Case report: dapsone hypersensitivity syndrome associated with treatment of the bite of a brown recluse spider

Dapsone (4-4-diaminodiphenyl-sulfone) is a member of the sulfone group of antibiotics used in the treatment of leprosy and various dermatitidies and more recently employed in the management of local reactions to the bite of the brown recluse spider, Loxosceles reclusa. A dapsone hypersensitivity syndrome, consisting of fever, headache, nausea, vomiting, lymphadenopathy, hepatitis, hemolysis, leukopenia, and mononucleosis, has been described in patients treated with the drug for leprosy. A case report of the hypersensitivity syndrome occurring in a patient being treated with dapsone for a brown recluse spider bite is presented.     

A retrospective review of black widow spider envenomation

Because there are few recent studies of black widow spider (Latrodectus Mactans) envenomation, a six-year retrospective study was conducted by patients admitted to or discharged from our hospital with this diagnosis. Fourteen patients with apparently severe envenomation were found and reviewed for the frequency of presenting signs and symptoms, the use of laboratory and radiographic studies, and the effectiveness of drug therapies. The most frequent symptoms were bite site pain (79%), abdominal pain (71%), and lower extremity weakness (57%). The most frequent signs were bite site lesions and abdominal tenderness or rigidity (71%). Laboratory and radiographic studies did not influence the initial emergency department evaluation. All drug therapies resulted in good clinical outcome despite two complications, and we therefore believe that the use of antivenom for symptomatic relief should be discouraged.     

Clinical presentation and treatment of black widow spider envenomation: a review of 163 cases.

STUDY OBJECTIVE: To review cases of black widow spider envenomation to describe the clinical presentation and evaluate the efficacy of treatment. DESIGN: Retrospective chart review. SETTING: An urban toxicology referral center. TYPE OF PARTICIPANTS: All patients attended by the toxicology service and discharged from our hospital between January 1982 and December 1990 with a diagnosis of black widow spider envenomation. INTERVENTIONS: Inclusion criteria were either a positive black widow spider identification or a visible envenomation site ("target lesion"). Depending on the clinical presentation, patients were categorized as grade 1, 2, or 3 in severity. The efficacy and side effects of treatment alternative were evaluated. MEASUREMENTS AND MAIN RESULTS: One hundred sixty-three patients met the inclusion criteria. The most common sites of envenomation were the upper and lower extremities. The most common presenting complaint was generalized abdominal, back, and leg pain. One hundred eighteen patients initially presented to our institution, and 45 were transfers. Pain relief of grade 2 and 3 envenomations was achieved most effectively with either black widow spider-specific antivenin alone or a combination of IV opioids and muscle relaxants. Fifty-eight patients received antivenin with complete resolution of symptoms in a mean time of 31 +/- 26.7 minutes. Of the 118 patients initially seen at our institution, the mean total duration of symptoms was 9 +/- 22.7 hours in patients receiving antivenin and 22 +/- 24.9 hours in patients not receiving antivenin. Fifty-two percent of patients not receiving antivenin required hospitalization, whereas only 12% of those receiving antivenin were admitted. One patient died of severe bronchospasm after receiving antivenin. Calcium gluconate was not effective in providing symptomatic relief in this series, with 96% of the grade 2 and 3 envenomations treated initially with calcium gluconate requiring the addition of IV opioids or other analgesics for symptomatic relief. Fifty-five percent of patients initially receiving IV morphine and 70% of those initially receiving both IV morphine and benzodiazepines obtained symptomatic relief without additional medication. CONCLUSION: One hundred sixty-three envenomations by black widow spiders were reviewed and graded according to severity with treatment modalities evaluated. Although calcium gluconate usually has been considered the first-line treatment of severe envenomations by black widow spiders, we found it ineffective for pain relief compared with a combination of IV opioids and benzodiazepines. The use of antivenin significantly shortened the duration of symptoms in severe envenomations.     

Case report: Acute myocardial infarction complicating a viper bite.

Myocardial infarction is a rare complication of snakebite. The present report describes a 40-year-old Jordanian farmer who developed an acute myocardial infarction several hours after a snakebite. The diagnosis of myocardial infarction was confirmed by a typical history of retrosternal chest pain, characteristic electrocardiographic changes, and elevated serum creatinine kinase (MB-CK). The patient had no risk factors for coronary artery disease and the coronary arteries were normal on cardiac catheterization. The possible mechanisms leading to myocardial infarction following snakebite are discussed.     

Felty's syndrome in black Americans: a case report

This is a case report of a black woman with Felty's syndrome, who had recurrent, severe leg ulcers refractive to the usual treatment. The leg ulcers healed promptly after splenectomy and there has not been a recurrence of these lesions after three years' follow-up. The rarity of Felty's syndrome in blacks is highlighted and the literature on this aspect is reviewed. Information on seven patients with Felty's syndrome seen at the University of Cincinnati Medical Center is provided and the relationship of skin ulcers to splenectomy reviewed.     

Thoracic compartment syndrome secondary to a thoracic procedure: a case report

Prolonged open sternotomy is a well-known phenomenon in the pediatric and adult cardiac surgery literature. It is usually an adjuvant in the treatment of a severely compromised heart. We present a case of thoracic compartment syndrome that developed postoperatively from a noncardiac thoracic procedure. Management, diagnosis, and literature review are presented.     

Chromoblastomycosis after a leech bite complicated by myiasis: a case report

Background  

Chromoblastomycosis is a chronic mycotic infection, most common in the tropics and subtropics, following traumatic fungal implantation.     

