A 70-year-old man was admitted to our clinic with complaints of fever, jaundice, dyspnea, and generalized rash after 3 months of allopurinol treatment for gout. On physical examination, he was found to have fever (38.5°C), jaundice, and generalized maculopapular rash. Leukocytosis, eosinophilia, elevation of liver enzymes, and hyperbilirubinemia were detected in his blood analysis. Skin biopsy was consistent with drug-induced hypersensitivity. He was diagnosed as Drug Rash with Eosinophilia and Systemic Symptoms (DRESS). Allopurinol treatment was stopped and steroid treatment was launched. At day 24 of admission, the patient died because of multiple organ failure.
The honey which is produced in the Blacksea Region of Turkey,also known as the 'mad honey', includes a toxin which was named Andromedotoxin. The toxin causes not only gastrointestinal but also cardiovascular side effects. This toxin (Andrometoxin) is derived from R.Luteum and R. Panticum which are the two members of Rhododendron plant family. In this study, we aimed to present a patient with typical poisoning findings after consuming mad honey. Keywords GirişBal zehirlenmesi nadir görülen bir gıda zehirlenmesi sebebidir. Türk halkı arasında deli bal olarak bilinen ve Türkiye' de Karadeniz bölgesinde dünyada ise Nepal, Brezilya ve Japonya' da üretilen balda bulunan Rhododendron Panticum (RP) ve Rhododendron Luteum (RL) isimli nektarların gastrointestinal sistem belirtilerinin yanında şiddetli kardiyovasküler sistem yan etkilerinin olduğu bilinmektedir. 1,2,3 Rhododendron cinsi bitkiler tarafından üreti-len Grayanotoksin (GT) toksisiteden sorumludur. 4,5 Semptomlar deli balın yenmesi sonrası ani olarak başlamakta ve sonlanması nadiren 24 saati geçmektedir. Bu yazıda acil servisimize nefes darlığı, göğüs ağrısı, baş dönmesi, bulantı ve terleme yakınmaları ile başvuran ve anamnezinde deli bal tüketimi saptanan olguyu sunmayı amaçladık.Olgu 63 yaşında bayan hasta, yaklaşık iki saat önce baş-layan nefes darlığı, göğüs ağrısı, baş dönmesi, bulantı ve terleme yakınmaları ile acil servisimize başvurdu. Hastanın acil servise başvurusunda genel durumu iyi, bilinci açık, koopere ve oryenteydi, kalp hızı 40 atım/dk, solunum sayısı 16/dk, ateş 37 °C ve kan basıncı 60/40 mmHg saptandı, diğer sistem muayeneleri normaldi. Elektorkardiyogramında sinüs bradikardisi (40 atım/dk) dışında özellik yoktu (Figür-1). Telekardiyografi normaldi. Anamnezinde yakın-maları başlamadan yaklaşık bir saat önce Karadeniz Böl-gesinden getirttiği baldan iki kaşık yediği ve yakınmalarının bundan sonra başladığı öğrenildi. Özgeçmişinde bilinen bir sağlık probleminin ve herhangi bir ilaç kullanımının olmadı-ğı öğrenildi. Hastanın deli balı tüketim öyküsünün olması ve tabloya ait karakteristik bulgular göz önüne alınarak tanı
Eosinophilic gastroenteritis (EGE) is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It can be seen anywhere in the gastrointestinal tract. It is diagnosed in the biopsies taken during endoscopic examination to the patients with abdominal pain and chronic diarrhea. A 40-year-old woman was admitted with abdominal pain and chronic diarrhea. She has not any disease, food, pollen, or drug allergy in her medical history. Leukocyte: 19,400/mm3 (neutrophil: 19.9%, eosinophil: 57.4%, lymphocyte: 16.5%), platelet: 281,000/ mm3, immunoglobulin E: 1721 IU/mL (normal range: 20–100 IU/mL) was counted in her blood examination. The duodenal biopsy was reported as EGE. We applied methylprednisolone 20 mg/day. With this treatment, the patient's symptoms regressed. In this article we present a case of chronic diarrhea diagnosed EGE. The first step in diagnosing is suspecting EGE. It should be borne in mind in patients with chronic diarrhea.
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