ABSTRACT
Two young men developed severe bullous eruptions with a distinctive clinical picture of severe flexural involvement and extensive mucosal ulceration. Biopsies showed subepidermal bullae and associated inflammation consisted of predominantly neutrophils. Both had IgG and C3 staining of the dermal-epidermal junction on direct immunofluorescence. Bullous pemphigoid was diagnosed on the basis of clinical, histopathological and immunofluorescence findings. Both cases occurred after recent ingestion of cephalexin. We believe they represent the first reported cases of bullous pemphigoid induced by cephalexin.
Subject(s)
Cephalexin/adverse effects , Cephalosporins/adverse effects , Pemphigoid, Bullous/chemically induced , Pemphigoid, Bullous/pathology , Adrenal Cortex Hormones/administration & dosage , Adult , Biopsy, Needle , Cephalexin/therapeutic use , Cephalosporins/therapeutic use , Follow-Up Studies , Hand Injuries/drug therapy , Humans , Male , Treatment OutcomeSubject(s)
Glomerulonephritis, Membranoproliferative/complications , Nocardia Infections/complications , Pneumonia, Bacterial/complications , Adult , Anti-Bacterial Agents/therapeutic use , Bronchoalveolar Lavage Fluid/microbiology , Drug Therapy, Combination , Follow-Up Studies , Glomerulonephritis, Membranoproliferative/pathology , Glomerulonephritis, Membranoproliferative/therapy , Glucocorticoids/therapeutic use , Humans , Male , Nocardia/isolation & purification , Nocardia Infections/diagnosis , Nocardia Infections/therapy , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/drug therapy , Radiography, Thoracic , Renal Dialysis , Renal Insufficiency/etiology , Renal Insufficiency/pathology , Renal Insufficiency/therapyABSTRACT
Dehydration in developed countries is an uncommon but important mechanism resulting in the death of infants and children. The clinicopathological features of a series of 37 fatal dehydration cases autopsied at the Adelaide Children's Hospital over a 33-year period (1961-1993) are presented. Causative factors for dehydration included gastroenteritis (21 cases), gastroenteritis with high environmental temperature (one case), high environmental temperatures (six cases), neglect/failure to thrive (four cases), mental retardation/chromosomal abnormality (three cases), congenital adrenal hyperplasia (one case), and unsuspected cystic fibrosis (one case). The mean age at death was 11.4 months (range 2 weeks to 6.25 years; median 6 months; 95% confidence interval 6 months to 1 year and 4 months; male-to-female ratio, 19:18). Sixteen of the 22 cases of fatal gastroenteritis (73%) occurred during the fall/winter months (March to August). There were a total of seven aboriginal or part aboriginal children in the group (19%). Children with mental retardation were at higher risk of dehydration, and previously unsuspected cases of child abuse/neglect also presented with lethal dehydration. Vitreous humor electrolyte levels and immunoassay for rotavirus were useful diagnostic adjuncts.
