A Report on a patient with encephalopathy probably due to hypersensitive reaction of pyrindrug is presented. A 29-year-old man was admitted on August 18, 1961, with high fever and disturbances of consciousness. Because of fever with chill, he was given aspirin 1.0g and aminopyrin 0.3g daily for 4 days by his physician on August 14. On the next day a lot of urticaria-like skin eruptions with purpuric bleedings were found on his face, neck, chest and upper extremities, while he continued to have high fever and headache. Then, he was injected penicillin on August 16 and 17. The abnormal speech and behavior was observed by his family on August 17. He developed tonic convulsion followed by disturbances of consciousness on the day of admission. On admission he was found in a delirious state and urticaria-like skin eruptions with purpura were noted on a part of the upper body. The temperature was 39.5C; blood pressure 134/70. There were spot-like submucous bleedings on the eyelids and the mouth, and nothing particular in the chest and abdomen. The pupils were smaller in size and reacted slowly to light, corneal reflexes were absent.
Tendon reflexes of both lower extremities were overactive and pathologic reflexes on the left side were revealed. Leucocytes showed“shift to the left”; platlets count 39, 690; NPN 46.9 mg/dl; total cholesterol 105 mg/dl.
Erythrocyte sedimentation rate was accelerated moderately. No abnormalities were found in the urine and stool. The spinal fluid was slightly xanthochromic but clear with a initial pressure of 250 mm water. The cell count was 32/3, total protein 14 mg/dl, Nonne-Apelt 1+, and Pandy 2+. The test of Automatic nervous function was normal. Chest X-ray showed an exsudative focal shadow in the upper area of the left lung. Electrocardiogram was normal. Leucocytolysis was positive with aminopyrin (23.14%) and penicillin (19.16%) . After admission to the hospital, he was treated with predonisolone and antibiotics. Then the patient improved gradually since August 21, and recovered almost completely from symptoms on August 26. Hypersensitive reactions of pyrin drug are not uncommon, but most of these reactions are manifested by skinsymptoms, disturbances of the wall of blood vessels and/or blood dyscrasias.
Such serious cerebral symptoms due to hypersensitive reaction of pyrin drug, as in this patient, is quite rare. From the clinical course and examinations it was suggested that the clinical features of this patient might be caused circulatory disturbances, small and local bleedings or edema in the brain and meninges, resulting from disturbances of the wall of blood vessels and blood dyscrasias.
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