Category: Allergy-Immunology

Author: Jared Scott, MD

Educational Pearls:

• Scombroid is a type of food poisoning associated with dark fish (i.e. tuna, salmon, mackerel) that mimics anaphylaxis.

• Occurs through conversion of histidine to histamine by bacteria in the fish.

• Symptoms include flushing, lips swelling, nausea, diarrhea in setting of recent fish consumption.

• Treat with antihistamines.

 

References

Ridolo E, Martignago I, Senna G, Ricci G. Scombroid syndrome: it seems to be fish allergy but… it isn’t. Curr Opin Allergy Clin Immunol. 2016. 16(5):516-21. doi: 10.1097/ACI.0000000000000297.

Patterson R, Little B, Tolan J, Sweeney C. How to manage a urinary catheter balloon that will not deflate. Int Urol Nephrol. 2006;38(1):57-61. Review. PubMed PMID: 16502053

Author: Nick Hatch, MD

Educational Pearls:

• Behcet Disease is an autoimmune disease that can affect any organ system.

• Typical symptoms include recurrent oral and genital ulcers, but more concerning features include skin rashes, ocular problems, and strokes.

• Patients with Behcet disease with hypotension should have low threshold for giving steroids.

References:

Arlt W, Allolio B. Adrenal insufficiency. Lancet, 2003; 361:1881.

Sakane T, Takeno M, Suzuki N, Inaba G. Behçet’s disease. New England Journal of Medicine. 1999; 341:1284.

Author: Sam Killian, M.D.

Educational Pearls

• Anaphylaxis is common in the ED. These patients are treated and then usually watched for 4-6 hours.
• Biphasic happens in patients that have a complete resolution of their anaphylaxis  for at least an hour, but then have a recurrence that requires pharmacologic  intervention. Most of the time this happens 3-6 hours later, but can happen more than 10 hours later.
• More commonly happens in patients that have a delayed presentation,  a wide pulse pressure, need multiple doses of epi, require the use of  a beta agonist, or are ages 6-9 years old.
• Educate patients about the possibility of Biphasic anaphylaxis before discharge. 

 

Check out this episode!

Run Time:  5 minutes

Author: Peter Bakes M.D.

Educational Pearls:

• Case presentation: 18 year old otherwise healthy male presents to the ED complaining of neck stiffness, headache, and right ankle irritation. The patient recently traveled to Italy in an area endemic of Lyme Disease. The patient 2 weeks prior had a viral infection w/ rhinorrhea and diarrhea. The patient was diagnosed the previous day with a “UTI” and is currently taking antibiotics.
• Other important information that would be useful for evaluation would be a prior evaluation for lyme, known pre-existing joint processes, and previous rheumatoid history.
• The patient had no rash on exam, no associate features of lyme, and no bacteria in the urine, but had noted unilateral conjunctivitis, and a red, inflamed ankle joint.
• Possible causes of presentations of one red, warm, inflamed painful joint: Gouty arthritis, pseudogout, septic joint, lyme arthritis, acute on chronic arthritis, and reactive arthritis.
• This patient was diagnosed with Reiter’s syndrome now known as a reactive arthritis – an antibody response to an infection. Classically presents as a genitourinary or gastrointestinal infection in a young male with the clinical triad of urethritis, conjunctivitis, and arthritis a few weeks after an infection.

Link to Podcast: http://medicalminute.madewithopinion.com/reiter-s-syndrome/

References: http://www.aafp.org/afp/2003/0701/p83.html