Gilles de la Tourette syndrome after long-term chlorpromazine therapy.

Following 6 years of continuous chlorpromazine therapy for schizophrenia, a young woman developed multifocal tics and vocalizations characteristic of Tourette syndrome. The symptoms first appeared when chlorpromazine was withdrawn. They were permanent, although partially ameliorated by chronic haloperidol therapy. Because of her age and past history, these symptoms were attributed to chronic neuroleptic therapy analogous to neuroleptic-induced tardive dyskinesia, rather than to Tourette syndrome per se. These symptoms suggest that chronic receptor-site blockade can result in hypersensitivity of dopamine receptor sites, and that this may play a role in the pathophysiology of Gilles de la Tourette syndrome. This is the first evidence that hypersensitivity of dopamine receptors is involved in the pathophysiology of Tourette syndrome.

Criteria for the diagnosis of staphylococcal scalded skin syndrome in adults.

The diagnosis of staphylococcal scalded skin syndrome is usually made upon the bases of characteristic skin lesions and the isolation of toxin-producing staphylococci. However, these criteria are not always reliable. An adult patient with characteristic skin lesions was colonized with phage group 2 staphylococci. The patient was subsequently found to have a drug-induced toxic epidermal necrolysis. The criteria necessary for the diagnosis of staphylococcal scalded skin syndrome are reviewed.

Pulmonary disease in idiopathic urticarial vasculitis.

A 45-year-old woman developed chronic urticaria clinically and cutaneous necrotizing vasculitis histologically, with arthralgias, abdominal pain, angioedema, hemoptysis, and pleuritic chest pain. An open lung biopsy revealed a leukocytoclastic vasculitis of the pulmonary venules, which may be etiologically associated with the chronic obstructive lung disease detected in this patient by pulmonary function tests. The documentation of pulmonary disease in patients with urticarial vasculitis emphasizes the potentially serious nature of this disorder and the need for careful diagnosis and prompt, vigorous treatment.

Dapsone in the treatment of erosive lichen planus.

A patient with erosive lichen planus responded to therapy with dapsone after multiple therapeutic modalities had failed. The potential usefulness of dapsone therapy for lymphocyte-mediated inflammatory diseases such as erosive lichen planus is suggested.