A CASE OF ORF VIRUS HUMAN ECTHYMA CONTAGIOSUM AFTER EID ALADHA RELIGIOUS PRACTICES M. Manolas; S. Lee; J. Dwyer; E. Swiatlo Department of Internal Medicine, Tulane Health Sciences Center, New Orleans Orf virus, also known as ecthyma contagiosum and a member of the Parapoxvirus genus, is a contagious zoonotic infection acquired through contact with infected goats or sheep in conjunction with skin trauma. Orf virus in humans usually manifests as a pustular dermatitis that evolves through six clinical stages, each lasting about one week and ending in resolution. We present the case of a 45-year-old Moroccan-born man who developed multiple painful erythematous-violaceous ulcers of the hands after incurring a knife injury while butchering a goat to celebrate the Muslim feast Eid al-Adha. The diagnosis of Orf was established based on epidemiologic risk factors, histopathology, and classic skin lesions.
WHEN TWO DRUGS ARE BETTER THAN DOUBLE OF ONE: A CASE OF PHENYTOIN TOXICITY. T. Weiss; C. Talley; S. Stender; D. Matrana; S. Holloway; T. Joshi; S. Sanne Department of Internal Medicine, LSU Health Sciences Center - New Orleans Introduction: Phenytoin has a relatively broad therapeutic range, so toxicity is not seen often. Due to the broad therapeutic range and the infrequency of toxicity, not much is known about the presentation and management of phenytoin toxicity. Below is a presentation of a patient who presented with acute phenytoin toxicity. Case: 31 year old man with a past medical history of a seizure disorder and vertigo secondary to a traumatic brain injury from a motor vehicle accident presented to the Emergency Department with the primary complaint of dizziness. He had ataxic gait, horizontal nystagmus, abdominal pain, nausea and vomiting. His home medications included phenytoin, zonisamide, cyanocobalamin, Depakote, and ergocalciferol. On admission, it was discovered that the patient had run out of his zonisamide, so he had been taking double doses (300mg BID) of the phenytoin for the past couple of days. As a result, his blood phenytoin levels were supra-therapeutic at a 55.8 μg/ mL (normal therapeutic range is 10-20 μg/mL). The patient’s vital signs were within normal limits. EKG showed sinus bradycardia but normal intervals and QT interval. His potassium was slightly low at 3.4 mmol/L, and his glucose was slightly elevated at 103 mg/dL. His liver enzymes and renal function were within normal limits. CT scan of the head on admission showed no acute infarct, intracranial hemorrhage, or mass lesion. Discussion: Phenytoin is known to have a half-life of at least 48 hours, so it could be expected that it would take time for the Phenytoin level to drop to a therapeutic range of 30 or below. In this case, the values dropped very gradually, and even increased on the second day. On researching the pharmacokinetics of phenytoin, it was discovered that after oral ingestion of phenytoin, the drug continues to be absorbed in the GI tract for up to 60 hours. Additionally phenytoin circulates in the blood with 90% bound
lesion was thought to be associated with the working diagnosis of possible lymphoma. It is likely she may have had pyomyositis of the gastrocnemius resulting in transient bacteremia with hematogenous seeding to the spleen. Her recent diagnosis of diabetes mellitus, with a hemoglobin A1C of 11 is likely her risk factor. It is unusual that she did not have any fever, abdominal symptoms or culture positive bacteremia given the appearance of her abscess. While antibiotics and percutaneous drainage have been successful in other cases, her abscess was loculated and extensive which was why the decision was made for total splenectomy. She did well post operatively and after completion of antibiotics.
31 J LA MED SOC | VOL 171 | NO. 1
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