RESUMEN
An 87-year-old woman was admitted to our hospital with general fatigue, anorexia, nausea, and chest pain, and was diagnosed with Takotsubo cardiomyopathy and a stomal ulcer. Pseudohyperchloremia and a negative anion gap were detected in laboratory tests. She was continuously taking commercially available analgesics, including bromvalerylurea. On the 11th day of hospitalization, her bromide concentration was high (331.2 mg/L). She was readmitted with fatigue and anorexia one and a half years after her last hospitalization. On admission, her serum chloride and bromide levels were also high. Despite being instructed to stop taking analgesics after the first hospitalization, she was unable to stop taking the medication. It took more than two years for her blood bromide concentration to decrease and the withdrawal of the medication to be confirmed. Clinicians should consider bromide intoxication in patients with unclear neuropsychiatric symptoms and high chloride levels.
Asunto(s)
Analgésicos , Humanos , Femenino , Anciano de 80 o más Años , Analgésicos/efectos adversos , Analgésicos/uso terapéutico , Bromuros/efectos adversos , Bromisovalum/efectos adversos , Enfermedad CrónicaAsunto(s)
Equilibrio Ácido-Base/efectos de los fármacos , Desequilibrio Ácido-Base/inducido químicamente , Analgésicos/efectos adversos , Bromisovalum/efectos adversos , Cloruros/sangre , Desequilibrio Ácido-Base/sangre , Desequilibrio Ácido-Base/diagnóstico , Adulto , Biomarcadores/sangre , Combinación de Medicamentos , Femenino , HumanosRESUMEN
Bromoderma is a rare skin disorder caused by bromide intake. It presents as single or multiple papillomatous nodules or plaques, and ulcers studded with small pustules on the face or limbs. The clinical features of bromoderma are similar to those of pyoderma gangrenosum. A 41-year-old Japanese woman was diagnosed with pyoderma gangrenosum 11 years prior to presentation. Pyoderma had repeatedly appeared over her entire body despite treatment. She also frequently complained of syncopal episodes. She was admitted to our hospital after loss of consciousness and an episode of generalized convulsion. Laboratory tests revealed a negative serum anion gap and hyperchloremia. Her serum bromide level was significantly elevated, suggesting bromide intoxication. The patient had a 10-year history of high serum bromide levels. After the intake of bromide-containing sedatives was stopped, there was no recurrence of pyoderma in the absence of treatment. In conclusion, this case was diagnosed as bromoderma with commercial sedative-induced bromide intoxication. Although the US Food and Drug Administration have banned the use of bromides, over-the-counter (OTC) treatments containing bromides are still used in Japan and other countries. Long-term use of OTC medicines containing bromvalerylurea may result in the development of bromoderma. If unclarified neurological or psychiatric symptoms are associated with pyoderma, we propose measurement of the patient's serum chloride concentration. Determination of hyperchloremia is helpful for the diagnosis of chronic intoxication with bromides.
Asunto(s)
Bromuros/efectos adversos , Bromisovalum/efectos adversos , Erupciones por Medicamentos/patología , Hipnóticos y Sedantes/efectos adversos , Medicamentos sin Prescripción/efectos adversos , Piodermia Gangrenosa/patología , Enfermedades Raras/patología , Equilibrio Ácido-Base , Adulto , Anorexia Nerviosa/tratamiento farmacológico , Biopsia , Bromuros/administración & dosificación , Bromuros/sangre , Bromisovalum/sangre , Bromisovalum/uso terapéutico , Cloruros/sangre , Ciclosporina/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Erupciones por Medicamentos/sangre , Erupciones por Medicamentos/etiología , Eritema/inducido químicamente , Eritema/tratamiento farmacológico , Eritema/patología , Femenino , Glucocorticoides/uso terapéutico , Humanos , Hipnóticos y Sedantes/sangre , Hipnóticos y Sedantes/uso terapéutico , Medicamentos sin Prescripción/análisis , Prednisolona/uso terapéutico , Piodermia Gangrenosa/tratamiento farmacológico , Enfermedades Raras/sangre , Enfermedades Raras/inducido químicamente , Convulsiones/etiología , Síncope/etiología , Privación de TratamientoAsunto(s)
