RESUMO
A 15-year-old girl was admitted to the emergency room because of a bilateral tonic-clonic seizure. The family reported that the episode began with rapid hand movements in front of the patient's eyes while staring at the sun. The patient has a history of multiple admissions in the emergency department due to similar events since the age of eight. Most occurrences were associated with episodes of frustration. The review of the literature has shown that this type of phenomenon, designated in some studies by sunflower syndrome, may be overlooked in patients with photosensitive epilepsy. Despite the unknown etiology, there are several reasons why patients experience this type of behavior, and thus a multidisciplinary approach is needed.
Uma jovem de 15 anos foi admitida no Serviço de Urgência após ter sofrido crise epiléptica tónico-clónica bilateral. A família relatou que o episódio surgiu na sequência de ter iniciado movimentos rápidos das mãos na frente dos olhos enquanto olhava para o sol. A doente havia sido assistida, por diversas vezes, no Serviço de Urgência, devido a eventos semelhantes, desde os oito anos de idade. A maioria dos episódios estava associada a episódios de frustração. A revisão da literatura mostrou que esse tipo de fenómeno, designado em alguns estudos por sunflower syndrome, pode ser desvalorizado em doentes com epilepsia fotossensível. Apesar da etiologia desconhecida, existem várias razões pelas quais os doentes apresentam este tipo de comportamento, enfatizando a necessidade de uma abordagem multidisciplinar.
Assuntos
Epilepsia Reflexa/etiologia , Estimulação Luminosa/efeitos adversos , Convulsões , Luz Solar/efeitos adversos , Adolescente , Encéfalo/diagnóstico por imagem , Epilepsia Reflexa/tratamento farmacológico , Feminino , Humanos , Imageamento por Ressonância Magnética , Comportamento AutodestrutivoRESUMO
Background: We describe a rare case involving paracetamol, a commonly used drug worldwide. Increased paracetamol consumption increases the risk of adverse drug reactions. Case Presentation: This is a case of a 9-year-old girl who visited the emergency department due to sudden onset sneezing, nasal itching, urticaria, and angioedema after paracetamol ingestion. The diagnostic and etiologic studies revealed an immunoglobulin E (IgE)-mediated hypersensitivity mechanism to paracetamol. Conclusion: Few cases of this phenomenon have been reported in previous literature. As confirmed in this study, a negative skin prick test did not exclude hypersensitivity, and conducting intradermal tests (IDTs) increased diagnostic accuracy. The patient had a positive IDT, confirming the underlying IgE-mediated reaction. The follow-up of a confirmed paracetamol hypersensitivity implies patient education about avoidance of any paracetamol-containing formulation, including combination products and clarification of available alternative drugs. This is likely the first publication documenting IgE-mediated paracetamol allergy in pediatric patients. We intend to underline the clinical benefits of diagnostic confirmation toward suspected drug hypersensitivity reactions in children, a particularly useful topic for pediatricians and pediatric allergists.