A 34-year-old man presented with an out-of-hospital cardiac arrest shortly after dermal exposure to tetramethylammonium hydroxide (TMAH). The patient was accidentally exposed to 2.38% TMAH despite the use of personal protective equipment and was referred to our emergency department one hour after the exposure. He was resuscitated using advanced cardiac life support and intensive care. However, he remained unconscious despite target temperature management. Second-degree chemical burns were found on 10% of his total body surface area. Brain magnetic resonance imaging showed severe anoxic-ischemic encephalopathy involving bilateral supratentorial grey matter. TMAH was detected in the patient’ s blood and urine. To the best of our knowledge, this is the first report of the identification of TMAH in the serum and urine after exposure to the agent. Previous cases of cardiac arrest reported were due to exposure to high concentrations of 25% TMAH. We postulate that even low concentrations of TMAH could be absorbed rapidly after dermal exposure and can have fatal consequences.

PURPOSE: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have difficulty in sputum expectoration. METHODS: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and immunologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB-suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum specimen or in the bronchial washing fluid. RESULTS: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the remaining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the sputum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tuberculosis. None of the patients had significant complications due to bronchoscopy. CONCLUSION: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspecting PTB in children who have difficulty expectorating sputum.
Bronchoscopy* ; Child* ; Diagnosis ; Diagnosis, Differential ; Diagnostic Imaging ; Drug Resistance ; Humans ; Isoniazid ; Mycobacterium tuberculosis ; Mycoplasma ; Pneumonia ; Prothionamide ; Pulmonary Medicine ; Sputum* ; Tertiary Care Centers ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary*

Linezolid is an antibiotic in the oxazolidinone family that works as a bacterial protein synthesis inhibitor. It is used for the treatment of Gram-positive, multidrug-resistant bacteria. Adverse effects of linezolid include bone marrow suppression, peripheral or optic neuropathy, and, less commonly, lactic acidosis. Lactic acidosis usually occurs as a result of cardiopulmonary failure or sepsis, but it is sometimes caused by drugs, such as linezolid, and treatment of such lactic acidosis involves cessation of the drug. We report a case of lactic acidosis caused by the use of linezolid for the treatment of persistent methicillin-resistant Staphylococcus aureus bacteremia, which occurred after endoscopic sclerotherapy of gastic varices.
Acetamides ; Acidosis, Lactic ; Bacteremia ; Bacteria ; Bacterial Proteins ; Bone Marrow ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Optic Nerve Diseases ; Oxazolidinones ; Sclerotherapy ; Sepsis ; Varicose Veins ; Linezolid

Linezolid is an antibiotic in the oxazolidinone family that works as a bacterial protein synthesis inhibitor. It is used for the treatment of Gram-positive, multidrug-resistant bacteria. Adverse effects of linezolid include bone marrow suppression, peripheral or optic neuropathy, and, less commonly, lactic acidosis. Lactic acidosis usually occurs as a result of cardiopulmonary failure or sepsis, but it is sometimes caused by drugs, such as linezolid, and treatment of such lactic acidosis involves cessation of the drug. We report a case of lactic acidosis caused by the use of linezolid for the treatment of persistent methicillin-resistant Staphylococcus aureus bacteremia, which occurred after endoscopic sclerotherapy of gastic varices.
Acetamides ; Acidosis, Lactic ; Bacteremia ; Bacteria ; Bacterial Proteins ; Bone Marrow ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Optic Nerve Diseases ; Oxazolidinones ; Sclerotherapy ; Sepsis ; Varicose Veins ; Linezolid

BACKGROUND: Limited data are available for the clinical utility of serial interferon-gamma producing T-cell response after initiation of treatment in patients with extrapulmonary tuberculosis (TB). We studied the serial TB-specific antigen T-cell responses measured using the T-SPOT.TB assay during the course of therapy. MATERIALS AND METHODS: We prospectively enrolled adult patients who were newly diagnosed with active extrapulmonary TB over a 24-month period. All patients were given standard anti-TB treatment. Blood samples were obtained for T-SPOT.TB at diagnosis, as well as 1-, 3-, 6-, and 12-months after initiating anti-TB therapy. RESULTS: A total of 52 patients with extrapulmonary TB (38 confirmed and 14 probable TB) were included in the final analysis. All patients had clinical and radiologic improvement after treatment and cured. T-SPOT.TB was positive for 90% at diagnosis, 100% at 1-, 3-, and 6-months, and 93% at 12-months after initiation of anti-TB therapy. There was no significant difference in median T-cell response between early secreting antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) at all time points. Median T-cell response steadily increased up to 6 months and then decreased. CONCLUSIONS: T-SPOT.TB assay remained positive after successful anti-TB treatment in most patients with extrapulmonary TB. Our data suggests that serial T-SPOT.TB has limited clinical utility as a surrogate marker of treatment response in patients with extrapulmonary TB.
Adult ; Biomarkers ; Enzyme-Linked Immunosorbent Assay ; Humans ; Interferon-gamma ; Prospective Studies ; T-Lymphocytes ; Tuberculosis