A 24-year-old male with a history of spondyloarthropathy presented with high fever, cervical lymphadenopathy and generalized maculopapular rash. He was treated with prednisolone for chronic uveitis before being switched to sulfasalazine 3 weeks prior to admission. Laboratory findings revealed marked leukocytosis with frequent atypical lymphocytes. Sulfasalazine was discontinued and the etiology of mononucleosis syndrome explored. During admission, he developed acalculous cholecystitis and hypotension. All symptoms quickly improved following administration of systemic corticosteroids. The investigation for infectious mononucleosis yielded negative results and a diagnosis of sulfasalazine-induced hypersensitivity syndrome was confirmed using enzyme-linked immunospot assays.
Acalculous Cholecystitis ; Adrenal Cortex Hormones ; Drug Hypersensitivity ; Enzyme-Linked Immunospot Assay ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Hypotension ; Infectious Mononucleosis ; Leukocytosis ; Lymphatic Diseases ; Lymphocytes ; Male ; Prednisolone ; Spondylarthropathies ; Sulfasalazine ; Uveitis ; Young Adult

A 24-year-old male with a history of spondyloarthropathy presented with high fever, cervical lymphadenopathy and generalized maculopapular rash. He was treated with prednisolone for chronic uveitis before being switched to sulfasalazine 3 weeks prior to admission. Laboratory findings revealed marked leukocytosis with frequent atypical lymphocytes. Sulfasalazine was discontinued and the etiology of mononucleosis syndrome explored. During admission, he developed acalculous cholecystitis and hypotension. All symptoms quickly improved following administration of systemic corticosteroids. The investigation for infectious mononucleosis yielded negative results and a diagnosis of sulfasalazine-induced hypersensitivity syndrome was confirmed using enzyme-linked immunospot assays.
Acalculous Cholecystitis ; Adrenal Cortex Hormones ; Drug Hypersensitivity ; Enzyme-Linked Immunospot Assay ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Hypotension ; Infectious Mononucleosis ; Leukocytosis ; Lymphatic Diseases ; Lymphocytes ; Male ; Prednisolone ; Spondylarthropathies ; Sulfasalazine ; Uveitis ; Young Adult

INTRODUCTIONHealthy individuals may be exposed and sensitised to allergens, and have a positive response to a skin prick test despite being asymptomatic. The objectives of this study were to evaluate the prevalence of atopic sensitisation and identify the reactivity of healthy volunteers to common aeroallergens.

METHODSHealthy volunteers with no known allergic symptoms were recruited in this study. All volunteers were scheduled to undergo a skin prick test with 16 common aeroallergens that were previously identified among atopic patients.

RESULTSA total of 100 volunteers (mean age 28 years) were enrolled in this study. 42 volunteers had positive skin prick tests for at least one allergen. The median number of sensitised allergen was 2 (range 1-7). Volunteers with positive skin tests (n = 42) were younger than those with negative skin tests (n = 58) (mean age 25.5 vs. 29.2 years; p < 0.05). The group with positive skin tests also had a higher proportion of males (57.1% vs. 31.0%; p < 0.01) and first-degree relatives with a history of atopic diseases (31.0% vs. 10.3%; p < 0.05). The most common sensitised allergens in these healthy asymptomatic volunteers were mite (n = 33), house dust (n = 23) and American cockroach (n = 20).

CONCLUSIONIn this study, up to 42% of healthy volunteers, particularly those with a family history of atopy, were sensitised to allergens. Reactivity of the skin test without allergic symptoms, however, does not indicate allergic disease. Therefore, the skin test should only be indicated in atopic symptomatic individuals.

Adult ; Allergens ; chemistry ; Animals ; Cockroaches ; Cross-Sectional Studies ; Dermatitis, Atopic ; diagnosis ; immunology ; Dust ; Female ; Healthy Volunteers ; Humans ; Hypersensitivity ; diagnosis ; immunology ; Male ; Middle Aged ; Mites ; Skin Tests ; methods ; Young Adult

Asia is one of the most diverse and dynamic continents. Due to recent rapid industrialisation and urbanisation, morbidity patterns are likely to be diverse in Asian populations. Chronic cough is a disease condition resulting from host-environmental interactions, and is associated with a high global epidemiological burden. However, the underlying epidemiology remains unclear, particularly in Asia. We performed a literature search to identify peer-reviewed articles on chronic cough in community-based adult Asian populations that have been published between January 2000 and June 2015. In this review, we aim to examine the epidemiological characteristics and determinants of chronic cough in several geographical areas of Asia.
Adult ; Asia ; Asian Continental Ancestry Group ; Cough ; Epidemiology ; Humans ; Risk Factors

Lamotrigine is a recent medication which is prescribed for various neuropsychiatric conditions. It is generally well-tolerated, but recent pharmacoepidemiological evidence suggests that lamotrigine is associated with risks of developing severe cutaneous drug reactions like toxic epidermal necrolysis (TEN). However, there still remains the diagnostic challenge regarding how to confirm the drug causality in suspected cases. In most cases so far, lamotrigine causality has not been objectively demonstrated, which was possibly due to high risk of oral challenge tests or the lack of useful in vitro drug assays. Here we report a case of lamotrigine-induced TEN, of which the drug causality was confirmed by in vitro granulysin and cytokine assays.
Cyclosporine ; In Vitro Techniques ; Killer Cells, Natural ; Stevens-Johnson Syndrome