Statin-associated peripheral neuropathy: review of the literature

Various pharmacologic agents are available for the treatment of hypercholesterolemia, including 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, commonly referred to as statins, which offer favorable lipid-lowering effects and reductions in morbidity and mortality. Statins are usually better tolerated than other lipid-lowering agents and therefore have become a mainstay of treatment for hypercholesterolemia. However, recent case reports of peripheral neuropathy in patients treated with statins may have gone unnoticed by health care professionals. To evaluate the possible link between statins and peripheral neuropathy, literature searches using MEDLINE (January 1993--November 2003) and International Pharmaceutical Abstracts (January 1970--June 2002) were performed. Key search terms were statin, neuropathy, and HMG-CoA reductase inhibitors. Based on epidemiologic studies as well as case reports, a risk of peripheral neuropathy associated with statin use may exist; however, the risk appears to be minimal. On the other hand, the benefits of statins are firmly established. These findings should alert prescribers to a potential risk of peripheral neuropathy in patients receiving any of the statins; that is, statins should be considered the cause of peripheral neuropathy when other etiologies have been excluded.     

Colchicine myotoxicity: case reports and literature review

Two of our patients experienced myotoxicity associated with colchicine administration. The first was a 54-year-old woman who was receiving dialysis and came to the emergency department with progressive generalized weakness and vomiting. She recently had taken colchicine for the treatment of gout. Physical examination revealed proximal muscle weakness and tenderness on palpation. Her creatine kinase (CK), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were elevated at 7185, 563, and 541 U/L, respectively. Drug-induced myopathy was suspected and colchicine was discontinued. The patient was discharged after symptom resolution 1 week later. The second patient was an 83-year-old woman with chronic renal insufficiency who came to the hospital with anorexia, diarrhea, and inability to get out of bed due to progressive weakness. Her colchicine dosage recently had been increased for gout management. Physical examination revealed generalized muscle weakness and tenderness on palpation. Her CK, ALT, and AST levels were elevated at 1797, 147, and 172 U/L, respectively. Electromyographic results were consistent with colchicine myopathy. The patient was discharged with minimal residual muscle weakness 1 week after discontinuation of colchicine. A literature search identified 82 documented cases of colchicine-induced myotoxicity. Most patients had a history of proximal weakness and pain with elevated CK, ALT, and AST levels. Onset of symptoms generally occurred days to weeks after initial administration of colchicine at the usual dosage in patients with renal impairment or a change in underlying disease state in those receiving long-term therapy. Muscle toxicity was not necessarily accompanied by gastrointestinal symptoms. Concomitantly administered drugs often were cyclosporine or corticosteroids. Diagnosis may be confirmed by electromyography or muscle biopsy. Colchicine-induced myotoxicity is a rare adverse effect but is well described in the literature. Clinicians should recognize that renal impairment is the primary risk factor for development of colchicine-induced myotoxicity, and that dosage adjustment or alternative therapy may be required.     

Cleistanthus collinus poisoning: case reports and review of the literature

We report the cases of two previously healthy young patients who ingested the liquid extracted from the crushed leaves of Cleistanthus collinus (Family: Euphorbiaceae) in an attempt to commit suicide. Both patients developed life threatening complications such as hypokalemia, hypotension, cardiac arrhythmias, neuromuscular weakness, respiratory failure, and renal failure following a transient quiescent period of up to 4 days. Other significant findings noted include leucocytosis, coagulopathy, elevated liver enzymes, hyperchloremic metabolic acidosis, and an alkaline urinary pH. Both patients received supportive care as no specific antidote was available, and ultimately died. We have reviewed the published literature on C. collinus poisoning.     

