Mustafa Volkan Demir

Allopurinol-induced DRESS syndrome.

A 70-year-old man was admitted to our clinic with complaints of fever, jaundice, dyspnea, and generalized rash after 3 months of allopurinol treatment for gout. On physical examination, he was found to have fever (38.5°C), jaundice, and generalized maculopapular rash. Leukocytosis, eosinophilia, elevation of liver enzymes, and hyperbilirubinemia were detected in his blood analysis. Skin biopsy was consistent with drug-induced hypersensitivity. He was diagnosed as Drug Rash with Eosinophilia and Systemic Symptoms (DRESS). Allopurinol treatment was stopped and steroid treatment was launched. At day 24 of admission, the patient died because of multiple organ failure.

Eosinophilic Gastroenteritis: A Rare Case Report

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It can be seen anywhere in the gastrointestinal tract. It is diagnosed in the biopsies taken during endoscopic examination to the patients with abdominal pain and chronic diarrhea. A 40-year-old woman was admitted with abdominal pain and chronic diarrhea. She has not any disease, food, pollen, or drug allergy in her medical history. Leukocyte: 19,400/mm3 (neutrophil: 19.9%, eosinophil: 57.4%, lymphocyte: 16.5%), platelet: 281,000/ mm3, immunoglobulin E: 1721 IU/mL (normal range: 20–100 IU/mL) was counted in her blood examination. The duodenal biopsy was reported as EGE. We applied methylprednisolone 20 mg/day. With this treatment, the patients symptoms regressed. In this article we present a case of chronic diarrhea diagnosed EGE. The first step in diagnosing is suspecting EGE. It should be borne in mind in patients with chronic diarrhea.

A Case of QT Prolongation Associated with Panhypopituitarism

We describe a 37-year-old patient with panhypopituitarism who experienced symptoms and signs of hormonal insufficiency and QT prolongation on electrocardiogram without electrolyte disturbances. After hormonal (steroidal and thyroid) replacement therapy electrocardiographic findings were normalized. Hormonal disorders should be considered as a cause of long QT intervals which may lead to torsade de pointes, even if plasma electrolyte levels are normal, because life-threatening arrhythmia is treatable by supplementation of the hormone that is lacking.

Successful treatment of excessive dose of carbamazepine

Carbamazepine is used in the treatment of epilepsy; it is also prescribed for treatment of neuralgic pain syndromes and certain affective disorders. Carbamazepine intoxication with suicide attempt is a relatively common clinical problem that can result in coma, respiratory depression, arrhythmia, hemodynamic instability, and death. There is no specific antidote. Multiple-dose activated charcoal and hemodialysis are the main treatment for carbamazepine intoxication. In this paper, we report the case of a 19-year-old woman with excessive dose carbamazepin intoxication and our successful treatment with multiple-dose activated charcoal and hemodialysis.

Propylthiouracil induced leukocytoclastic vasculitis: A rare manifestation.

Propylthiouracil (PTU) is a common drug used in patients with hyperthyroidism. It may cause perinuclearantineutrophil cytoplasmic antibodies (p-ANCA) in few patients with Graves’ disease. This antibody has been associated with different forms of vasculitis. We report a patient who presented with cutaneous manifestations of leukocytoclasticvasculitis with simultaneous development of p-ANCAs during PTU therapy for Graves’ disease.

A rare cause of pancytopenia: Sheehan's syndrome

Sheehans syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. Pancytopenia is rarely observed in patients with Sheehans syndrome. We present a patient of Sheehans syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after the treatment. Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia and indicate a series of hormonal examinations. A high index of suspicion is required in women with pancytopenia for possible treatable cause like Sheehans syndrome.

Spontaneous abdominal hemorrhage due to warfarin treatment

Warfarin is an anticoagulant used in the prevention of thromboembolism. Common clinical indications for warfarin use are atrial fibrillation, artificial heart valves, deep venous thrombosis. Common side effect of warfarin is hemorrhage. Intra-peritoneal hemorrhage is one of the complications, usually following trauma. We report spontaneous intra-abdominal hemorrhage secondary to warfarin therapy. A 79 year-old male patient was admitted to emergency clinic with the complaints of one day duration of abdominal pain. There was no history of trauma. He had been on warfarin for the prophylaxis of atrial fibrillation.The diagnosis of the spontaneous intra-abdominal bleeding secondary to warfarin was made and the patient was admitted internal medicine inpatient clinic.This case provides a learning lesson to the physicians to consider this rare but significant complication of warfarin in the differential diagnosis of all the cases of abdominal pain in patients who are on warfarin therapy.

Nicolau syndrome caused by the "self-injection" of diclofenac

Nicolau syndrome (NS) is a rare injection-related local complication. Some drugs have been implicated to cause this syndrome. Several cases were previously reported in the literature. In this paper, an interesting case of NS in a 30-year-old male patient after intramuscular self-injection of diclofenac was presented.

Neuroleptic malignant syndrome induced by concomitant use of risperidone and quetiapine

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition induced by neuroleptic medications. In severe cases, NMS can rapidly lead to death. NMS is reported less frequently now-a-days with the advent of new antipsychotic drugs. We discuss 20-year-old male patient with NMS induced by risperidone and quetiapin.

Acute Intermitent porphyria and early hematin treatment before confirming the diagnosis

The term porphyria refers to a heterogeneous group of metabolic diseases resulting from variable catalytic defects of the enzymes involved in the heme biosynthesis pathway. Acute intermittent porphyria (AIP) is an autosomal dominant disorder resulting from a partial deficiency of porphobilinogen (PBG) deaminase. A 21-year-old woman presented to us with the complaints of abdominal pain and vomiting. Her father and sister are diagnosed as acute intermittent porfiria. The laboratory findings showed profound hyponatremia, hypokalemia and high values of creatine kinase. AIP was suspected because of family history and clinic of patient. Our initial management consisted of continuous infusion of 10% glucose and 3% NaCI solution. We decided to start hematin treatment because of no clinical response with current therapy. After the hematin treatment she had regained consciousness, the abdominal pain subsided. The hyponatremia and elevation of creatine kinase was corrected. The analysis of PBG in 24-h urine confirmed the diagnosis of AIP.