Hydromorphone-induced chorea as an atypical presentation of opioid neurotoxicity: A case report and review of the literature.

BACKGROUND: While opioid-induced myoclonus is well described, there are limited reports of opioid-induced chorea. Here we present the first case of chorea as a manifestation of opioid neurotoxicity due to hydromorphone. CASE PRESENTATION: A 20-year-old woman presenting with fevers and cutaneous lesions was diagnosed with hemophagocytic lymphohistiocytosis secondary to primary cutaneous lymphoma. Surgical resection of a cutaneous lesion was complicated by severe postoperative pain requiring rapid opioid dose escalation. Seven days after hydromorphone was initiated, she developed positive myoclonus, hallucinations, delirium, and involuntary, flowing movements consistent with chorea. She had no personal or family history of nervous system disorders and was not taking any medications associated with drug-induced chorea. Case management: The remainder of her neurologic examination was unremarkable. Her renal function was normal and no etiology was found on neuroimaging or laboratory workup. Hydromorphone was discontinued and pain control was achieved with fentanyl. Case outcome: The patient's neurotoxic symptoms including chorea resolved within 72 h of hydromorphone discontinuation. CONCLUSION: Further studies are needed to determine which patients have a unique sensitivity to opioids predisposing them to chorea. Clinicians should be aware that chorea may be a sign of such toxicity so that rapid corrective action can be taken.

Host Plant Effects on Winter Moth (Lepidoptera: Geometridae) Larval Development and Survival.

The winter moth, Operophtera brumata (L.) is an invasive forest and agricultural pest in North America that causes severe defoliation to a wide range of host species. This study examines the differential larval densities, development, and survival on seven host species in midcoast Maine: red oak (Quercus rubra L., Fagales: Fagaceae), apple (Malus domestica L., Rosales: Rosaceae) and crab apple (Malus sp. L., Rosales: Rosaceae), red maple (Acer rubrum L., Sapindales: Sapindaceae), pin cherry (Prunus pensylvanica L., Rosales: Rosaceae), white birch (Betula papyrifera L., Fagales: Betulaceae), wild lowbush blueberry (Vaccinium angustiflolium L., Ericales: Ericaceae), and highbush blueberry (Vaccinium corymbosum L., Ericales: Ericaceae). We also explore the degree of synchrony between selected host plants and larval hatch and its effect on survival. We found that densities, development, and survival were significantly greater on red oak (Quercus rubra) and apple (Malus sp.) than on all other target species and were lowest on pin cherry (Prunus pennsylvanica). We found low larval densities in open, wild lowbush blueberry fields; however, larvae successfully fed and developed on wild lowbush blueberry in a laboratory setting. This suggests that winter moth is a potential pest to wild lowbush blueberry in Maine if the outbreak expands to include areas with wild lowbush blueberry production.

A New Record of Aedes thibaulti In Massachusetts.

For the 1st time, collections of adult female Aedes thibaulti are reported from Massachusetts. Initial collections occurred in 2016 and again in 2017 and 2018. This mosquito was found at 35 locations within 28 municipalities, including the city of Boston. Most of the Ae. thibaulti were collected with the Centers for Disease Control and Prevention miniature light traps baited with CO2. Collections were made from epidemiological (EPI) wk 22 to 35 with a peak at EPI wk 24. Although larvae have not yet been collected, the most common wetland types adjacent to collection sites were forested wetlands, which is consistent with the known larval habitat of this mosquito species. Aedes thibaulti is likely established in the state of Massachusetts.