Amoxicillin/Clavulanic Acid-Induced Symmetric Drug-Related Intertrigious and Flexural Exanthema.

ß-Lactams, particularly penicillins, may cause several allergic reactions. We described symmetric drug-related intertriginous and flexural exanthema (SDRIFE) illness in this case, a rare instance of systemic contact dermatitis caused by amoxicillin/clavulanic acid that needs to be considered in the differential diagnosis. A 65-year-old male patient was admitted to our Allergy Outpatient Clinic because of increased blue-purple pigmentation on the flexural surfaces of the hip, forearm, axilla, and posterior face of the neck. The patient was receiving a combination of angiotensin receptor blocker (ARB) and hydrochlorothiazide diuretic medication for hypertension. The patient used an antibiotic containing amoxicillin three months ago; As a result, there was localized redness, itching, and black spotting without any systemic symptoms. Similarly, the patient reported that when he used amoxicillin for an upper respiratory tract infection eight months ago, he experienced similar side effects within 20 days and recovered when he applied corticosteroid ointment. Due to the symmetrical site involvement following the consumption of penicillin group antibiotics with a five-month gap and subsequent comparable reactions in our patient, SDRIFE was taken into consideration. The results of the skin punch biopsy identified Baboon Syndrome (SDRIFE). Treatment with topical corticosteroids and antihistamines began. Clinically speaking, SDRIFE is distinguished by significant erythema of the gluteal/perianal area and/or V-shaped erythema of the inguinal/perigenital area, symmetric involvement of at least one other intertriginous or flexural area, and the absence of systemic signs or symptoms. The possibility that the medication may have contributed to the patient's erythematous eruption in the flexural regions should be taken into account, and the patient should be advised to stop taking the medication and not use it again.

Anaphylaxis After Consumption of Guar Gum-Containing Food: A Report of Two Cases.

Guar gum is a food additive that acts as a thickening agent. Although the relationship between guar gum and occupational rhinitis/asthma has already been established, only very few cases of anaphylaxis were associated with guar gum ingestion. We present two examples of anaphylaxis induced by guar gum. Both cases were successfully treated with adrenaline. Moreover, serum-specific immunoglobulin E (IgE) with the culprit agent was detected in blood samples. To the best of our knowledge, here we present the first case of class 6 guar gum-specific IgE-positive anaphylaxis. This report aims to raise awareness of rare food additive allergies such as guar gum.

Four decades without diagnosis: Sheehan's syndrome, a retrospective analysis.

AIM: Sheehan's syndrome (SS) remains a frequent cause of hypopituitarism in undeveloped and developing countries, but due to improvements in obstetric care, it is rare in developed countries. We aimed to share the results of a retrospective study analyzing the demographic, clinical, imaging, and hormonal characteristics of a large group of patients with SS, and also increase awareness of this syndrome especially in developed countries. METHODS: The medical records of 124 patients with SS patients who were followed up in the Endocrinology Department of Dicle University between 1995 and 2015 were assessed retrospectively. RESULTS: The mean period of diagnostic delay was 20.37 ± 8.34 years on average. 5.7% of patients with SS were literate; 62% of patients delivered at home. Anemia was identified in 64.5% of SS patients. Mean blood sodium levels were 129.8 ± 11.3 mEq/L. The mean urine densities were 1013 ± 6.5. Osteoporosis and osteopenia were found in 44 (35.4%) and 71 (57.2%) patients, respectively, According to pituitary magnetic resonance imaging (MRI) analyses, 92 (74.2%) patients with SS had completely empty sella, 29 (23.3%) had partially empty sella, and 1 patient had microadenoma, and 2 had normal pituitary MRI results. CONCLUSIONS: Improved obstetric care and effective interventions for postpartum hemorrhage have limited the prevalence of SS in developed countries. However, in developing countries like Turkey, SS due to postpartum bleeding remains common. Thus, physician's awareness of the symptoms of SS is urgently required to avoid the associated morbidity and mortality.

The efficacy of oral glutamine in prevention of acute radiotherapy-induced esophagitis in patients with lung cancer.