Acetaminofén/efectos adversos , Antitusígenos/efectos adversos , Bromisovalum/efectos adversos , Codeína/análogos & derivados , Difenhidramina/efectos adversos , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/etiología , Difilina/efectos adversos , Efedrina/análogos & derivados , Acetaminofén/administración & dosificación , Administración Oral , Adolescente , Antitusígenos/administración & dosificación , Bromisovalum/administración & dosificación , Codeína/administración & dosificación , Codeína/efectos adversos , Difenhidramina/administración & dosificación , Combinación de Medicamentos , Difilina/administración & dosificación , Eosinófilos/inmunología , Efedrina/administración & dosificación , Efedrina/efectos adversos , Femenino , Humanos , Inmunización , Pruebas Cutáneas , ComprimidosAsunto(s)
Lesiones Encefálicas , Bromisovalum/efectos adversos , Hipnóticos y Sedantes/efectos adversos , Psicosis Inducidas por Sustancias/fisiopatología , Bromisovalum/administración & dosificación , Humanos , Hipnóticos y Sedantes/administración & dosificación , Masculino , Persona de Mediana Edad , Psicosis Inducidas por Sustancias/tratamiento farmacológico , Trastornos Relacionados con Sustancias/complicaciones , Taiwán , Resultado del TratamientoAsunto(s)
Barbitúricos/sangre , Bromisovalum/sangre , Monitoreo de Drogas/métodos , Hipnóticos y Sedantes/sangre , Barbitúricos/administración & dosificación , Barbitúricos/efectos adversos , Barbitúricos/farmacocinética , Biomarcadores/sangre , Bromisovalum/administración & dosificación , Bromisovalum/efectos adversos , Bromisovalum/farmacocinética , Cromatografía Líquida de Alta Presión , Interacciones Farmacológicas , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/farmacocinética , Valores de Referencia , Manejo de EspecímenesAsunto(s)
Antidepresivos/efectos adversos , Antipsicóticos/efectos adversos , Bromisovalum/efectos adversos , Hipnóticos y Sedantes/efectos adversos , Piperazinas/efectos adversos , Piridinas/efectos adversos , Trastornos Relacionados con Sustancias , Compuestos de Azabiciclo , Humanos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicología , Trastornos Relacionados con Sustancias/terapia , ZolpidemRESUMEN
Bromoisovalerylurea (bromisovalum) is a sedative-hypnotic given orally as a racemic mixture of optical isomers (i.e., (+)- and (-)-enantiomer) and frequently taken in overdose in order to commit suicide. Sera from 16 overdosed subjects were analyzed for each enantiomer by high-performance liquid chromatography on chiral stationary phases. The (+)-enantiomer concentration was lower than the (-)-enantiomer concentration in all specimens, that is, the ratio of the (+)-enantiomer to the total concentration ranged from about 50% to 0%. The ratio of the (+)-enantiomer was continuously decreasing in each subject. The data indicate that the drug in gastrointestinal tract was absorbed into blood nonstereoselectively and that the drug in blood was eliminated stereoselectively. The enantioselective determination of this drug will give useful information on absorption and elimination.
Asunto(s)
Bromisovalum/sangre , Hipnóticos y Sedantes/sangre , Bromisovalum/efectos adversos , Cromatografía Líquida de Alta Presión , Sobredosis de Droga , Humanos , Hipnóticos y Sedantes/efectos adversos , Isomerismo , Intento de SuicidioAsunto(s)
Corteza Cerebelosa/patología , Degeneraciones Espinocerebelosas/etiología , Alcoholismo/complicaciones , Anticonvulsivantes/efectos adversos , Antidepresivos/efectos adversos , Antineoplásicos/efectos adversos , Atrofia , Bromisovalum/efectos adversos , Humanos , Litio/efectos adversos , Síndromes Paraneoplásicos , Fenitoína/efectos adversos , Degeneraciones Espinocerebelosas/patologíaRESUMEN
A patient with bromisovalum-induced toxic epidermal necrolysis showed pronounced delayed hypersensitivity to bromisovalum by patch testing. Biopsy specimens from the cutaneous lesion and the site of the positive patch test reaction were analyzed and compared immunohistologically. The findings were similar: most of the mononuclear cells disposed along the dermoepidermal junction and migrating into the epidermis were CD8-positive lymphocytes, whereas the dermal inflammatory infiltrates were composed predominantly of CD4-positive lymphocytes. This case showed the potential usefulness of patch testing in evaluating cases of toxic epidermal necrolysis. We believe that delayed hypersensitivity plays a crucial role in the development of drug-induced toxic epidermal necrolysis. Furthermore, potential effector cells with phenotypic characteristics of CD8-positive lymphocytes (suppressor/cytotoxic T cells) seem to represent important mediators of the epidermal damage of the cutaneous lesion in our case.