Eosinophilic fasciitis associated with L-tryptophan ingestion.

OBJECTIVE: To present the first case of eosinophilic fasciitis associated with L-tryptophan ingestion. CLINICAL FEATURES: A 23-year-old Australian man developed myalgia and weakness, and later the clinical features of eosinophilic fasciitis, while taking L-tryptophan. INTERVENTION AND OUTCOME: The amino acid supplementation was discontinued and he was treated with prednisone (30 mg/day) for six weeks with significant improvement. CONCLUSION: In sclerodermatous skin diseases, such as eosinophilic fasciitis, the possibility of ingestion of tryptophan-containing products should be considered.     

Adverse reaction to mefloquine associated with ethanol ingestion.

A 40-year-old man with no history of neuropsychiatric illness was taking one 250-mg tablet of mefloquine (MFQ) weekly for malaria prophylaxis while in Tanzania. He experienced no adverse reaction in association with his first two doses. Concurrently with both his third and his fourth dose he consumed about half a litre of whisky. On both occasions he experienced hallucinations, paranoid delusions and suicidal ideation. Thereafter he continued taking the MFQ, abstained completely from ethanol ingestion and had no recurrence of psychiatric symptoms. It is hypothesized that the combination of MFQ and ethanol caused the two episodes of severe psychiatric disturbance.     

Typhoid fever with severe pancytopenia.

A patient suffering from typhoid fever with severe pancytopenia is presented. Bone marrow examination revealed extensive haemophagocytosis which possibly contributed to the pancytopenia.     

Severe dysphagia associated with major tranquillizer treatment.

A 56 year old patient with psychiatric complications of systemic lupus erythematosus developed severe dysphagia complicated by weight loss and aspiration. Following investigation it was concluded that the addition of haloperidol to her treatment was the major precipitating cause and withdrawal of the drug was followed by an objective improvement in swallowing. Patients taking major transquillizers may be at increased risk of severe dysphagia; regular observation of swallowing is suggested as a useful addition to the clinical examination of these patients.     

Transient pancytopenia associated with parvovirus infection in paroxysmal nocturnal haemoglobinuria

A 25 year old woman with a 15-year history of paroxysmal nocturnal haemoglobinuria developed transient pancytopenia following infection with human parvovirus B19. This is the first report of transient pancytopenia in a patient with an acquired haemolytic anaemia due to parvovirus. The possible mechanism of pancytopenia in such a case is discussed.     

氯吡格雷相关的致死性全血细胞减少1例报告

1 临床资料患者,女,82岁,因"发热并发现‘全血细胞减少'1 d"于2010年7月29日收入我院血液科.既往有"冠心病、心律失常、高血压病"病史,2010年7月6日患者因"急性冠脉综合征"在心内科治疗,当时查血常规三系正常,出院后予"氯吡格雷、普伐他汀、单硝酸异山梨酯"口服.患者于2010年7月28日上午起出现发热,体温最高39.2℃,稍觉恶寒,无寒战,伴有腹泻、解黄稀便,无腹痛、恶心及呕吐,自述近两日觉左足疼痛明显、活动受限,无活动性出血,无头晕心悸.     

Retrobulbar haemorrhage associated with chronic Gingko biloba ingestion

Retrobulbar haemorrhage is a rare and potentially sight threatening complication after peribulbar local anaesthetic injection for cataract surgery. A case is reported of a woman who developed this complication and was subsequently found to have been taking Gingko biloba extract tablets which may have predisposed her to developing the haemorrhage.     

Severe coagulopathy associated with white-lipped green pit viper bite.

The authors report a case of Trimeresurus albolabris (white-lipped green pit viper) bite in a 6-year-old girl living in rural Yuen Long. Despite repeated use of Agkistrodon halys antivenin, the patient developed severe coagulopathy with defibrination syndrome on the fourth day of envenomation, which was also refractory to therapy with fresh frozen plasma. When treatment was switched to green pit viper antivenin, the coagulopathy resolved promptly. The case is illustrative of the potential lethality to children of snakebites in Hong Kong and suggests that the A halys antivenin may not be effective for the treatment of T albolabris bites.     

Severe orthostatic hypotension associated with carcinoma of the bronchus.

A patient is described who had severe orthostatic hypotension. An account is given of his treatment with a monoamine oxidase inhibitor and tyramine. At post-mortem, 8 months after the illness began, a small oat cell carcinoma of the bronchus was found. It is suggested that the orthostatic hypotension was a nonmetastatic manifestation of the underlying carcinoma.     

Haemolytic anaemia associated with ingestion of naphthalene-containing anointing oil

We present a patient who developed a severe haemolytic anaemia as a result of ingestion of a naphthalene-containing anointing oil. Previous reports of naphthalene-induced haemolytic anaemia are reviewed. Predisposing factors to haemolysis are outlined and the variability in the haematological response to naphthalene is discussed. It is clear that ingestion of anointing oil is dangerous; even topically, significant absorption of naphthalene may occur especially in infants, as it is oil-based. Because of these dangers, the use of naphthalene-containing anointing oils should be strongly condemned.     

Partial oesophageal perforation associated with cold carbonated beverage ingestion

We present a rare case of spontaneous intramural oesophageal perforation after the rapid ingestion of a cold carbonated beverage. A previously well patient presented with sudden onset of severe retrosternal pain associated with pain on swallowing. A contrast computed tomography scan and gastroscopy confirmed the diagnosis. With the widespread popular practice of drinking cold carbonated beverages, especially during the summer season, clinicians should be aware of this possible serious complication.