Capecitabine induced cutaneous hyperpigmentation: report of a case

We report an unusual case of cutaneous and mucosal hyperpigmentation in a thirty-six year old African American woman who was receiving capecitabine chemotherapy for Stage IV breast carcinoma. Possible etiologies for the hyperpigmentation are discussed. To our knowledge, this is the first reported case of capecitabine associated cutaneous hyperpigmentation.     

Rhabdomyolysis associated with quinacrine therapy in a patient with chronic cutaneous lupus erythematosus

We describe a patient who developed rhabdomyolysis 6 weeks after starting combination therapy with hydroxychloroquine and quinacrine for the treatment of chronic cutaneous lupus erythematosus (CCLE). Myopathy due to 4-aminoquinolone antimalarials has been well documented. It is plausible that quinacrine may induce muscle injury in a manner similar to other antimalarials but, to our knowledge, rhabdomyolysis associated with antimalarial therapy has not been reported.     

Bexarotene and interferon-alpha combination therapy in a patient affected by relapsing anaplastic large cell lymphoma with cutaneous involvement

A 74-year-old man presented with relapsing systemic anaplastic large cell lymphoma (ALCL) with cutaneous involvement who had a third recurrence of cutaneous lesions associated with inguinal lymphonodes enlargement. Due to severe worsening of general conditions, treatment with low dose bexarotene associated with interferon-aalphawas initiated. Four months later, skin nodules disappeared with reduction of lymphonodes size. Two months after stopping therapy, lymphonodal relapse of the lymphoma was seen; however, cutaneous lesions were still in complete remission. Association of low dose bexarotene with interferon-xalphaseems to represent a possible alternative therapy for relapsing systemic ALCL presenting as prevalent cutaneous involvement in patients with severe worsening of general conditions. In our case, this protocol was unable to maintain a longer disease free survival in comparison with the 2 previous polychemotherapy cycles. Further extended studies are required in order to define the possible rule of this combination therapy in relapsing systemic ALCL.     

临床药师对肺隐球菌病患者的药学服务

目的：探讨临床药师在肺隐球菌病治疗中的药学服务内容。方法：通过参与肺隐球菌病患者治疗的全过程,进行治疗用药分析及药学监护。结果：临床药师可以从抗感染方案调整、给药剂量优化,药物有效性、安全性和相互作用监护、对护士和患者进行用药教育以及患者随访等方面作为切入点,提供用药服务。从患者异常实验室检查结果分析原因,培养临床思维。结论：临床药师作为医疗团队的成员之一,可以在肺隐球菌病患者的治疗中发挥作用。     

Ergotism in a patient with a portosystemic shunt

Summary A case of ergotism is described in a patient with Banti's syndrome in whom a porto-systemic shunt had been made three times. She was admitted to hospital with severe ischaemia of the extremities after having taken a single oral dose of 1 mg ergotamine tartrate. Her condition improved rapidly after 2 to 3 days and the circulation was normal after one week. The possible mechanism of ergotism in this patient is discussed. Although the plasma concentration of ergotamine was not measured, the likeliest explanation was that the serious side effects were related to the altered pharmacokinetics and loss of first-pass metabolism of the drug due to the venous bypass of the liver.     

Seizures in a pediatric patient with a tiagabine overdose

Introduction

Tiagabine (TGB) is a novel antiepileptic that decreases GABA uptake. The literature contains one report of an adult with epilepsy who ingested up to 1 gram of TGB and developed status epilepticus. We reported on a pediatric patient who ingested significantly less TGB but still developed tonic-clonic seizures.

Case report

A previously healthy, 13 kg, two-year-old girl developed generalized tonic-clonic seizure activity at home approximately 1 hour after ingesting 90 mg of her grandmother’s TGB (forty five 2 mg tablets). At the hospital she had two 5 minute seizures at 1.5 and 3.5 hours post ingestion. Her serum TGB levels were 530 and 130 ng/ml approximately 5 and 11 hours post-ingestion (5–70 ng/ml trough levels with most probable range for seizure control). She was discharged 27 hours post ingestion, and she was in good condition.

Conclusion

An overdose of TGB, a novel anti-epileptic, can cause convulsive seizures.     

Anticoagulation with anisindione in a patient with a warfarin-induced skin eruption

A 71-year-old woman experienced a pruritic, maculopapular, morbilliform rash on her lower extremities 5 days after starting warfarin for recurrent deep vein thrombosis. The rash extended to her truncal areas and progressively worsened until somewhat painful vesicular lesions developed. Warfarin was discontinued, and subcutaneous injections of enoxaparin were begun; the rash resolved. In addition to a history of deep vein thrombosis, the patient had experienced a hypersensitivity skin reaction to warfarin in the past that necessitated withdrawal of the drug and placement of a vena caval filter. Because no clear consensus exists on whether dyes used in compounding warfarin play a causative role or whether allergic cross-sensitivity occurs among the coumarin derivatives, the patient was rechallenged with a dye-free warfarin 10-mg tablet. The pruritic rash returned along with the vesicular lesions and continued to worsen until the warfarin was discontinued again. The patient subsequently was given oral anticoagulant therapy with anisindione, an indanedione, and her symptoms resolved completely. Health care providers managing patients who are receiving oral anticoagulant therapy should be aware of the maculopapular allergic reactions associated with warfarin and consider alternative treatment options such as anisindione.