To study the local epidemiology and clinical presentation after ingestion of oral mucosal irritating plants. Methodology: Cases presenting with immediate oral mucosal irritation after plant product ingestion from July 2005 to June 2009 were retrieved from the Hong Kong Poison Information Centre's clinical database. Their clinical features and management were reviewed. Results: Thirty cases were retrieved and analysed, including 14 males and 16 females. Poisoning occurred all year round with no seasonal predilection. Vomiting and dysphagia were the two most common symptoms other than immediate oral mucosal irritation. Half of the cases could be managed with symptomatic treatment and discharged after a few hours of observation. Six patients presented with angioedema and were managed initially with the use of intravenous steroid, antihistamine and with or without adrenaline. Urgent airway assessment with laryngoscope was performed in 3 patients. No patient required endotracheal intubation. Conclusion: Oral mucosal irritating plant ingestion is not uncommon in Hong Kong. Its clinical feature can mimic angioedema on presentation. Immediate and localized oral mucosal symptoms after plant product ingestion are the key to diagnosis.
It is not uncommon for patients with shingles and renal failure who develop confusion during the course of therapy. The patient may have suffered from the adverse reaction of acyclovir or have the neurologic complication related to the dermatological herpes zoster. Acyclovir induced neurotoxicity and herpes encephalitis have similar clinical feature but their treatments are completely different. Often, doctors face challenges in differentiating the two conditions and the dilemma of whether to continue or stop acyclovir. We reported two cases of renal impairment patient who developed altered mental state after receiving oral acyclovir for the herpes skin lesion. One suffered from varicella encephalitis and the other had acyclovirinduced neurotoxicity. The difference in clinical features among the two conditions and the management of acyclovir-induced neurotoxicity was highlighted.
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