Improvement of Systemic Symptoms after Dental Implant Removal

Dental implants have spread worldwide in dentistry. The risks and complications reported are limited to local issues. However, in this case, a patient complained of systemic symptoms after dental implantation. This case report aims to demonstrate that systemic symptoms such as lumbago, shoulder stiffness, neck pain, hip joint pain, and facial pain improved after the removal of well-osseointegrated titanium implants. The results suggest that harmful electromagnetic waves received by implants affect body conditions;however, to date, the underlying mechanisms have not been identified. Therefore, further research is required.

Pulmonary sarcoidosis:A novel sequelae of drug reaction with eosinophilia and systemic symptoms:A case report

BACKGROUND Drug reaction with eosinophilia and systemic symptoms(DRESS)syndrome is an uncommon yet serious adverse drug hypersensitivity reaction with the presentations including rash,fever,lymphadenopathy,and internal organ involvement.Sarcoidosis is a systematic granulomatous disease with unknown etiology.We herein report a case of pulmonary sarcoidosis secondary to allopurinol-induced DRESS.CASE SUMMARY A 37-year-old man with a history of hyperuricemia was treated with allopurinol for three weeks at a total dose of 7000 milligrams before developing symptoms including anorexia,fever,erythematous rash,and elevated transaminase.The patient was diagnosed with DRESS and was treated with prednisone for 6 mo until all the symptoms completely resolved.Three months later,the patient presented again because of a progressively worsening dry cough.His chest computed tomography images showed bilateral lung parenchyma involvement with lymph node enlargement,which was confirmed to be nonnecrotizing granuloma by pathological examination.Based on radiologic and pathological findings,he was diagnosed with sarcoidosis and was restarted on treatment with prednisone,which was continued for another 6 mo.Reexamination of chest imaging revealed complete resolution of parenchymal lung lesions and a significant reduction in the size of the mediastinal and hilar lymph nodes.Following a 6-month follow-up of completion of treatment,the patient's clinical condition remained stable with no clinical evidence of relapse.CONCLUSION This is the first case in which pulmonary sarcoidosis developed as a late complication of allopurinol-induced DRESS.The case indicated that the autoimmune reaction of DRESS may play an important role in the pathogenesis of sarcoidosis.

Drug Reaction with Eosinophilia and Systemic Symptoms： Retrospective Analysis of 104 Cases over One Decade

Background： Drug reaction with eosinophilia and systemic symptoms （DRESS） is a severe, life-threatening disorder caused by drugs. In the present study, we tried to explore the types of DRESS-inducing drugs, incubation period, features of skin rashes, accompanying visceral damage, and effectiveness of glucocorticoid therapy so as to inform clinical practice. Methods： Patients diagnosed with a drug-induced rash, dermatitis, and DRESS admitted to our hospital from January 2006 to December 2015 were included in the study. The diagnosis followed the criteria and scoring system set by the European Registry of Severe Cutaneous Adverse Reactions. Statistical analyses were carried out using SPSS version 17.0 （IBM, Armonk, NY, USA）, and a value ofP 〈 0.05 was considered statistically significant. Results： Among 104 patients, 38 were male and 66 female （aged 18-83 years）. The latent period was 13 （interquartile range [IQR]： 10-17） days. The most common allergy-inducing drugs were antibiotics （n = 37, 35.6%）, followed by antiepileptic drugs and traditional Chinese medicines （TCMs）. Eighty-two cases （78.8%） had rash with area 〉50% body surface area （BSA）. Liver damage occurred in 90% of cases. Patients were divided into oral antihistamine group and glucocorticoid/immunosuppressive agent/intravenous immunoglobulin （IVIG） group. Sex, age, incubation period, duration of hospital stay, and the number of patients with body temperature 〉38.5℃ were not significantly different between the two groups. However, the number of patients meeting the criteria of＂definite＂ and ＂probable＂ （X2 =5.852, P = 0.016）, with an eosinophilic granulocyte count of〉1.5 x10^9/L 0,2 7.129, P = 0.008）, and with rash area of〉50% BSA （X2 = 4.750, P = 0.029）, was significantly different. Conclusions： Antibiotics were associated with allergic reactions, but TCMs also had an important role. Allergy resulting from repeat use of the same drug was more severe with a shorter incubation period. The most typical rash was widespread erythematous papules. Liver damage accounted for 〉90% of cases.

Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

Lower Back Pain and Forearm Tendinitis Linked to Irritation of Oral Mucosa by Teeth

We present a case of a woman with refractory lower back pain and forearm tendinitis, which improved dramatically after morphological modification of natural teeth. The subject was a 35-year-old Japanese woman, who was suffering from lower back pain when bending forward and she had severe pain from her right thumb to her wrist. These symptoms were not improved by massage and orthopedic treatment. On the other hand, once modifying the morphology of natural teeth, those symptoms improved dramatically. No side effects were observed, and the prognosis was good. Our observation suggested a close relationship between the oral situation and remote musculoskeletal conditions, and further multidisciplinary studies are needed to clarify the mechanisms.

Effective Treatment of Acne Fulminans with Oral Corticosteroids

An 18-year-old man had numerous multiple painful nodulocystic lesions, pustules, and necrotic hemorrhagic ulcerative lesions with crusts on the face, back, chest and upper arm two weeks ago. Systemic symptoms such as fever, general fatigue and arthralgia were not observed. Laboratory findings revealed an elevated white blood cell count with a neutrophilia and C-reactive protein. Oral antimicrobials did not respond. Consequently, oral prednisolone (20 mg/d) for two weeks induced remarkable improvement promptly. A case of acne fulminans without systemic symptoms successfully treated with oral corticosteroids has been reported.