Pneumatosis cystoides intestinalis: case reports and review of the literature

Pneumatosis cystoides intestinalis is an uncommon condition in which submucosal or subserosal gas cysts are found in the wall of the small or large bowel. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical and bacterial causes. Approximately 85% of cases are thought to be secondary to coexisting disorders of the gastrointestinal tract or the respiratory system. Since 1986 we have observed 4 cases of pneumatosis cystoides intestinalis. A review of the literature is presented with emphasis on the etiology, diagnosis, differential diagnosis, and therapy of pneumatosis cystoides intestinalis. Symptoms of pneumatosis cystoides intestinalis include diarrhea, constipation, rectal bleeding, passage of mucus per rectum, vague abdominal discomfort, abdominal pain, urgency, malabsorption, weight loss, and excessive flatus. Depending on the location of the gas filled cysts the range of symptoms in each patient may vary enormously.     

Childhood longitudinal melanonychia: case reports and review of the literature

"Longitudinal melanonychia" refers to a brown or brown-black longitudinal band on a fingernail or toenail. A number of conditions can cause longitudinal melanonychia, but its main importance is that, in some patients, it may indicate the presence of a subungual malignant melanoma. Hyperpigmented nail bands are not uncommon in African-American, Latino and Asian patients, especially those over sixty years of age, and are often multiple in these groups. Longitudinal melanonychia is most worrisome when there is a solitary, dark, broad longitudinal band with pigment extending over the proximal nail fold (Hutchinson's sign). Such findings are considered to be a strong indication for biopsy of the nail matrix to rule out melanoma. Since nail matrix biopsy sometimes results in permanent nail deformity, and since the incidence of malignant melanoma is quite small in the pediatric age group, there is some controversy as to whether this procedure should routinely be performed in children. We report two cases of dramatic longitudinal melanonychia in toddlers and review the current literature on the management of this striking condition in the pediatric age group.     

Fatal propafenone overdoses: case reports and a review of the literature

First synthesized in 1970, propafenone is a frequently used 1C antiarrhythmic drug metabolized into two major metabolites, 5-hydroxypropafenone and norpropafenone. Paradoxically, fatal intoxication is rarely described, and only six cases have been reported in the literature. We report our experience with two patients found dead of self-inflicted poisoning where the propafenone blood concentration was very high (one concentration to our knowledge is one of the highest reported in the literature). At autopsy, no evidence of significant pathological disease were found. Propafenone was detected in blood by gas chromatography-mass spectrometry and by high-performance liquid chromatography using a diode-array detector, respectively, as propafenone artifact and propafenone. Blood propafenone concentrations were 4180 ng/mL and 9123 ng/mL. The literature regarding propafenone pharmacokinetic and intoxication is reviewed, and we discuss the low death rate attributed to this drug in contrast to its frequent use.     

Lenvatinib-induced renal failure: two first-time case reports and review of literature

Introduction: Lenvatinib (LEN) is a multi-kinase anti-angiogenic drug recently approved in several cancers. LEN is not easily manageable due to its complex safety profile. Proteinuria and renal failure (RF) were reported among the most frequent LEN-induced adverse events (AEs), often leading to discontinuations or dose modifications. Understanding the pathogenesis of these AEs could ameliorate the management of LEN-induced renal toxicity.

Areas covered: We present two cases of LEN-induced renal failure (LIRF) with different pathogenesis. 1) LIRF with severe proteinuria in a man treated for a metastatic papillary thyroid carcinoma. Kidney biopsy showed a glomerular damage secondary to LEN, having excluded other causes of RF. 2) LIRF without proteinuria in a woman with metastatic adenoid cystic carcinoma of minor salivary gland. A tubulointerstitial nephropathy was supposed by clinical evaluation and laboratory tests. Effective management was obtained by oral steroids without interrupting LEN.

Expert opinion: The case 1 presented for the first time the histological picture of LIRF with a classical glomerular damage leading to secondary proteinuria and tubular failure. Case 2 showed an alternative LIRF pattern of likely tubulointerstitial injury without proteinuria. These reports reflect two sides of the same coin, both to be considered in case of LIRF.     