AIM OF THE STUDY: This study explores the efficacy of oral glutamine in the prevention of acute radiotherapy-induced esophagitis in patients with lung cancer who are treated with thoracic radiotherapy. MATERIAL AND METHODS: This study was planned as a retrospective randomized experimental study. Forty-six patients with lung cancer, who were treated and kept under control between January 2008 and January 2010, were included in the study by the Department of Radiation Oncology, Faculty of Medicine, Dicle University. The patients were divided into two groups. The first group (n = 21) was given prophylactic oral powder glutamine (daily 30 g), while the second group (n = 25) was not given oral glutamine. RESULTS: There were 21 patients in Group 1 (45.7%) and 25 patients in Group 2 (54.3%). No significant statistical difference was observed between the two groups in terms of age, gender, stage, histopathological type, treatment choice, received radiation doses, esophagus length in RT field, or location of the tumor (p > 0.05). A significant statistical difference was observed between the glutamine-supplemented group (first group) and the glutamine-free group (second group) according to the grade of esophagitis (p < 0.0001). CONCLUSIONS: In our retrospective randomized experimental study, we determined that the severity of acute radiotherapy-induced esophagitis might be decreased with oral glutamine in patients with lung cancer who were treated with thoracic radiotherapy.

Tumor lysis syndrome during radiotherapy for prostate cancer with bone and bone marrow metastases without visceral metastasis.

A 60-year-old male patient presented to our clinic with metastatic (bone and bone marrow) prostate cancer. Radiotherapy (RT) with a total of 30 Gy was planned in 10 fractions for the painful left shoulder region. On the 6th day of RT, urinary output decreased suddenly and dyspnea developed. Laboratory findings suggested tumor lysis syndrome (TLS). The patient, who showed improvement in overall status and had no requirement for hemodialysis up to this time, developed sudden impairment in overall status, dyspnea, and hypotension on the 11th day of follow-up. Thirty minutes after the development of these symptoms, the patient had a cardiopulmonary arrest and died. At the time of writing this was the fourth case of TLS during RT for solid tumors in adults, the first case of TLS during RT for prostate cancer and the fifth among total cases of prostate cancer in published reports.

Analysis of thrombophilic genetic mutations in patients with Sheehan's syndrome: is thrombophilia responsible for the pathogenesis of Sheehan's syndrome?

The gene mutations of Factor V R506Q (FV-Leiden), prothrombin (FII G20210A), methylene tetrahydrofolate reductase (MTHFR) C677T and A1298C and PAI-1 4G/5G are well-established risk factors for thrombosis. We aimed to investigate the prevalence of these gene mutations and their possible impact on the development of pathogenesis in patients with Sheehan's syndrome (SS). 40 female patients with SS compared to a control group of 45 healthy women. The presence of FV-Leiden, FII G20210A, MTHFR C677T, MTHFR A1298C and PAI-1 4G/5G gene mutations were assessed by polymerase chain reaction analysis with a light cycler analyzer. An odds ratio of greater than one is considered to increase the risk of SS disease as found in Factor V Leiden, FII G20210A, MTHFR C677T, MTHFR A1298C and PAI-1 4G/5G polymorphism, as follows respectively: 1.13, 1.85, 6.00, 8.14 and 1.45. MTHFR C677T and MTHFR A1298C polymorphism were found significantly higher in SS patients than the control group (P<0.001), however FV-Leiden, FII G20210A and PAI-1 4G/5G polymorphism showed no significant difference (P>0.05). The level of plasma total homocysteine (tHcy) was significantly higher in patients with SS than in the control group (P<0.001). We suggest that the genetic mutations of FV-Leiden, FII G20210A, MTHFR C677T, MTHFR A1298C and PAI-1 4G/5G increase the risk of SS. Also, high plasma tHcy levels may be a risk factor for the development of SS.

Assessment of bleeding disorders in Sheehan's syndrome: are bleeding disorders the underlying cause of Sheehan's syndrome?

Sheehan's syndrome (SS) is an adenopituitary insufficiency caused by hypovolemia secondary to excessive blood loss during or after childbirth. However, the mechanism of postpartum hemorrhage and ischemia is not clear. We aimed to evaluate the bleeding disorders among patients with SS, in comparison with healthy controls. In addition, we investigated underlying causes in postpartum hemorrhage that begin the event. The present study was conducted at the Dicle University School of Medicine. Forty-eight patients with SS and 50 age-matched female healthy controls were included. Biochemical and hormonal variables were measured, as was platelet function by means of closure times (PFA-100 testing using collagen plus epinephrine and collagen plus ADP), von Willebrand factor (vWF) level, prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), and coagulation factors. Although PT and INR were significantly higher in patients with SS (both P<0.01), aPTT and levels of fibrinogen, vWF, and factors II, V, VII, VIII, IX, X, XI, and XII did not differ significantly. Closure times with collagen/epinephrine and collagen/ADP also did not differ significantly between patients with SS and control patients. The nonspecific etiology and presence of excessive postpartum hemorrhage in patients with SS suggest that coagulation disorders may play a role in their predisposition to bleeding. The increased PT and INR noted might implicate bleeding diathesis as the underlying etiology, although no significant decreases were noted in factor levels. Further studies are needed to elucidate this complex mechanism of this disorder.