Drug hypersensitivity syndrome is characterized by fever, skin rash and internal organ involvement. It is commonly seen with aromatic group of anticonvulsants viz. phenytoin, carbamazepine and phenobarbitone. Here, we report a case of hypersensitivity reaction to pregabalin, used for treating postherpetic neuralgia.

BackgroundCoronavirus disease 2019 (COVID-19) infection is associated with troponin elevation, which is associated with increased mortality. However, it is not clear if troponin elevation is independently linked to increased mortality in COVID-19 patients. Although there is considerable literature on risk factors for mortality in COVID-19-associated myocardial injury, the Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI), and Sequential Organ Failure Assessment (SOFA) scores have not been studied in COVID-19-related myocardial injury. This data is important in risk-stratifying COVID-19 myocardial injury patients.

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Introduction: COVID-19 infection is associated with troponin elevation, which is associated with increased mortality. We wanted to evaluate whether troponin levels, GRACE scores, and TIMI scores were independently associated with mortality in COVID-19 patients. Methods: Out of 1500 COVID-19 patients admitted to our hospitals, 217 patients with troponin levels were included. Key variables were collected manually, and survival analysis was done. Results: Mortality was 26.5% in the normal troponin group and 54.6% in the elevated troponin group. Patients with elevated troponins had increased frequency of hypotension (P=0.01), oxygen support (P<0.01), low absolute lymphocyte count (P<0.01), elevated blood urea nitrogen (P<0.01), higher C-reactive protein (P<0.01), higher D-dimer (P<0.01), higher lactic acid (P<0.01), and higher qSOFA, SOFA, TIMI, and GRACE scores (all scores P<0.01). On cox regression, troponin elevation (HR 1.85, 95% CI 1.18-2.88, P<0.01), TIMI score >3 (HR 1.79, 95% CI 1.11-2.75, P=0.01), GRACE score >140 (HR 2.27, 95% CI 1.45-3.55, P<0.01) were highly associated with mortality whereas cardiovascular disease (HR 1.40, 95% CI 0.89-2.21, P=0.129) and cardiovascular risk factors (HR 1.15, 95% CI 0.73-1.81, P=0.52) were not. We created four separate multivariate cox regression models for troponin, GRACE score, TIMI score, and SOFA score while adjusting for age, use of non-rebreather or high flow nasal cannula, hemoglobin<8.5, suspected or confirmed source of infection, and qSOFA score. GRACE (HR 1.02, 95% CI 1.01-1.04, P<0.01) and SOFA scores (HR 1.19, 95% CI 1.08-1.31, P<0.01) were independently associated with mortality whereas Troponin (HR 1.08, 95% CI 0.63-1.85, P=0.76) and TIMI score (HR 1.02, 95% CI 0.99-1.06, P=0.12) were not. SOFA scores are positively correlated with GRACE scores (r=+0.39). Conclusion: Troponin elevation in COVID-19 patients is mostly due to demand ischemia rather than acute coronary syndrome-related. This was shown by the association of troponin with a higher degree of systemic inflammation and end-organ dysfunction. We recommend SOFA scores and GRACE scores in risk stratifying COVID-19 patients with myocardial injury.