IntroductionDrug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but life-threatening reaction to drugs such as carbamazepine and allopurinol. The condition is characterized by skin rashes, fever, hematological disturbances, lymphadenopathy, and organ failure, most probably hepatic dysfunction. To date, only a few cases of valproate-induced DRESS syndrome have been reported.Case PresentationWe report on the case of a 60-year-old man who had been treated with valproic acid some time before being referred to Kowsar Hospital, Semnan, Iran in December 2015. He was given valproic acid 1000 mg PO, and after 20 days, he had developed widespread rashes, fever, esophagitis, cervical lymphadenopathy, and tender hepatomegaly. Laboratory results at Kowsar showed a drop in hemoglobin, in addition to lymphocytosis, thrombocytopenia, and elevated serum transaminases. DRESS was diagnosed, and corticosteroid therapy was initiated. Administration of the culprit drug to the patient was also stopped. Intravenous immunoglobulin (IVIG) improved the general condition of the patient.ConclusionsOnly a small number of case reports have described valproic acid-induced DRESS syndrome; therefore, the condition is difficult to prevent. Rechallenge with valproic acid should be avoided in patients with a history of reaction to the drug.
Introduction: The relationship between vitamin D deficiency and thyroid gland disorders is controversial. Objectives: Given the prevalence of vitamin D deficiency and the significance of thyroid disorders, the purpose of the study was to examine the relationship between anti-thyroid peroxidase (anti-TPO) antibody and vitamin D deficiency. Patients and Methods: This cross-sectional study was conducted on 35 patients with vitamin D deficiency and 35 people as a control group with normal vitamin D considered more than 20 ng/mL. Serum TSH and anti-TPO antibody tests were assessed for all subjects in both groups. The level of 25 [OH] D3 less than 20 ng/mL was considered as the deficiency of vitamin D and the serum level of anti-TPO antibody more than 40 IU/mL as positive level. Results: Mean age of patients with vitamin D deficiency was 37.00 ± 13.8 years and 46.3 ± 15.9 years in the control group. Mean age in the two groups was different (P=0.010). Around 51.4% of patients had vitamin D deficiency. There were no significant differences in TSH level among the groups (P=0.436). Anti-TPO antibody (anti-TPO Ab) level in 31.4% of the patients with vitamin D deficiency and in 11.4% of patients in the control group was positive with a significant difference (P=0.041). Logistic regression analysis showed the chance of positive anti-TPO Ab in people with vitamin D deficiency was 3.55% of the subjects without vitamin D deficiency (OR = 3.55, 95%, CI: 1.01-12.55, P=0.049). Conclusion: Considering the greater chance (three-fold) of positive anti-TPO Ab titers in patients with vitamin D deficiency in this study, more interventional studies are suggested concerning the effect of vitamin D deficiency on anti-TPO Ab.
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