Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with azithromycin in acute Epstein-Barr virus infection.

We report the first pediatric case of drug reaction with eosinophilia and systemic symptoms associated with azithromycin use in the setting of acute Epstein-Barr virus infection in an 8-year-old boy. Our patient presented with fever, cutaneous eruption, eosinophilia, and hypotension requiring intensive care unit admission. He was discharged in good condition without any long-term sequelae. This case underscores the importance of timely and accurate diagnosis of acute viral infections and appropriate use of antibiotics as well as recognition of the clinical signs of drug reaction with eosinophilia and systemic symptoms.

Completeness in the reporting of dermatologic adverse drug reactions associated with monoclonal antibody epidermal growth factor receptor inhibitors in phase II and III colorectal cancer clinical trials.

The epidermal growth factor receptor inhibitors cetuximab and panitumumab have demonstrated activity against colorectal cancer (CRC), with decreased systemic toxicities compared with cytotoxic chemotherapy. However, most patients experience dermatologic adverse drug reactions (dADRs). Our study examines completeness of reporting of dADRs to cetuximab and panitumumab in clinical trials for CRC. The PubMed MEDLINE database was searched for "cetuximab and CRC" or "panitumumab and CRC." Searches were limited to phase II or phase III clinical trials. Each result was evaluated for type of dADRs, grades included, correlation with survival, and dose modification. Ten of the 13 cetuximab articles (76.9%) analyzed included data on dADRs. Eight of ten (80%) reported all grades of rash, effect on dose modification was reported in 20%, and patient discontinuation in 30%. Five (50%) reported a positive correlation between dADRs and survival or response. Three of 7 (42.9%) panitumumab articles reported dADRs. None of the articles reported lower-grade rash. Information on drug dose adjustments was reported in one (33.3%), while discontinuation was reported 3 (100%) articles. Correlation between dADRs and survival was included in 2 panitumumab articles (66.6%). Our results indicate considerable variability in reporting of dADRs. This suggests that the ability to determine patient risk and the capability to compare dermatologic toxicity profiles between agents is limited by current reporting methods. To improve patient counseling and prophylactic antitoxicity interventions, implementation of standards for reporting of dADRs is critical.

Bone mineral density and urine calcium excretion among subjects with and without nephrolithiasis.

BACKGROUND: Bone mineral density (BMD) is reduced among patients with idiopathic hypercalciuria (IH) and nephrolithiasis. To disentangle effects of diet, stone formation, and physiology upon BMD, we studied vertebral and femoral neck BMD among relatives of hypercalciuric stone formers, and contrasted those with to those without stones. METHODS: Among 59 subjects from 11 families, vertebral and femoral neck BMD, diet calcium intake, urine excretions of calcium, sodium, ammonium, titratable acid, sulfate, urea nitrogen, and serum levels of calcitriol and markers of bone turnover were studied. RESULTS: Stone formers (SF) consumed less calcium than non-stone formers (NSF). Spine and femoral neck BMD z-scores varied inversely with urine calcium loss and urine ammonium excretion among SF but not NSF. No correlations of BMD z-score were found for bone markers, calcitriol, or any of the other measurements. CONCLUSION: SF consumed less calcium, presumably to prevent more stones, and displayed a bone mineral responsiveness to calcium loss and ammonium excretion not present among NSF, who ate more calcium. Lowered calcium consumption in IH, perhaps in response to stone formation, alters bone responses in a direction that can predispose to mineral loss and eventual fracture.