1/3. The efficacy of therapeutic plasmapheresis for the treatment of fatal hemophagocytic syndrome: two case reports.A potentially fatal hemophagocytic syndrome (HPS) has been noted in patients with reactive HPS. We describe 2 patients with reactive HPS treated with a regimen of therapeutic plasmapheresis and evaluate the efficacy of plasmapheresis for fatal HPS. Case 1 was a 31 year-old woman who had been treated for systemic lupus erythematosus (SLE) with corticosteroid hormones and immunosuppressants. She presented with persistent leukopenia and thrombocytopenia with spiking fever. She had an elevated level of serum ferritin, liver dysfunction, coagulopathy, and plasma inflammatory cytokines. Her bone marrow smear disclosed numerous hemophagocytosis of histiocytes. She was administered therapeutic plasmapheresis with total plasma exchange by fresh frozen plasma. There was an immediate and prominent decrease of cytokines, and she completely recovered. Case 2 was a 34 year-old woman who had been receiving high doses of corticosteroids and plasmapheresis for severe Stevens-Johnson's syndrome. After 18 months, she presented with physical and laboratory findings resembling lupus-like conditions and was administered high doses of corticosteroids and immunosuppressants. Human parvovirus B19 infection was detected by IgM and IgG antibodies and viral dna from a bone marrow sample; moreover, a bone marrow smear disclosed findings of HPS. Repeated therapeutic plasmapheresis was effective for improving her symptoms and laboratory abnormalities; however, she suffered from septic methicilline resistant staphylococcus aureus infection and finally died of a brain hemorrhage resulting from disseminated intravascular coagulation (DIC).- - - - - - - - - - ranking = 1keywords = staphylococcus aureus, staphylococcus, aureus (Clic here for more details about this article) |
2/3. ethambutol-induced toxic epidermal necrolysis.Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that most commonly is related to drug exposure and that clinically can be confused with other bullous dermatoses, particularly staphylococcal scalded skin syndrome (SSSS) and erythema multiforme major (the stevens-johnson syndrome). We report the first case, to our knowledge, of TEN associated with ethambutol hydrochloride administration. Toxic epidermal necrolysis can be partially differentiated from other bullous dermatoses by history and clinical presentation. Microbiological results (eg, the isolation of staphylococcus aureus in SSSS) and immunological studies (eg, the demonstration of immune complexes in the stevens-johnson syndrome) may aid in differentiation, but ultimately the diagnosis depends on histopathological examination of involved skin.- - - - - - - - - - ranking = 0.038942721189165keywords = aureus (Clic here for more details about this article) |
3/3. An abscess associated with a through-the-lid keratoprosthesis one year after intraocular lens insertion.A through-the-lid keratoprosthesis in a patient with severe stevens-johnson syndrome resulted in 20/20 vision for one year, at which time the patient experienced a sudden and painless loss of vision. Surgical exploration revealed a staphylococcus aureus intraocular abscess and a 10-mm-thick cyclitic membrane. electrophysiology had shown normal retinal function by ERG and VER at the time of this surgery. Vision has since deteriorated to no light perception.- - - - - - - - - - ranking = 0.038942721189165keywords = aureus (Clic here for more details about this article) |