Colistin Induced Neurotoxicity in a Multidrug Resistant UTI: a case report

Eagle’s syndrome a rare cause of neck pain: a case report

Introduction:Ingestion of honey that has a toxin called as grayanotoxin causes wild or mad honey poisoning. This toxin is also known as rhodotoxin as it is found in nectar of some rhododendron species mainly found in the mountains of Bhutan, India, Nepal and Turkey. (1) It acts on sodium channel and increases parasympathetic effect. (2) This can lead to nausea, vomiting, dizziness, sweating, altered consciousness, hypotension, bradycardia, cardiac rhythm abnormalities like first-, second-, and third -degree AV block, asystole and sinus bradycardia. (3,4) Wild honey is being used as alternative medicine to treat hypertension, diabetes, peptic ulcer disease, bower disorder, arthritis, flu and as sexual stimulant. (5) We present a case report of wild honey poisoning who presented to emergency with bradycardia and hypotension.

Introduction:Beginning in 1940s Dapsone (diaminodiphenyl sulfone or DDS) was used to treat leprosy1.  In early 1950 Lowe reported Dapsone hypersensitivity reaction and it was named by Allday and Barnes2. Dose dependent (pharmacological) adverse effects which includes hemolytic anemia and methemoglobinemia and dose independent (idiosyncratic) adverse effects that includes dapsone hypersensitivity syndrome (DHS) are two types of adverse effects caused by dapsone2. Fever, rash, lymphadenopathy, hepatitis, splenomegaly, hemolytic anemia, atypical lymphocytosis are some features of dapsone hypersensitivity syndrome and they generally occur after patients receive DDS for 5 to 6 weeks2,3.  If DHS is not detected early and managed it can lead to irreversible organ damage and death4. The prevalence of DHS is estimated to be 1.4 % with a fatality rate of 9.9 % 3. We present a case of Dapsone hypersensitivity syndrome who presented to emergency with fever, jaundice, maculopapular rash, deranged LFT and methemoglobinemia following use of dapsone for 5 weeks duration.