J Emerg Med
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Review Case Reports
Emergent "Bloody Diarrhea" Associated with the Use of Oral Cefdinir in Young Children: A Brief Report and Review of Literature.
Cefdinir is an extended-spectrum, third-generation, oral cephalosporin widely used in pediatric population to treat common bacterial infections, including otitis media and streptococcal pharyngitis. It is considered a safe and well-tolerated alternative to penicillin and macrolides. ⋯ This report describes a case series of 3 infants presenting to the emergency department for evaluation of "bloody diarrhea." The parents noticed red stools when their children were started on oral cefdinir when they were previously receiving iron-containing preparations. Reddish-colored heme-negative stools observed in all cases were due to the interaction of the drug with supplemental iron or iron-containing formula feeds. This adverse effect was reversible on discontinuation of cefdinir. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Red stools due to cefdinir is an underreported benign adverse drug reaction with fewer than 10 cases described in the literature. Thorough history taking with an appropriate focus on diet and drug history are essential to avoid parental anxiety, unnecessary patient workup, and economic burden to the caregivers in these cases. Awareness of this unusual adverse effect among emergency physicians could prevent further inconvenience for already overburdened health systems.
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The Omicron variant of SARS-CoV-2 has a predilection for the upper airways, causing symptoms such as sore throat, hoarse voice, and stridor. ⋯ Croup was prevalent during the Omicron wave, atypically affecting patients ≥6 years of age. COVID-19-associated croup should be added to the differential diagnosis of children with stridor, regardless of age. © 2022 Elsevier Inc.
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The emerging 2022 human mpox virus outbreak has presented with unique disease manifestations challenging prior case definitions. ⋯ We present a case of a 42-year-old transgender woman with human immunodeficiency virus controlled on antiretroviral therapy, presenting with sore throat, who, after three emergency department visits, was found to have acute tonsillitis complicated by airway obstruction secondary to mpox. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Sore throat is a common presentation to the emergency department. mpox should be placed on the list of differential diagnoses when evaluating patients who present with pharyngitis to avoid complications or a missed diagnosis.
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Vitamin B12, or cobalamin, is a nutrient that is vital for metabolic function. Absorption of ingested B12 is dependent on intrinsic factor, which is secreted by parietal cells within the stomach. Pernicious anemia is caused by an intrinsic factor deficiency or autoantibodies against intrinsic factor. The presence of parietal cell antibodies can destroy parietal cells, which can also lead to a deficiency in intrinsic factor. Both lead to megaloblastic anemia caused by vitamin B12 deficiency. The typical presentation of pernicious anemia includes fatigue, pale appearance, tingling sensation, depression, alterations to vision and smell, urinary incontinence, psychotic episodes, and weakness. The most effective treatment for pernicious anemia is intramuscular B12. ⋯ A 27-year-old woman with a history of vitiligo presented to the emergency department (ED) with bilateral lower extremity weakness, clumsiness, numbness, and tingling. Physical examination revealed ataxia, no sensation below her umbilicus, decreased strength, and hyperreflexia in both lower extremities. Complete blood count in the ED revealed low hemoglobin and hematocrit and elevated mean corpuscular volume, concerning for pernicious anemia. Further laboratory testing upon inpatient admission revealed a low vitamin B12 level and parietal cell antibodies in the blood. The patient's pernicious anemia was treated with intramuscular vitamin B12 injections, which led to near complete resolution of her symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early suspicion and detection of pernicious anemia in the ED can prevent serious and permanent hematologic and neurologic damage and the development of other autoimmune disorders.