The Journal of the Arkansas Medical Society最新文献

Objective: To describe a patient who developed acute interstitial nephritis, hepatitis and serum sickness-like syndrome after receiving piperacillin-tazobactam (zosyn) therapy.

Case summary: A 30-year-old woman received a 7-day course of piperacillin-tazobactam as empiric treatment for pneumonia. The patient's kidney function worsened and she turned anuric needing dialysis. She also developed fever and a rash. Laboratory analysis showed elevated liver function and leukocytosis. Kidney biopsy showed acute interstitial nephritis. The patient responded well to steroids; white blood cell count normalized and her liver and kidney function improved over a period of one month.

Discussion: Piperacillin-tazobactam is one of the most commonly used antibiotics in the hospital setting. It has rarely been associated with acute interstitial nephritis, hepatic injury, or serum sickness-like reactions. Steroids have improved the outcome in most of the cases of interstitial nephritis.

Conclusion: Clinicians should be aware of piperacillin-tazobactam as a drug capable of causing interstitial nephritis, hepatitis and serum sickness-like syndrome. It is essential that we monitor for these rare but severe complications.

Diabetic Ketoacidosis (DKA) has high morbidity and mortality and can be prevented. It is extremely important to give clear guidance to patients and families on how to manage diabetes during intercurrent illnesses to avoid complications of ketoacidosis, dehydration,uncontrolled or symptomatic hyperglycemia and hypoglycemia. This descriptive review of clinical cases and management guidelines for sick days in children and adolescents with diabetes is provided as a resource for physicians who may take calls from parents of sick children with diabetes or manage these children in a clinic, emergency room or hospital setting.

We report a case of Acute Eosinophilic Pneumonia (AEP) in a 29-year-old white woman with recent use of a'flea bomb' (containing pyrethroids) at home while remaining indoors, about 48 hours prior to presentation, and recent change in smoking habit (restarted 2 weeks prior after quitting for 10 years). She presented with two days of worsening fever, shortness of breath, productive cough, developed hypoxemic respiratory failure and ARDS. She required a PEEP of 20 and 100% FiO2 to maintain oxygenation. Bronchoalveolar lavage showed 36% Eosinophils. She was given IV steroids with dramatic clinical and radiological improvement. To the best of our knowledge, this is the second report associating AEP with pyrethroid exposure.

Tick-borne diseases are illnesses transmitted by ticks harboring wide variety of pathogens. Arkansas is reported as one of the states with a high incidence of tick-borne diseases. In Arkansas the four most frequently occurring tick-borne diseases are Rocky Mountain Spotted Fever (RMSF, also known as Spotted Fever Rickettsiosis), Ehrlichiosis, Tularemia and Anaplasmosis. Lyme disease, on the other hand, is not acquired in Arkansas and is only acquired by traveling to states where Lyme disease is endemic. The majority of tick-borne diseases are diagnosed based on a history of tick bite or exposure and the individual's clinical presentation. The recognition of specific symptoms requires prompt treatment to prevent long-term sequelae. Hence, knowledge of tick-borne diseases and preventive measures can help reduce the risks associated with the infection.