1/5. esomeprazole-induced central fever with severe myalgia.OBJECTIVE: To report a case of central fever associated with severe myalgia following esomeprazole. CASE SUMMARY: A 64-year-old man presented with intense cephalalgia; severe, diffuse myalgia; and fever (>40 degrees C) after esomeprazole initiation for treatment of gastritis. Five hours after ingestion of the first esomeprazole pill (40 mg), the patient developed fever associated with cephalalgia and myalgia. This condition lasted about 40 hours and disappeared spontaneously. Symptoms partially responded to acetaminophen. Four days later, the patient received a second dose of esomeprazole 40 mg. Subsequently, 4 hours later, fever (>40 degrees C), headache, and difficulty in the movement of all parts of the body recurred. neurologic examination was negative except for a minor state of disorientation. All reflexes were normal or slightly decreased. No skin lesions or breathing difficulty was noted. Routine blood tests were normal. Again, symptoms resolved spontaneously about 40 hours later. DISCUSSION: The temporal connection between esomeprazole intake and the onset of fever suggests a probable causal link, as confirmed by the Naranjo probability scale. However, the pathogenic mechanism remains unclear. Considering that esomeprazole is able to cross the blood-brain barrier, its peak serum concentration is reached 90-180 minutes after oral administration, and its serum half-life is approximately 2 hours, we assume that the appearance of fever with accompanying neurologic and muscular symptoms might result from the drug interference with the hypothalamic regulatory center of body temperature. CONCLUSIONS: Hyperpyrexia of central origin associated with intense cephalalgia and myalgia may occur as an adverse effect of esomeprazole therapy.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
2/5. Actinomycotic suppurative thyroiditis in a child.AIM: To present a rare case of actinomycotic suppurative thyroiditis in an infant with provision of the etiology, pathogenesis, clinical findings and treatment of this rare disease. DESIGN: A report of an 18-month-old female infant who presented with fever, erythema, induration and tenderness of the neck. The patient had the diagnosis of acute suppurative thyroiditis after a series of laboratory evaluation. RESULT: She was treated successfully with surgical debridement and intravenous penicillin g. CONCLUSION: Although rare, actinomyces spp. should be considered in the etiology of acute suppurative thyroiditis. Because of its fastidious nature the probability of positive culture is low, thus, the microbiology laboratory should be called in advance to make preparations before culture and transport.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
3/5. Temperature-dependent double spikes in C-nociceptors of neuropathic pain patients.Five patients with small-fibre neuropathy characterized by temperature-dependent spontaneous pain, hyperalgesia/allodynia and signs of neurogenic inflammation were studied clinically and thermographically, and by microneurography. thermography revealed hyperthermia confined to painful and hyperalgesic skin of distal extremities, in absence of sympathetic vasomotor denervation. Quantitative sensory testing documented either reduced thresholds or increased suprathreshold magnitude for heat pain. Microneurography identified 13 primary cutaneous C-nociceptors generating abnormal impulses in response to electrical stimuli and, in one patient, nociceptors firing spontaneously. All five patients showed examples of double spikes, in which a single brief electrical stimulus occasionally or regularly evoked two impulses. In one case, a second impulse occurred at one of three different delays. In all five patients, warming of the skin increased the probability of a second impulse occurring. Impulse doubling has previously been reported as occurring rarely in normal subjects and is attributable to unfiltering of multiple orthodromic impulses due to unidirectional conduction failure at branch points. A higher incidence of double firing in neuropathic pain patients is probably due to a reduced safety factor for conduction in the terminal arborizations of their C-nociceptors. These observations show that unidirectional conduction block provides a peripheral mechanism of temperature-dependent nociceptor hyperactivity in small-fibre neuropathy that may contribute to hyperalgesia.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
4/5. serum sickness-like reaction associated with cefazolin.BACKGROUND: Although rare, serum sickness-like reactions have been documented to occur following the administration of many antibiotics. cefazolin, a first generation cephalosporin, is a commonly prescribed antibiotic which is considered to be generally safe and well tolerated. There have been no prior reports linking this drug with sickness-like reactions. We report a probable case of serum sickness-like reaction following a single dose of cefazolin. CASE PRESENTATION: A 23 year old man with no significant past medical history was admitted to undergo a laparoscopic donor nephrectomy as part of a living-related renal transplant. One gram of intravenous cefazolin was administered perioperatively. The surgery was completed without complication and the remainder of his hospital course was uneventful. Ten days following discharge the patient developed fevers, painful and swollen joints, and a cutaneous eruption overlying his trunk and extremities. There was no evidence of systemic vasculitis. These clinical findings were most consistent with a serum sickness-like reaction. A brief course of corticosteroids and antihistaminergic therapy was initiated, and complete resolution of the patient's symptoms followed. The Naranjo probability scale indicated that this adverse drug event was probable. CONCLUSION: serum sickness-like reaction may be associated with cefazolin therapy.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |
5/5. The use of antithymocyte globulin in the treatment of severe aplastic anemia in children.The benefit of antithymocyte globulin in severe aplastic anemia in the pediatric age group was assessed. Four children received ten alternate-day courses of ATG (horse antihuman thymocyte globulin) as well as antihistamines and corticosteroids to minimize allergic reactions. The outcome of 19 other children with severe aplastic anemia who received ATG was also summarized. Combined data reveal that 12 of 23 have had a complete or partial response with residual thrombocytopenia and a probability of 48% survival one year from the start of ATG therapy as projected by life table analysis. Only one death has been recorded in the responding group. Response rate did not appear to be influenced by age, sex, etiology, initial blood count, interval prior to ATG therapy, or dose of ATG employed. Complications were minimal and included minor urticarial reactions and intermittent fever. Therapy with ATG should be considered in childhood severe aplastic anemia when bone marrow transplantation is not possible.- - - - - - - - - - ranking = 1keywords = probability (Clic here for more details about this article) |