Coagulopathy after snake bite byBothrops neuwiedi: Case report and results of in vitro experiments

Summary Coagulation studies were performed in a patient who had been bitten by a snake of the speciesBothrops neuwiedi. The patient presented with hemorrhagic necrosis at the envenomization site and considerable bleeding from venous puncture sites. He developed a severe defibrination syndrome with a clottable fibrinogen level of approximately 0.1 g/l. Fibrinogen was not measurable by clotting time assay. Fibrin degradation products were greatly elevated. Treatment with antivenom caused an anaphylactic reaction within ten minutes and serum sickness after three days. In vitro experiments revealed thatB. neuwiedi venom directly activates Factors II and X, but does not activate Factor XIII. In vivo consumption of Factor XIII afterB. neuwiedi envenomization is ascribed to the action of Factor IIa. At low venom concentrations clotting is initiated by activation of prothrombin by the venom either directly or via Factor X activation. Treatment with heparin might be beneficial in coagulopathy secondary to snake bite by reducing circulating active thrombin. The venom contains thrombinlike proteases which cause slow clotting of fibrinogen, and plasmin-like components causing further proteolysis of fibrinogen and fibrin. Antivenom has no effect on the proteolytic action of the snake venom. The in vivo effects of antivenom are presumably caused by acceleration of the elimination of venom components from the circulation. Intravenous administration of antivenom caused normalization of blood coagulation parameters within 48 h.     

Release of neurotransmitters and depletion of synaptic vesicles in cerebral cortex slices by alpha-latrotoxin from black widow spider venom.

The effect of alpha-latrotoxin on cerebral cortex slices was studied by both biochemical and morphological methods. This toxin greatly stimulates the release of preloaded gamma-amino[3H]butyric acid from cortex slices. The response increases linearly with dose. The release is not dependent on the presence of extracellular Ca2+, and therefore it is not mediated by the release of other transmitters from other types of neurons. In contrast, no significant increase in the release of a nontransmitter substance alpha-amino[14C]isobutyric acid is observed. Since previously we have shown that alpha-latrotoxin stimulated the release of acetylcholine and norepinephrine from cortex slices, it appears that the toxin probably selectively releases all neurotransmitters. The toxin also profoundly depletes the synaptic vesicle population in boutons in the cortex slices. The results suggest that the release of neurotransmitter and the depletion of synaptic vesicle in boutons are manifestations of a single action of the toxin. Therefore, alpha-latrotoxin can be used as a good tool for the identification of neurotransmitters and in studies on the mechanism of neurotransmitter release.     

Action of black widow spider venom on quantized release of acetylcholine at the frog neuromuscular junction: dependence upon external Mg2+.

Black widow spider (Latrodectus tredecimguttatus) venom (BWSV) increases several hundredfold the frequency of occurrance of minature end-plate potentials (Fmepp) at frog neuromuscular junctions bathed in Ringer's solutions containing either Ca2+ of Mg2+, but it has little effect on Fmepp at junctions bathed in modified Ringer's solution containing 1--2 mM ethylene glycol bis(beta-aminoethyl ether)-N,N'-tetraacetic acid (EGTA) but no Ca2+ or Mg2+. When Mg2+ is added to preparations that have been treated with BWSV in the modified solution, Fmepp increases exponentially with time. Fmepp falls again to low values when the Mg2+ is removed. The rate constant of the exponential rise is proportional to [Mg2+]o in the range 1--4 mM, and the threshold [Mg2+]o is 0.1--0.5 mM. Increasing the K+ concentration of the bathing solution decreases the ability of Mg2+ to increase Fmepp. Addition of Ca2+, Co2+, Mn2+, or Zn2+ also leads to a large increase in Fmepp. These results are consistent with the possibility that BWSV increases the permeability of the nerve terminal to divalent cations. BWSV can, however, increase Fmepp in hypertonic solutions in the absence of external divalent cations. This result suggests that the effects of BWSV on the nerve terminal may not be confined to increasing the permeability of the plasma-lemma.     

经桡动脉冠状动脉介入治疗并发支架脱载和骨筋膜室综合征一例

<正>1临床资料患者男性,49岁,主因"间断性胸痛4 d"于2015年2月8日入院。患者于4 d前休息时突然出现胸痛,为心前区闷痛,约巴掌大小,向双上肢放射,自行含服复方丹参滴丸10粒,持续8~10 min后缓解。次日晨起6∶00~7∶00无明显诱因患者上述症状再次发作,含服复方丹参滴丸10粒,持续8~10 min后缓解,当地医院查心电图大致正常,但此后上述     

Goodpasture's syndrome: recurrence after a five-year remission. Case report and review of the literature

Herein is reported the case of a man who has had a recurrence of Goodpasture's syndrome following a five-year remission. The patient presented initially in 1977 at the age of 28 with Goodpasture's syndrome manifested by pulmonary hemorrhage without clinical evidence of renal disease, and positive antiglomerular basement membrane antibody. Following treatment with corticosteroids, remission occurred and the serum antiglomerular basement membrane antibody became negative. In 1983, he experienced a relapse with the reappearance of serum antiglomerular basement membrane antibody, the development of severe life-threatening intrapulmonary hemorrhage, and hematuria. This case illustrates that life-threatening relapse may occur in Goodpasture's syndrome despite a prolonged remission and the disappearance of detectable antiglomerular basement membrane antibody in the circulation.     

Intra-abdominal compartment syndrome as a rare complication after aortic reconstruction]

An intraabdominal compartment-syndrome developed due to ischemia and hemorrhage through a suture subsequent to partial reconstruction of the abdominal aorta, aorto-mesenterical and bilateral aorto-renal T-bypass. In order to decrease the elevated intraabdominal pressure, a decompression with secondary wound closure by an artificial net is the therapy of choice. The arising problems which determined the fatal outcome of this case are discussed.