1/232. Vancomycin-induced neutropenia associated with fever: similarities between two immune-mediated drug reactions.A 39-year-old woman being treated for osteomyelitis with vancomycin developed severe neutropenia and drug fever. After she discontinued therapy, both disorders quickly resolved. These adverse reactions have rarely been reported with vancomycin, and share many similarities with regard to clinical features and postulated mechanisms of induction. To our knowledge this is the first case documenting drug fever as a principal component of vancomycin-induced neutropenia, and provides further evidence in support of an immune-mediated mechanism.- - - - - - - - - - ranking = 1keywords = reaction (Clic here for more details about this article) |
2/232. Jarisch-Herxheimer reaction. Case report.The Jarisch-Herxheimer reaction is a response to the treatment of syphilis. The most common findings are fever, malaise, headache, and exacerbation of cutaneous lesions. The reaction is thought to be due to the effects of treponema breakdown products, and it should not be confused with an allergic reaction to the antibiotic employed. Thus, further therapy must not be withheld. Treatment is symptomatic.- - - - - - - - - - ranking = 1.4keywords = reaction (Clic here for more details about this article) |
3/232. Management of neuroleptic malignant syndrome with anticholinergic medication.neuroleptic malignant syndrome (NMS) is a life-threatening adverse reaction arising from the use of neuroleptic medications. While dopaminergic agonists, dantrolrene and supportive care are traditionally utilized in the stabilization and management of NMS, anticholinergic medication may also prove effective therapy. Treatment with anticholinergic medication has been suggested in cases of NMS associated with mild hyperthermia. We describe a case of 17-y-old female, who was brought to the emergency department for a possible "acute dystonic reaction". The patient received 50 mg diphenhydramine i.v., which resulted in improvement in mental status. The patient was readmitted to the emergency department 1 d following discharge with symptoms similar, but now considering the diagnosis of NMS. diphenhydramine 50 mg i.v. was again administered and resulted in significant improvement.- - - - - - - - - - ranking = 0.4keywords = reaction (Clic here for more details about this article) |
4/232. Subclinical syphilitic hepatitis, which was markedly worsened by a Jarisch-Herxheimer reaction.Early syphilitic hepatitis is uncommon and tends to be overlooked. However, the diagnosis of this disease is important, because appropriate treatment results in rapid resolution of the hepatitis. We report a case of subclinical early syphilitic hepatitis exaggerated by a Jarisch-Herxheimer reaction. This reaction helped to realize the diagnosis in this case.- - - - - - - - - - ranking = 1.2keywords = reaction (Clic here for more details about this article) |
5/232. Delayed hemolytic transfusion reaction presenting as a painful crisis in a patient with sickle cell anemia.CONTEXT: patients with sickle cell anemia (SCA) are frequently transfused with red blood cells (RBC). Recently we reported that the calculated risk of RBC alloimmunization per transfussed unit in Brazilian patients with SCA is 1.15%. We describe a delayed hemolytic transfusion reaction (DHTR) presenting as a painful crisis in a patient with SCA. CASE REPORT: A 35-year-old Brazilian female with homozygous SCA was admitted for a program of partial exchange transfusion prior to cholecystectomy. Her blood group was O RhD positive and no atypical RBC alloantibody was detected using the indirect antiglobulin technique. Pre-transfusional hemoglobin (Hb) was 8.7 g/dL and isovolumic partial exchange transfusion was performed using 4 units of ABO compatible packed RBC. Five days after the last transfusion she developed generalized joint pain and fever of 39 degrees C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirrubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria. Hemoglobin electrophoresis showed 48.7% HbS, 46.6% HbA1, 2.7% HbA2, and 2.0% HbF. The patient's extended RBC phenotype was CDe, K-k , Kp(a-b ), Fy(a-b-), M N s , Le(a b-), Di(a-). An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384) was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient was discharged, asymptomatic, 7 days after admission.- - - - - - - - - - ranking = 1keywords = reaction (Clic here for more details about this article) |
6/232. What is the cause of a rash after measles-mumps-rubella vaccination?Surveillance and laboratory confirmation of measles will increase in importance as australia implements enhanced measles control. We describe a 17-month-old child with fever and rash after measles-mumps-rubella vaccination. Detection of vaccine-strain measles virus in his urine by polymerase chain reaction confirmed the diagnosis of a vaccine reaction rather than wild-type measles. We propose that measles virus should be sought and identified as vaccine or wild-type virus when the relationship between vaccination and measles-like illness is uncertain.- - - - - - - - - - ranking = 0.4keywords = reaction (Clic here for more details about this article) |
