1/6. Fever and rash in a 3-year-old girl: rocky mountain spotted fever.Initial symptoms of rocky mountain spotted fever (RMSF), a tick-borne illness caused by rickettsia rickettsii, are nonspecific and include headache, gastrointestinal disturbances, malaise, and myalgias, followed by fever and rash. The classic triad of fever, rash, and history of tick exposure is uncommon at presentation. Clinical manifestations of RMSF range from virtually asymptomatic to severe. Because of the potentially fatal outcome of RMSF, presumptive clinical diagnosis and empiric antimicrobial therapy can be critical. We present the case of a 3-year-old girl from new york State who presented with fever and rash.- - - - - - - - - - ranking = 1keywords = fatal outcome (Clic here for more details about this article) |
2/6. ethosuximide induced agranulocytosis.agranulocytosis caused by ethosuximide is extremely rare in children. Drug-induced agranulocytosis is an unexpected side effect of a drug, and delay in diagnosis of agranulocytosis can result in a fatal outcome. We experienced a case of a 16-month-old male infant with down syndrome in whom fever appeared 16 days after the start of administration of ethosuximide and then severe pneumonia developed. Results of a blood test on admission showed a decreased leukocyte count of 1700/microl, and a hemogram showed that there were no granulocytes. The erythrocyte and thrombocyte counts were within normal ranges. The results of a bone marrow aspiration test showed that there was no production of any types of granulocytes. The patient required mechanical ventilation due to deterioration in his pneumonia and complication with disseminated intravascular coagulation, but the neutrophilic leukocytes began to increase from the 8th day after discontinuation of ethosuximide administration and start of treatment with granulocyte colony-stimulating factor, and the patient survived. The mechanism of onset in this case is thought to have been immunologic. Careful attention should be given to this type of agranulocytosis because of its sudden onset at 1-2 weeks after the start of administration of the causal drug. A drug-induced lymphocyte stimulation test was useful for diagnosis in this case, showing a positive reaction only for ethosuximide.- - - - - - - - - - ranking = 1keywords = fatal outcome (Clic here for more details about this article) |
3/6. Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta with fatal outcome.Ulceronecrotic Mucha-Habermann disease is a severe, febrile form of pityriasis lichenoides et varioliformis acuta. The condition may sometimes have a fatal outcome, especially in elderly patients. In this paper, we are reporting on a 60-year-old male patient who suffered from the eruption of erythematous, haemorrhagic, ulceronecrotic papules accompanied by high temperature. Erosions and ulceronecrotic papules covered over 80% of his body. Three weeks after his admittance to our hospital, clinical signs resembling ileus together with the leucocytosis occurred. The patient was transferred to the department of internal medicine and later to the surgery department. The fulminant course of the disease could not be stopped, and the patient died of severe intestinal and colon gangrene caused by the massive thrombosis of superior mesenteric artery. Up to date, only 23 cases of this severe form of the disease have been reported, and even with the early recognition, fulminant course may lead to death.- - - - - - - - - - ranking = 5keywords = fatal outcome (Clic here for more details about this article) |
4/6. Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta.An unusually severe form of pityriasis lichenoides et varioliformis acuta (PLEVA) with a fatal outcome in an 82-year-old woman is reported. After a period of a mild eruption, extensive polymorphous, papular and ulcerohemorrhagic skin lesions developed, associated with intermittent high temperature and constitutional symptoms. skin biopsies showed the typical histopathological changes of PLEVA. Early recognition of this severe variant of PLEVA is important, since the fulminating course can lead to death.- - - - - - - - - - ranking = 1keywords = fatal outcome (Clic here for more details about this article) |
5/6. Toxic shock syndrome in transsphenoidal neurosurgery.An overlooked toxic shock syndrome (TSS) may lead to a fatal outcome. In neurosurgery a transsphenoidal approach with post-operative nasal tamponade may promote toxic shock syndrome without signs of local wound infection. By discussing the case history of a patient after hypophysectomy by the transsphenoidal route, we propose that after the appearance of the first signs of toxic shock syndrome, quick removal of the nasal tamponade is a life saving procedure.- - - - - - - - - - ranking = 1keywords = fatal outcome (Clic here for more details about this article) |
6/6. Acute segmental gastro-intestinal gangrene probably of clostridial origin. Report of a case.A 29-year-old female suffering from acute terminal ileitis was subjected to laparotomy undertaken on the tentative diagnosis of acute appendicitis. The appendix was found to be normal and was removed. The course was complicated with segmental gastro-intestinal gangrene with fatal outcome. The involvement of histotoxic clostridial infection as a causative factor is discussed.- - - - - - - - - - ranking = 1keywords = fatal outcome (Clic here for more details about this article) |