Hoigne syndrome

Neuropsychiatric diseases Hyperventilation Panic fear attacks Globus hystericus Anaphylaxis factitia Hoigne syndrome Epileptic cramps Apoplectic insult... 

The well-known adverse reaction formerly often observed after intramuscular injection of clemizol penicilUn in the treatment of syphilis with anaphylaxis-like symptoms plus CNS involvement in the absence of immimological sensitization to penicillin was called the Hoigne syndrome or embolic-toxic reaction, and might be explained by intravasal appUcation of LA with subsequent toxic effects [8]. 

Such reactions have been called pseudo-anaphylactic reactions or acute non-allergic reactions (174,208-210,219-223), panic attack syndrome, and acute psychotic reactions (212,224). In several countries, the term Hoigne syndrome is used. 

Silber TJ, D Angelo LJ. Panic attack following injection of aqueous procaine penicillin G (Hoigne syndrome) J Pediatr 1985 107(2) 314-15. 

Liver Liver impairment was reported in patient with systemic sclerosis after concomitant administration of bosentan and clarithromycin [125 ], Hoigne syndrome in a patient who took clarithromycin for rosacea [126" ], and cholestatic hepatitis in a 64-year-old patient who took clarithromycin for Helicobacter pylori eradication [127 ]. 

Rallis E, Moussatou V, Saltos L. aari-thromydn-induced Hoigne syndrome in a patient treated for rosacea. J Eur Acad Dermatol Venereol 2009 23(9) 1093-4. 

A peculiar neuropsychiatric reaction to intramuscular injection of procaine penicillin comprises fear of death and auditory and visual hallucinations. A widely supported theory claims that this so called Hoigne syndrome is an embolic-toxic reaction, but recent findings strongly suggest that free procaine, liberated in vivo, is responsible. In one study, 26 patients received 4.8 million units of procaine penicillin i.m. Immediately after injection the plasma procaine levels amounted to 6.6 ixglraX (3.6-11 /ug/ml) and dropped quickly to less than 1 jUg/ml in all cases within 30 minutes. One of these patients experienced auditory and visual hallucinations his zero-time level of procaine was 9.5 jug/ml. The observation that the same symptoms can be elicited by intravenous injection of procaine and also that the time sequence of the plasma procaine levels and of the symptoms coincide (since the latter too disappear in 30 minutes) clearly indicate procaine as the causative factor (13, W -). 

In contrast to hypersensitivity, other adverse reactions do not require sensitization and require similar doses of drug for recurrence. A special case is a syndrome (Hoigne s syndrome) that resembles an immediate allergic reaction combined with hallucinations, aggressive behavior, anxiety, and auditory and visual disturbances, which has been described after intramuscular procaine penicUhn and benzathine penicillin. It is probably due to accidental intravascular injection and results from micro-embohsm of the penicUhn depot formulation (271-275). 

Silber TJ, D Angelo L. Psychosis and seizures following the injection of peniciUin G procaine. Hoigne s syndrome. Am J Dis Child 1985 139(4) 335-7. 

Dry J, Leynadier F, Damecour C, Pradalier A, Herman D. Reaction pseudo-anaphylactique a la procaine-penicilline G. Trois cas de syndrome de Hoigne. [Pseudo-anaphylactic reaction to procaine-penicillin G. 3 cases of Hoigne s syndrome.] Nouv Presse Med 1976 5(22) 1401-3. 

Schmied C, Schmied E, Vogel J, Saurat JH. Syndrome de Hoigne ou reaction pseudo-anaphylactique a la procaine penicilline G un classique d actualite. [Hoigne s syndrome or pseudo-anaphylactic reaction to procaine penicillin G a still current classic.] Schweiz Med Wochenschr 1990 120(29) 1045-9. 

Kryst L, Wanyura H. Hoigne s syndrome—its course and symptomatology. J Maxillofac Surg 1979 7(4) 320-6. 

Hoigne R. Interne Manifestationen und Labor-befunde beim Lyell-Syndrom. In Braun-Falco O, Bandmann HJ, editors. Das Lyell-Syndrom. Bern-Stuttgart-Wien Verlag H Huber, 1970 27. 

---