外阴颗粒细胞瘤 3例及文献回顾

目的 探讨女性外阴颗粒细胞瘤(granular cell tumor,GCT)临床特征、诊断、治疗及预后.方法 回顾性分析2018年1月至2019年11月中国科学技术大学附属第一医院(安徽省立医院)妇科收治的3例女性外阴GCT病人的临床资料.结果 3例病人年龄分别为31岁、49岁、39岁,外阴包块均无症状,其中病例1为妊娠期发现外阴包块,产后无明显缩小就诊,另2例为无意中发现外阴包块且随访期间进行性增大就诊.病例1术前未行活检,因包块与周围正常组织无明显边界,同时切除包块外正常组织0.5～1.0 cm;病例2先于门诊行单纯外阴包块切除术,术后病理提示切缘阳性入院再次扩大手术范围,达原切缘外1～2 cm;病例3术前外阴活检提示GCT,行外阴包块局部扩大切除术,达病灶外1～2 cm.3例病人均顺利出院,术后分别随访20个月、14个月、2个月未复发.结论 女性外阴GCT发病率低,多无临床症状,易被忽视.虽多为良性病变,但有少数有复发或恶变可能,一旦发现外阴部包块应重视,必要时外阴活检确诊,一旦诊断,及时手术治疗,并定期随访.     

Elimination half-life of acetone in humans: case reports and review of the literature

Two instances of finding abnormally high concentrations of acetone in urine (0.10 g/dL and 0.052 g/dL) without any measurable amounts of ethanol (<0.005 g/dL) or isopropanol (<0.005 g/dL) prompted a survey of the elimination kinetics of isopropanol and its metabolite acetone in humans. In a hospital patient who had ingested denatured alcohol, the elimination half-life (t(1/2)) of acetone during detoxification was 27 h and not 3-5 h as reported by other workers. Several other literature reports of individuals who had ingested isopropanol as well as controlled studies after administration of moderate amounts of acetone and/or isopropanol support the notion of a long elimination half-life of 17-27 h for acetone compared with a t(1/2) of 1-3 h for isopropanol.     

鼻腔结外Rosai-Dorfman病2例及文献复习

目的 探讨鼻腔结外Rosai-Dorfman病(RDD)的临床表现、病理特征及鉴别诊断.方法 对2例鼻腔结外RDD采用光镜及免疫组化、特殊染色结合临床资料及文献复习,对鼻腔结外RDD进行临床病理分析.结果 鼻腔结外RDD形态学有不同程度的纤维组织增生和以浆细胞为主的混合炎细胞浸润,胞质内含有淋巴细胞和浆细胞的大多角形组织细胞数量多少不一,呈簇状或散在分布.结论 鼻腔结外RDD较为少见,诊断有一定难度,形态学易与鼻硬结病、Langerhans细胞组织细胞增生症、肉芽肿性炎症、纤维组织细胞瘤等相混淆,需要免疫组化和特殊染色加以鉴别.     

第三芽孢梭菌致骨组织感染病例报告并文献复习

目的:探讨第三芽孢梭菌致骨组织感染的治疗方案,为类似疾病的诊疗提供参考。方法:北京积水潭医院于2016年4月20日和2017年8月3日收治第三梭菌致骨组织感染患者2例,根据其临床表现、病原学检查和治疗经过,并对PubMed、Medline、中国知网和万方数据库进行检索,复习相关文献。结果:综合文献及本院案例,共收集8例第三梭菌致骨组织感染病例,经彻底外科清创和敏感抗菌药物足疗程治疗后,均转归良好。结论:快速而准确的病原菌鉴定、充分的外科清创和足疗程的敏感抗菌药物治疗,对于第三芽孢梭菌致骨组织感染的治疗都是非常重要的。     

Chelonitoxism: new case reports in French Polynesia and review of the literature.

Eating the flesh of some marine turtles can cause a type of seafood poisoning called chelonitoxism. The purpose of this article is to report a new case of mass poisoning caused by consumption of sea turtle flesh in French Polynesia. The episode involved 19 members of the same family. Three persons required hospitalization after consuming two consecutive meals including turtle flesh. One 26-year-old woman who was pregnant at 14 weeks of amenorrhea lapsed into a coma and died due to multiorgan failure on the third day after the meal. This case confirms the potential severity of chelonitoxism as reported in several series in the literature showing high mortality rates. The causative toxins are currently unidentified. Further study is needed to better understand chelonitoxism.     

