A deceiving case of DRESS syndrome.
0
Citation
0
Reference
2
Related Paper
Cite
INTRODUCTION: Drug reaction with eosinophilia and systemic symptoms syndrome is a rare and potentially life-threatening form of drug hypersensitivity which can be difficult to diagnose due to its long latency period and nonspecific symptoms. We present a case of a woman diagnosed with DRESS after a gastroenterology consult for elevated LFTs. CASE DESCRIPTION/METHODS: A 60-year-old female with a complex past medical history including polysubstance abuse presented to the hospital with fever, diffuse body rash, shortness of breath and altered mental state. Four weeks prior to her admission, the patient was hospitalized for alcohol withdrawal. An EEG at that time showed status epilepticus and she was placed on phenytoin and levetiracetam, then discharged. On the current admission, the patient was afebrile, tachycardic, tachypneic, hypotensive. The patient was on a ventilator, diffusely tender to palpation of her abdomen, and had a diffuse brawny rash. Her labs showed an elevated leukocyte count of 27.7 K/mm 3 with 30% eosinophils and elevated ALP of 206 IU/L. CXR showed left basilar consolidation, consistent of pneumonia. She was started on antibiotics, but was suspected to have an adverse drug reaction. Few days later her LFTs worsened. ALP went up to 1315 IU/L, AST 294 U/L, ALT 260 U/L, but bilirubin was normal. Further workup to rule out other causes of liver injury, including an acute hepatitis panel, ANA, AMA, and ASMA were all negative. RUQ ultrasound and CT scan of the abdomen were unrevealing. ALP levels continued to increase to 1673 IU/L and WBC peaked at 60 K/mm 3 with 50% eosinophilia. DRESS was suspected secondary to anticonvulsants started from prior hospitalizations. Phenytoin and levetiracetam were discontinued and changed to zonisamide. She was closely monitored in the hospital for several weeks. Her pulmonary function, leukocytosis, eosinophilia, and LFTs improved and she was discharged to a nursing facility where she fully recovered. DISCUSSION: DRESS syndrome is a severe form of drug hypersensitivity that involves the skin and often other visceral organs. Although our patient had many typical findings of DRESS, including fever, rash, abnormal LFTs, leukocytosis, and eosinophilia, diagnosis was challenging due to the patient's multiple comorbidities and prior hospital admissions initially overlooked. As treatment hinges on cessation of the culprit agent, it is essential to get a complete history and evaluate the patient as a whole to avoid missing this potentially life-threatening condition.
Cite
Citations (1)
This article seeks to investigate whether consumers ‘getting away with it’? As far as anti-counterfeit rules are concerned, whether the consumer purchases the real trade mark or the fake trade mark on a consumer-facing item, there is no meaningful distinction. Consumers consume genuine and counterfeit goods; more and more of the latter it seems. That certain consumers are somehow persuaded to buy fake trademarked goods is a hotly debated and politicized topic as global trade and IP meet. All the subsequent regulatory emphasis and political focus is on the counterfeiter; a target that remains far from grasp. Civil and criminal trade mark liability for the counterfeiter and the obligations for state actors are apparently not deterring professional infringers. Is a reconfiguration needed? It is clear that the overwhelming majority of counterfeits do not mislead or even confuse consumers as to trade mark authenticity. Is this why the consumer, an important actor in IP law, and especially trade mark law, disappears altogether from the anti-counterfeit radar? Yet trade mark regimes are partly about aligning legal standards with the consumer's perceived level of attentiveness; there appears to be a puzzle here. By first asking whether consumer liability should be addressed, this article airs views for and against a legal status as ‘counterfeitee’. The article seeks open up this aspect of the discussion surrounding counterfeiting with enough gusto for all of us (as IP specialists and consumers) to reconsider our role in the global trade of counterfeit goods.
Cite
Citations (0)