7/232. life-threatening reaction to vancomycin given for noninfectious fever.OBJECTIVE: To report a case of vancomycin-induced anaphylaxis (or anaphylactoid reaction) in a patient with a fever of unrecognized noninfectious origin. CASE SUMMARY: An 83-year-old white man, who was a patient of the veterans Affairs Medical Center, developed a serious anaphylactic (or anaphylactoid) reaction while receiving intravenous vancomycin as empiric therapy for a nosocomial fever of unknown origin. The fever was subsequently proved to have been due to acute polyarticular gout rather than an infection. DISCUSSION: This patient developed respiratory distress and an increased serum troponin concentration, suggestive of a myocardial enzymatic leak as a result of vancomycin therapy. Vancomycin was given before the noninfectious cause of his fever was recognized. CONCLUSIONS: Even with cautious slow infusion, intravenous vancomycin can precipitate life-threatening infusion-related reactions in some patients. Because of this, and to reduce selective pressure for vancomycin resistance, sources of fever that do not require treatment with vancomycin should be diligently investigated prior to the institution of empiric vancomycin therapy in febrile patients, particularly when the past medical history is suggestive of an alternative diagnosis.- - - - - - - - - - ranking = 1.4keywords = reaction (Clic here for more details about this article) |
8/232. Postoperative inflammatory reactions of impregnated Dacron grafts.The clinical efficacy of Dacron grafts that are impregnated with collagen or gelatin has been well demonstrated, but inflammatory reactions during the first few postoperative weeks have been reported. We experienced two patients, an 87-year-old man with a reconstruction of an abdominal aorta and a 7-year-old boy with a reconstruction of aortic arch with a collagen-impregnated graft (Hemashield), who continued to demonstrate a high fever with a high serum level of c-reactive protein (CRP) and immunoglobin for more than 5 months. The body temperature, the white blood cell (WBC) counts, and the serum level of CRP were compared on the seventh and 14th postoperative day among the 37 patients who underwent a reconstruction of either a thoracic or abdominal aorta using the Hemashield graft (Hemashield group) and a nonimpregnated graft (control group) in our hospital. An elevation of body temperature above 38 degrees C was seen 29% of the patients in the Hemashield group and 0% in the control group. No significant differences were seen in the WBC counts, but the serum level of CRP was significantly higher on the 14th postoperative day in the Hemashield group. We should therefore pay careful attention to inflammatory reactions after the implantation of the impregnated grafts.- - - - - - - - - - ranking = 1.2keywords = reaction (Clic here for more details about this article) |
9/232. Shaking, chills, and rigors with once-daily gentamicin.A patient receiving once-daily gentamicin experienced shaking, chills, and rigors. This adverse reaction has occurred in patients around the country at many different institutions. Although the etiology is thought to be mediated by higher than normal endotoxin levels in one product, other possibilities must be explored.- - - - - - - - - - ranking = 0.2keywords = reaction (Clic here for more details about this article) |
10/232. Interferon therapy in multiple myeloma.A woman with multiple myeloma relapsed after 6 years of satisfactory tumor control with melphalan therapy. When progression then occurred, she was given exogenous human leukocyte interferon, 3 x 10(6) reference units twice daily i.m., as the sole therapy. Side-effects of the interferon therapy consisted of fever reactions and thrombocytopenia. One month after the initiation of interferon therapy there was 1) improvement of general health with less pain and tiredness, 2) reduction of the M-component, IgG-lambda, in the serum, and 3) a reduced plasma cell concentration in the bone marrow. After 5 months of interferon therapy tumor progression occurred despite continuous interferon treatment. At the same time, the tumor cells were less sensitive to interferon in in vitro tests than prior to interferon therapy. It is suggested that interferon therapy should be given as initial treatment to a few patients with multiple myeloma in a phase I trial.- - - - - - - - - - ranking = 0.2keywords = reaction (Clic here for more details about this article) |
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