垂体后叶素相关渗透性脱髓鞘综合征2例与文献分析

两例患者因肺结核咯血静脉滴注垂体后叶素出现渗透性脱髓鞘综合征。例1为45岁男性患者,首日静脉滴注垂体后叶素10U,第2、3、4天为24～36U/d。第5天停药。因再现咯血,给予垂体后叶素24U/d,共2d。之后,患者出现烦躁不安、言语混乱,四肢不自主运动、实验室检查示血钠110mmol/L,补钠治疗2d后血钠升为134mmol/L。头颅MRI示双侧尾状核、豆状核对称性长T1、T2信号改变。经对症治疗后,患者症状有所好转。     

抗癫痫药物过敏综合症:两个案例报道和文献综述(英文)

抗癫痫药物过敏综合反应(AED)的发生涉及严重的皮肤、血和肝损伤。在严重的情况下,爆发性肝衰竭可能需要肝移植,大多数病人因肝衰竭而死去。严重的皮肤不良反应主要有罕见但致命的:史蒂夫·约翰逊综合症(SJS),中毒性表皮坏死松解症(TEN)和超敏反应综合征等。上述不良反应的致死率高达5%–50%。早期的准确诊断和及时治疗可能降低死亡率。本文报道了两个癫痫患者对卡马西平(CBZ)或苯巴比妥(PB)的过敏综合反应案例,来阐明癫痫的治疗过程和早期表现有助于改善癫痫的治疗方案,同时防止了潜在严重的AED的皮肤不良反应。两个案例报告强调在卡马西平及苯巴比妥的治疗中引起的致命性过敏反应可能与患者肝脏中缺少环氧化物羟化酶及基因缺失有关。     

Hemangiomas of the external auditory canal:a literature review and two new case reports

Aim  

The aim of this paper is to present two case reports of patients with hemangiomas of the external auditory canal, and to overview all cases published in English language literature so far.     

Cilengitide in bevacizumab-refractory high-grade glioma: two case reports and critical review of the literature

High-grade gliomas (HGG) are aggressive and highly vascularized brain tumours. Despite multimodality therapy including surgery, radiation therapy and in many cases temozolomide chemotherapy, the prognosis is dismal. Salvage therapies following progression after radiation therapy and chemotherapy have historically yielded disappointing results. Bevacizumab is an interesting antiangiogenic drug used as a second-line treatment but although most patients benefit, essentially all patients ultimately progress. Moreover, some clinical studies have documented low activity of a second attempt at vascular endothelial growth factor pathway inhibition after failure of a first. The use of another drug with a different angiogenic pathway inhibition may probably result in a higher activity. Here, we describe, to our knowledge for the first time, the activity and safety of cilengitide, an agent with a different antiangiogenic and anti-invasive activity, administered in two bevacizumab-refractory patients with HGG. In addition, we present a rapid review of the activity of cilengitide in HGG.     

Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review

Adverse effects are common in patients with acquired immunodeficiency syndrome (AIDS) who receive trimethoprim-sulfamethoxazole (TMP-SMX). Two patients experienced a rare anaphylactoid syndrome. Within hours of receiving a double-strength TMP-SMX tablet, a 28-year-old human immunodeficiency virus (HIV)-positive man developed fever, hypotension, and bilateral pulmonary infiltrates. Broad-spectrum antimicrobial therapy was begun but discontinued 2 days later when signs and symptoms resolved and specimens for Pneumocystis carinii were negative. A 38-year-old man developed rash, fever, hypotension, hyperbilirubinemia, renal dysfunction, and bilateral pulmonary infiltrates after taking two doses of oral TMP-SMX. Several antimicrobial agents, including parenteral pentamidine, were administered despite lack of evidence for P. carinii or other infection. four case reports of similar reactions in patients with AIDS have been published. Notable differences exist between the syndrome described and anaphylaxis. The TMP-SMX anaphylactoid reactions in patients with AIDS mimic sepsis or opportunistic infection, thus making diagnosis difficult.