occurred at home in remote rural areas with long
prehospital transport times. Initial resuscitative interventions were performed
in both cases in the prehospital setting and at poorly resourced peripheral
hospitals before referral. Prophylactic antibiotics were also given in both
cases. Laparotomy was performed for both patients. Reduction of eviscerated
bowel, exploratory laparotomy, and peritoneal lavage were performed with closure
of the abdominal wounds. No surgical site infections were encountered, and
patients were subsequently discharged after an uneventful convalescence.
Prehospital care is the crucial phase of management of these injuries, which
frequently take place in remote, rural settings and usually have a long time to
definitive intervention. Expeditious laparotomy and exploration are indicated, as
well as meticulous attention to techniques to avert infectious complications.
Despite the generally placid temperament of the domestic pig, their bite can
result in grave injuries, including abdominal evisceration necessitating prompt
referral and emergency laparotomy.
Copyright © 2019 Marketing EDGE.org. Published by Elsevier Inc. All rights
reserved.
DOI: 10.1016/j.wem.2019.08.002
PMID: 31672510 [Indexed for MEDLINE]
49. Ann Emerg Med. 2019 Nov;74(5):727-728. doi: 10.1016/j.annemergmed.2019.06.002.
Inhalational Methanol Intoxication: Emerging Issues in the Netherlands Resulting
From Illegal Drug Production.
Wijnands-Kleukers APG(1), Dijkman W(2), Brogtrop J(3), Kamps MJA(4), De Lange
DW(5), Sikma MA(5).
Author information:
(1)Dutch Poisons Information Center (DPIC), University Medical Center Utrecht,
University Utrecht, Utrecht, the Netherlands.
(2)Intensive Care Center, Máxima Medical Center, Veldhoven, the Netherlands.
(3)Department of Clinical Pharmacy, Máxima Medical Center, Veldhoven, the
Netherlands.
(4)Intensive Care Catharina Hospital, Eindhoven, the Netherlands.
(5)Dutch Poisons Information Center (DPIC), University Medical Center Utrecht,
University Utrecht, Utrecht, The Netherlands; Intensive Care, University Medical
Center Utrecht, Utrecht, the Netherlands.
DOI: 10.1016/j.annemergmed.2019.06.002
PMID: 31668249 [Indexed for MEDLINE]
50. BMJ Case Rep. 2019 Oct 30;12(10). pii: e231771. doi: 10.1136/bcr-2019-231771.
Severe hypercalcaemia due to household cleaner ingestion.
Satyarengga M(1), Silver KD(2).
Author information:
(1)Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition,
University of Maryland School of Medicine, Baltimore, Maryland, USA
satyarengga@gmail.com.
(2)Department of Medicine, Division of Endocrinology, Diabetes, and Nutrition,
University of Maryland School of Medicine, Baltimore, Maryland, USA.
We report the case of a 59-year-old man with a history of type 2 diabetes,
hypertension and chronic kidney disease who presented with symptomatic severe
hypercalcaemia (calcium 15.8 mg/dL) and acute kidney injury. Evaluation revealed
that the hypercalcaemia was not mediated by parathyroid hormone (PTH),
PTH-related peptide or 1,25-hydroxyvitamin D. Adrenal insufficiency was
subsequently diagnosed and was initially thought to be the aetiology of the
hypercalcaemia. He was treated with intravenous fluid, pamidronate and started on
hydrocortisone with resolution of his hypercalcaemia. Over the next several
months, despite adherence to hydrocortisone therapy, the patient continued to
have recurrent severe hypercalcaemia requiring hospitalisation. Additional
laboratory evaluation showed similar results to the initial evaluation. On
further questioning, the patient admitted to routinely ingesting the household
cleaning product Comet, which contains a large amount of calcium. Psychiatric
assessment confirmed the diagnosis of pica. The patient eventually discontinued
ingestion of Comet with resolution of his hypercalcaemia.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and
permissions. Published by BMJ.
DOI: 10.1136/bcr-2019-231771
PMID: 31666255 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.