Lindane (Kwell)-induced aplastic anemia

Article Abstract:

Aplastic anemia, a deficiency of the essential elements of the blood, results from a failure of the bone marrow to generate cells. This condition may be caused by disease of the bone marrow, exposure to toxic chemicals or ionizing radiation, or some antibiotics (for example, chloramphenicol, an antibiotic, or chlorothiazide, a diuretic), or other medications. The risk is related to the number of times a person is exposed, as well as to interaction with other drugs, the schedule of administration, and the dose. Aplastic anemia is potentially fatal. Lindane, used as an insecticide since the 1940s, is the active ingredient in Kwell, a product commonly used to rid the hair and scalp of head lice (pediculosis). Several cases of aplastic anemia have been reported with the use of lindane as an insecticide, but this is the first case in the literature of a case associated with lindane at a level of one percent. However, transient mild reductions in the number of all the cellular elements of the blood (pancytopenia) have been reported. Lindane can be absorbed through the digestive system, the skin, and the respiratory tract. The mechanism causing aplastic anemia is not known, but certain conditions may predispose a patient to it, including an abnormal immune condition. In this case, the patient had applied Kwell from his neck to his knees twice daily for three weeks, and he thus absorbed an enormous quantity of the chemical. Three years later the patient is still being followed-up as an outpatient, and he has not required any transfusions for 20 months. His white and red cell counts are normal, and his platelet counts have improved somewhat. This case illustrates the importance of obtaining a thorough drug history and the importance of instructing the patient on the correct use of a product. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Pediculosis, Lindane, Aplastic anemia, Kwell (Medication)

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Ceftriaxone therapy of chronic inflammatory arthritis: a double-blind placebo controlled trial

Article Abstract:

Chronic inflammatory arthritis is commonly treated with anti-inflammatory agents. If it were definitely known that there was a bacterial infection associated with chronic inflammatory arthritis, treatment would focus more on specific antibiotics and less on treating the inflammation. The results of culturing bacteria from the joints of arthritic patients and treatment with antibiotics have been disappointing, however. Recent evidence has pointed to the role of chronic bacterial infection as a cause of arthritis. One example is Lyme disease, a bacterial infection that causes chronic inflammatory arthritis and responds to antibiotics, and yet the causative bacteria are difficult to culture from infected joints. Patients with Lyme disease infected with the causative organism, Borrelia burgdorferi, were studied. The antibiotic ceftriaxone was chosen because of its efficacy in treating Lyme disease. It was assumed that if the patients treated with ceftriaxone responded to treatment, antibiotics might possibly benefit other patients with arthritis. Overall, 27 of 58 patients treated with ceftriaxone improved. Only two of six patients with disease of less than one year's duration responded, while 9 of 16 who had arthritis for more than eight years responded. Although patients had positive antibody test results to Borrelia burgdorferi, it is possible that ceftriaxone affected other organisms that may have been responsible for the chronic inflammatory arthritis. It is also possible that ceftriaxone has some yet undefined anti-inflammatory properties. Nevertheless, ceftriaxone is a potent broad spectrum antibiotic that promoted improvement in many patients with chronic inflammatory arthritis who had antibodies to B. burgdorferi. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lyme disease, Ceftriaxone

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Methotrexate-associated, early-onset pancytopenia in rheumatoid arthritis

Article Abstract:

A patient with rheumatoid arthritis, an inflammation and degeneration of joints associated with pain, stiffness and decreased mobility, presented with pancytopenia three weeks after being started on methotrexate, a low-dose steroid medication designed to decrease inflammation. Pancytopenia is associated with decreased production of all blood cells. The patient had minimal loss of kidney function before methotrexate treatment and had received a non-steroidal anti-inflammatory medication at the same time. Patients who receive methotrexate therapy for rheumatoid arthritis should be monitored early for injury to the bone marrow which would cause the loss of blood cell production. This advice is especially pertinent for patients with risk factors for possible methotrexate toxicity.

Methotrexate

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