A 33‐year‐old Malay female presented to our clinic for the evaluation of nail pigmentation. She had been diagnosed with essential thrombocytosis 2 years previously, but had failed to return for follow‐up. She presented again to the hematology department with symptoms of giddiness, blurring of vision, and left‐sided weakness and was started on hydroxyurea 3 g/day. Hydroxyurea was stopped after 1 month of administration because of pancytopenia. Concurrent medications taken included anagrelide, buscopan, allopurinol, omeprazole, and sangobion. None of these medications are known to cause nail pigmentation. She first presented to our department when she noticed nail pigmentation 7 weeks after starting hydroxyurea, but was otherwise well. There were no other cutaneous features of hyperpigmentation. Clinical examination revealed transverse bands which were seen on all 20 nails. These involved the proximal half of the fingernails and the proximal third of the toenails and were colored brown (see Fig. 1). 1 Transverse bands on all 10 fingernails 9 weeks after the commencement of hydroxyurea therapy

Herpes simplex virus (HSV) and varicella zoster virus (VZV) are related members of the Herpesviridae family and are well-documented human pathogens causing a spectrum of diseases, from mucocutaneous disease to infections of the central nervous system. This study was carried out to evaluate and validate the performance of a multiplex real-time polymerase chain reaction (PCR) assay in detecting and differentiating HSV1, HSV2, and VZV from clinical samples. Consensus PCR primers for HSV were designed from the UL30 component of the DNA polymerase gene of HSV, with 2 separate hydrolysis probes designed to differentiate HSV1 and HSV2. Separate primers and a probe were also designed against the DNA polymerase gene of VZV. A total of 104 clinical samples were available for testing by real-time PCR, conventional PCR, and viral culture. The sensitivity and specificity of the real-time assay was calculated by comparing the multiplex PCR result with that of a combined standard of virus culture and conventional PCR. The sensitivity of the real-time assay was 100%, with specificity ranging from 98% to 100% depending on the target gene. Both PCR methods detected more positive samples for HSV or VZV, compared with conventional virus culture. This multiplex PCR assay provides accurate and rapid diagnostic capabilities for the diagnosis and differentiation of HSV1, HSV2, and VZV infections, with the presence of an internal control to monitor for inhibition of the PCR reaction.

No abstract

Introduction: A 22-year-old Malay soldier developed dapsone hypersensitivity syndrome 12 weeks after taking maloprim (dapsone 100 mg/pyrimethamine 12.5 mg) for anti-malarial prophylaxis. Clinical Picture: He presented with fever, rash, lymphadenopathy and multiple organ involvement including serositis, hepatitis and thyroiditis. Subsequently, he developed congestive heart failure with a reduction in ejection fraction on echocardiogram, and serum cardiac enzyme elevation consistent with a hypersensitivity myocarditis. Treatment: Maloprim was discontinued and he was treated with steroids, diuretics and an angiotensin-converting-enzyme inhibitor. Outcome: He has made a complete recovery with resolution of thyroiditis and a return to normal ejection fraction 10 months after admission. Conclusion: In summary, we report a case of dapsone hypersensitivity syndrome with classical symptoms of fever, rash and multi-organ involvement including a rare manifestation of myocarditis. To our knowledge, this is the first case of dapsone-related hypersensitivity myocarditis not diagnosed in a post-mortem setting. As maloprim is widely used for malaria prophylaxis, clinicians need to be aware of this unusual but potentially serious association. Key words: Anti-malarial, Exanthema, Myocardium, Thyroiditis

No abstract