Two young women, were reffered to our hospital on two different occasions with history of breathlessness and mental confusion, following consumption of two different bio-organic plant nutrient compounds with a suicidal intent. On examination, they had cyanotic mucous membranes, and their blood samples showed the classic ‘dark chocolate brown’ appearance. Work up revealed cyanosis unresponsive to oxygen supplementation and absence of cardiopulmonary abnormality. Pulse oximetry revealed saturation of 75% in case 1 and 80% in case 2, on 8 liters oxygen supplementation via face masks, although their arterial blood gas analysis was normal, suggestive of “saturation gap”. Methemoglobinemia was suspected based on these findings and was confirmed by Carbon monoxide-oximetry (CO-oximetry). Methylene blue was administered and the patients showed dramatic improvement. Both the patients developed evidence of hemolysis approximately 72 hours following admission which improved with blood transfusion and supportive treatment. The patients were eventually discharged without any neurological sequalae.

No abstract

Fixed drug eruption (FDE) is an unusual adverse effect of any drug, especially antibiotics like clarithromycin. Herein we report a case of clarithromycin induced FDE in a 30-year-old man who presented with recurrent erythematous and pruritic cutaneous lesions on the lower lip, right hand and left thigh. The lesions were initially misdiagnosed as lichen planus and treated with topical steroids. Each recurrence was at the same site and the lesions faded within 2 weeks leaving behind violacceous pigmentation. All the cutaneous lesions were reproduced following an oral provocation test thus confirming the diagnosis of clarithromycin induced FDE, which is a rare occurrence. When it does occur, it is often misdiagnosed, so physicians should be aware of this condition in order to prevent future recurrences as it causes a lot of cosmetic and physical discomfort to the patient.

Though agranulocytosis is a well known adverse effect of antithyroid drugs (ATDs), aplastic anemia is thought to be rare. Herein we present a case report of carbimazole induced aplastic anemia in a patient of Grave's disease, who satisfied all the criteria for severe disease and had profound bone marrow hypoplasia. Drug induced aplastic anemia is thought to be a result of an idiosyncratic response directed against hematopoietic stem cells and is managed in a similar fashion to idiopathic aplastic anemia. The hematopoietic damage in our patient did not recover following ATD withdrawal and supportive treatment. This necessitated the use of immunosuppressive therapy with cyclosporine and antithymocyte globulin, which she could not afford and despite of all the supportive treatment she eventually succumbed to severe sepsis. Since ATDs are commonly used in clinical practice, the physicians should be aware of this rare but lifethreatening complication.