Introduction: The Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a very rare iatrogenic accident that is characterized by its difficult diagnosis due to its clinical latency and heterogeneous cl...Introduction: The Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a very rare iatrogenic accident that is characterized by its difficult diagnosis due to its clinical latency and heterogeneous clinic. The form induced by allopurinol remains exceptional and often ignored by clinicians, although potentially fatal. We are reporting an original observation of allopurinol-induced DRESS syndrome in elderly. Case report: A 64-year-old woman who had been treated with allopurinol for gout for three weeks, was hospitalized for a diffuse, erythematous and maculopapular cutaneous rash, associated with fever at 39℃ , dyspnea, generalized lymphadenopathy, and a hyperkeratotic and desquamative plantar eruption. The biology showed eosinophilia at 860/mm3 and cytolitic hepatitis without cholestasis or hepatocellular insufficiency with ASAT at 230 IU/l and alanine aminotransferase ( ALAT) at 280 IU/l. The infectious, immunological investigation, as well as the search for underlying malignant neoplasia or hematological malignancy were negative. The skin biopsy was inconclusive. The diagnosis of a DRESS syndrome induced by allopurinol was retained. The evolution was rapidly favorable after stopping allopurinol and treatment with systemic glucocorticoids. Conclusion: The incidence of cutaneous reactions to allopurinol is estimated at 1.5/100,000 H/year. The DRESS syndrome, the most serious form of these reactions, remains exceptional. This particular form of toxicity deserves to be known by clinicians, especially since allopurinol is widely prescribed in the elderly.展开更多
The sense of smell is largely taken for granted by laypersons and medical professionals alike.Indeed, its role in determining the flavor of foods and beverages, as well as in warning of, or protecting against, environ...The sense of smell is largely taken for granted by laypersons and medical professionals alike.Indeed, its role in determining the flavor of foods and beverages, as well as in warning of, or protecting against, environmental hazards, often goes unrecognized.This is exemplified, in part, by the fact that most patients presenting to medical clinics with 'taste' problems are typically subjected to complex brain imaging and gastroenterological tests without the sense of smell even being tested or considered as a basis of the problem.Aside from frank deficiencies in sweet, sour, bitter, salty and savory (umami) sensations, 'taste' disorders most commonly reflect inadequate stimulation of the olfactory receptors via the retronasal route;i.e., from volatiles passing to the receptors from the oral cavity through the nasal pharynx.This article describes the two most common procedures for measuring the sense of smell in the clinic and provides examples of the application of these tests to diseases and other disorders frequently associated with smell loss.Basic issues related to olfactory testing and evaluation are addressed.It is pointed out that smell loss, particularly in later life, can be a harbinger for not only a range of neurodegenerative diseases, but can be a prognostic indicator of early mortality.展开更多
文摘Introduction: The Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a very rare iatrogenic accident that is characterized by its difficult diagnosis due to its clinical latency and heterogeneous clinic. The form induced by allopurinol remains exceptional and often ignored by clinicians, although potentially fatal. We are reporting an original observation of allopurinol-induced DRESS syndrome in elderly. Case report: A 64-year-old woman who had been treated with allopurinol for gout for three weeks, was hospitalized for a diffuse, erythematous and maculopapular cutaneous rash, associated with fever at 39℃ , dyspnea, generalized lymphadenopathy, and a hyperkeratotic and desquamative plantar eruption. The biology showed eosinophilia at 860/mm3 and cytolitic hepatitis without cholestasis or hepatocellular insufficiency with ASAT at 230 IU/l and alanine aminotransferase ( ALAT) at 280 IU/l. The infectious, immunological investigation, as well as the search for underlying malignant neoplasia or hematological malignancy were negative. The skin biopsy was inconclusive. The diagnosis of a DRESS syndrome induced by allopurinol was retained. The evolution was rapidly favorable after stopping allopurinol and treatment with systemic glucocorticoids. Conclusion: The incidence of cutaneous reactions to allopurinol is estimated at 1.5/100,000 H/year. The DRESS syndrome, the most serious form of these reactions, remains exceptional. This particular form of toxicity deserves to be known by clinicians, especially since allopurinol is widely prescribed in the elderly.
文摘The sense of smell is largely taken for granted by laypersons and medical professionals alike.Indeed, its role in determining the flavor of foods and beverages, as well as in warning of, or protecting against, environmental hazards, often goes unrecognized.This is exemplified, in part, by the fact that most patients presenting to medical clinics with 'taste' problems are typically subjected to complex brain imaging and gastroenterological tests without the sense of smell even being tested or considered as a basis of the problem.Aside from frank deficiencies in sweet, sour, bitter, salty and savory (umami) sensations, 'taste' disorders most commonly reflect inadequate stimulation of the olfactory receptors via the retronasal route;i.e., from volatiles passing to the receptors from the oral cavity through the nasal pharynx.This article describes the two most common procedures for measuring the sense of smell in the clinic and provides examples of the application of these tests to diseases and other disorders frequently associated with smell loss.Basic issues related to olfactory testing and evaluation are addressed.It is pointed out that smell loss, particularly in later life, can be a harbinger for not only a range of neurodegenerative diseases, but can be a prognostic indicator of early mortality.
