Funtabulously Frivolous Friday Five 151
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF, introducing the Funtabulously Frivolous Friday Five 151
Question 1
Your house surgeon, having just reversed a patient on unfractionated heparin with haematemasis is agitated because the patient has “sulphur drugs – anaphylaxis” as an allergy alert and you’ve just given them protamine sulphate! Is it time to grab the adrenaline? Is this allergy relevant for protamine sulphate? What about furosemide – which is derived from the sulfonamides and contains a sulphur group?
Reveal the funtabulous answer
Patients who have “sulphur drug allergy” typically have had reactions to sulfonamide antibiotics.
It is possibly the arylamine group in the sulfonamides that is responsible for the allergic response. While many drugs contain a sulfonamide moiety, they don’t contain the arylamine group.
There is limited evidence to support true cross-reactivity between the sulfonamide antibiotics and non-antibiotic sulfonamides (e.g furosemide).
Sulfhydryl and sulfate drugs have no relationship to sulfonamide allergy and there is no evidence to support cross-reactivity. You can put away that adrenaline now….
Question 2
Your colleague has been reading the “mystery of the purple spotted pillowcase”, “the case of the red lingerie” and “the mystery of the blue girl”. What specialty is he in and what condition has led him to this reading material?
Reveal the funtabulous answer
Dermatology
These are all case reports of chromhidrosis – or coloured sweat.
A classification system based on the sweat glands has been proposed; apocrine chromohidrosis, eccrine chromohidrosis and pseudochromhidrosis.
The pathophysiology of apocrine chromhidrosis is unclear, but it is postulated that oxidized lipofuscin is the responsible pigment.
Eccrine chromohidrosis is due to water-soluble pigments being excreted via the eccrine glands. There have been cases of this with quinine, various dyes in the coating of tablets, and food pigments.
Pseudo-chromhidrosis is discolouration of the sweat from an exogenous source – typically caused locally by bacterial species like Corynbacterium and Pseudomonas.
- Cilliers J, de Beer C. The case of the red lingerie – chromhidrosis revisited. Dermatology. 1999;199(2):149-52.
Question 3
A tropical fish keeper comes in with uveitis. He’s 27 and has no past medical history and doesn’t take any medications. He had been well recently – other than coming off his bike while mountain biking in the outback. He’s particularly annoyed about that, as the multiple abrasions include a recently done tattoo on his right arm – which is now swollen and inflamed. You immediately hear the hoof-beats of zebras and think…?
Reveal the funtabulous answer
….of tattoo-associated uveitis.
A case series has reported uveitis associated with black ink used in tattoos. The uveitis occurs simultaneously with inflammation of the skin over the tattoo.
This condition responds to high-dose oral steroid.
- Ostheimer TA et al. Tattoo-associated uveitis. Am J Ophthalmol. 2014 Sep;158(3):637-43.e1.
Question 4
Who might suffer with tomomania?
Reveal the funtabulous answer
A surgeon! – a madness for cutting
It is an irrational desire to use operative procedures which can be by a doctor or a patient.
It is suspected in many avid plastic surgery enthusiasts. [Reference]
Question 5
What Split Enz song is a patient recovering from optic neuritis most likely to sing?
Reveal the funtabulous answer
FFFF
Funtabulously Frivolous Friday Five
Medical Registrar fascinated by the quirky history of medicine and those crazy microbes.