Possible fatal acetaminophen intoxication with atypical clinical presentation.

Acetaminophen or paracetamol, a commonly used over-the-counter analgesic, is known to elicit severe adverse reactions when taken in overdose, chronically at therapeutic dosage or, sporadically, following single assumptions of a therapeutic dose. Damage patterns including liver damage and, rarely, acute tubular necrosis or a fixed drug exanthema. We present a case of fatal acetaminophen toxicity with postmortem blood concentration 78 µg/mL and unusual clinical features, including a visually striking and massive epidermolysis and rhabdomyolysis, disseminated intravascular coagulation and myocardial ischemia. This case is compared with the most similar previous reports in terms of organ damage, clinical presentation, and cause of death. We conclude that a number of severe patterns of adverse effects to acetaminophen are emerging that were previously greatly underestimated, thus questioning the adequacy of the clinical spectrum traditionally associated with acetaminophen intoxication and leading to the need to review this spectrum and the associated diagnostic criteria.

Occupational contact dermatitis (drug-induced medicamentosa): six case reports.

We report six patients who had dermatitis after contacting certain chemical substances (one worker with contact 1-chloromethyl naphthalene and five with contact Hydroxy-phthalimide). They appeared like drug-induced erythma multiforme, bullosa epidermalysis from the point of contact gradually spreading to the whole body, combining high temperature, digestive system dysfunction, such as liver dysfunction etc. We can call this occupational drug-induced medicamentosa. The course of dermatosis diseases is 1 - 2 months. Hormone and sustaining treatment may be effective. We discuss chemistry substance, clinical presentation, diagnoses, treatment and relevant prognosis.

[Fatal toxic epidermolysis following administration of allopurinol]. / Epidermolyse toxique fatale après prise d'allopurinol.

Six days after initiating therapy with allopurinol, toxic epidermal necrolysis developed in a 73-year-old man with renal failure. It was responsible for a generalized vasculitis and gastrointestinal bleeding ultimately leading to death. The authors emphasize the need for a careful evaluation before prescribing this medication, particularly in patients with renal failure.

[Vegetative dystrophic epidermolysis bullosa. Urogenital manifestations and treatment with hydantoin]. / Epidermólisis ampollar distrófica vegetante. Manifestaciones urogenitales y tratamiento con hidantoína.

Dystrophic epidermolysis bullosa has a rare recessive polydysplastic vegetant variant, which was described by Nicolas et al. Two siblings are reported. The male was affected by urethral lesions, an exceptional finding in this disease. Many members in family died of renal insufficiency . A variety of therapeutics was indicated along ten years. Only hydantoins caused a marked involution of the lesions. An interesting feature was that high drug levels in the blood produced not only common side effects, such as macrulia , but also exacerbation of the dermatosis and growth of new lesions, which took on a botriomicoid aspect.

[Hematologic and dermatologic side-effects of antibiotic therapy]. / Hämatologische und dermatologische Nebenwirkungen bei Antibiotika-Behandlung.

The report details possible haematological and dermatological side effects due to co-trimoxazole: agranulocytosis and epidermiolysis bullosa (Lyell) respectively developed after short-term therapy with co-trimoxazole in two women treated for tonsillitis and acute relapse of chronic obstructive bronchitis respectively. The clinical findings, therapeutical management and clinical outcome of both patients are described. Reviewing the literature the relevance of co-trimoxazole induced side effects is discussed.

Doxorubicin-enhanced skin reaction after whole-body electron-beam irradiation for leukemia cutis.

This is the first report of doxorubicin (Adriamycin) interacting with whole-body electro-beam irradiation to produce generalized toxic epidermal necrolysis. The patient was a 32-year-old woman with acute myelomonocytic leukemia and leukemia cutis. The severe dermatitis obscured clinical recognition of concomitant pseudomembranous colitis and contributed to the patient's death during management of toxic megacolon. Suggestions are made for minimizing this occurrence in future patients treated in a similar fashion.

Toxic epidermal necrolysis.

Toxic epidermal necrolysis is one of the rarest events -- a dermatologic emergency. The clinical presentation is characteristic -- disseminate erythema and widespread bullous necrosis of the epidermis and mucous membranes. Toxicity is universal and mortality is substantial even with prompt and intensive therapy. Drugs are the most commonly incriminated agents and therapy remains controversial, the majority favoring high-dose systemic corticosteroids.