Stevens-Johnson Syndrome in a Patient on Concomitant Treatment with Levetiracetam and Trimethoprim/Sulfamethoxazole.

BACKGROUND Trimethoprim/sulfamethoxazole and levetiracetam are commonly prescribed medications in the treatment of infections and seizures, respectively. Despite their known efficacy, each has a reputation for triggering severe and sometimes life-threatening cutaneous adverse drug reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Although the mechanism of such cutaneous adverse drug reactions cannot be fully explained, it is thought to be a type IV T cell and NK cells-mediated hypersensitivity reaction that leads to keratinocyte apoptosis and epidermal necrosis. It is also thought that cutaneous adverse drug reactions are also linked to a patient's genetic predispositions, especially the human leukocyte antigens profiles and the N-acetyl transferase 2 phenotypic variation. CASE REPORT We describe a case of Stevens-Johnson syndrome in a severely ill 51-year-old man who was treated in an outside health care facility simultaneously with Trimethoprim/sulfamethoxazole and levetiracetam. The patient presented to our Emergency Department with Stevens-Johnson syndrome believed to possibly be related to the combination of these 2 agents. CONCLUSIONS The concomitant use of Trimethoprim/sulfamethoxazole and levetiracetam might have been responsible for heightening the potential of these 2 medications to trigger an unfortunate adverse drug reaction, but no formal culprit was able to be identified and no in vivo study was performed, due to ethical considerations. Thus, through this case report we strive to increase awareness of the potential risk of simultaneously prescribing these 2 medications.

Interrelated functionalities of hierarchically CNT/CeO2/Pt nanostructured layers: synthesis, characterization, and electroactivity.

We present a free-standing catalyst layer comprising current collector/CNTs (catalyst support)/CeO(2)/Pt (catalyst) nanostructured layers, each layer constructed upon the one below it. FESEM and TEM showed that a CeO(2) layer has a fluffy morphology recalling the texture of cotton, whereas Pt nanoparticles assemble into cauliflower or broccoli-like arrangement. New insights have been gained into the effect of CeO(2) on the structural properties of the beneath CNTs layer and on the above Pt layer. First, by means of Raman analysis, it was found that interaction of CeO(2) with CNTs induced a decrease in the crystallinity of the latter. Second, by TEM and XPS analyses, it was observed that the size of Pt nanoparticles in the CNT/CeO(2)/Pt structure was inferior to that in the CNT/Pt, implying that CeO(2) influenced the dispersion quality of Pt nanoparticles. For the first time, it is observed that CeO(2) supported CNTs undergo oxidation/reduction reactions at low potentials in the ethanol electrolyte. The electrochemical analysis showed that entities produced from those redox processes are surface adsorbed/desorbed species most likely hydroxides. This unexpected electroactivity is due to the beneath CNTs that boosted the conductivity of CeO(2). Such improved conductivity of CeO(2) has fostered the electron-transfer kinetics of ethanol at Pt as demonstrated by the decreased overpotential required to oxidize ethanol and by the specific mass activity, which was greater than that of CNT/Pt.