Severe acquired hemophilia with factor VIII inhibition associated with acetaminophen and chlorpheniramine.

Objective: To report a case of acquired hemophilia with a high-titer factor VIII inhibitor associated with the use of acetaminophen and chlorpheniramine in combination.

Case Summary: An 83-year-old woman presented with a severe bleeding disorder 2 weeks after she was prescribed acetaminophen and chlorpheniramine for treatment of a flu-like illness. Laboratory studies showed severe anemia with greatly reduced factor VIII activity and the presence of a high-titer factor VIII inhibitor at 228 Bethesda units.

Flutamide-associated acute liver failure.

The nonsteroidal antiandrogenic drug flutamide [4'-nitro-3'-(trifluoromethyl)isobutyranilide] is a safe and generally well-tolerated drug used for the treatment of prostate cancer. We describe the case of a 74-year-old male who developed life-threatening acute liver failure during flutamide therapy. Other causes of acute liver failure were appropriately ruled out and there was no evidence of active prostate cancer or liver metastases.

Kikuchi Fujimoto lymphadenitis: case report and literature review.

We describe a young woman with two severe episodes of Kikuchi Fujimoto disease occurring 16 years apart. Both episodes were proven by biopsy, and on the second occasion the patient remained dependent on high-dose prednisone for more than 6 months in order to control inflammation and achieve a reduction in cervical lymph node size. The second lymph node biopsy showed leukocytoclastic vasculitis in addition to the typical features of Kikuchi Fujimoto disease, but, even though the clinical interpretation of this finding was unclear, we documented no clinical or laboratory evidence of the development of other serious systemic disease over 20 years of follow-up.

Jaundice and the sepsis syndrome: a neglected link.

The relationship between the sepsis syndrome and the development of jaundice is intriguing, with jaundice having been described as the presenting sign of septicaemia in very few cases. We describe a patient who developed a deep jaundice with conjugated hyperbilirubinaemia caused by Staphylococcus aureus during the early course of septicaemia, when no other sign of the sepsis syndrome could be recognised. It is generally accepted that a mild jaundice may complicate the course of the sepsis syndrome, but it is most unusual to observe such a protracted phase of jaundice before the emergence of other specific clinical signs and laboratory abnormalities.

[Primary plasma cell leukemia. A fulminant case].

Primary plasma cell leukemia is a rare variant of malignant monoclonal gammapathies with de novo presentation in the leukemic phase. Only few series enrolling more than 20 patients have been reported in the literature. The authors deal with a patient who had a fulminant presentation of primary plasma cell leukemia with fatal outcome.

Catastrophic antiphospholipid syndrome in a patient with Behçet's disease.

We report on a patient who had a life-threatening relapse of Behçet's disease associated with a catastrophic antiphospholipid syndrome. The patient experienced over a short time a recurrent acute myocardial infarction, multiple venous thromboses, uveitis, and erythema nodosum. Search for thrombophilic factors was positive only for lupus anticoagulant (LAC) and criteria for the diagnosis of the antiphospholipid antibody syndrome were fulfilled.