Rashes systemic lupus erythematosus-related

Immunological abnormalities were reported in 23 adults in Woburn, Massachusetts, who were exposed to contaminated well water and who were family members of children with leukemia (Byers et al. 1988). These immunological abnormalities, tested for 5 years after well closure, included persistent lymphocytosis, increased numbers of T-lymphocytes, and depressed helper suppressor T-cell ratio. Auto-antibodies, particularly anti-nuclear antibodies, were detected in 11 of 23 adults tested. This study is limited by the possible bias in identifying risk factors for immunological abnormalities in a small, nonpopulation-based group identified by leukemia types. Other limitations of this study are described in Section 2.2.2.8. A study of 356 residents of Tucson, Arizona, who were exposed to trichloroethylene (6-500 ppb) and other chemicals in well water drawn from the Santa Cmz aquifer found increased frequencies of 10 systemic lupus erythematosus symptoms, 5 (arthritis, Raynaud s phenomenon, malar rash, skin lesions related to sun exposure, seizure or convulsions) of which were statistically significant (Kilbum and Warshaw 1992). 

The most common side effects, which are related to the intravenous infusion itself, include rash, low blood pressure, chills, and chest pain. These symptoms are generally temporary and often respond to a decrease in infusion rate. In addition, some patients develop antibodies, which have been associated in rare cases with symptoms similar to those of patients with systemic lupus erythematosus. These symptoms were also temporary. Another side effect is increased risk of infections. Fatal cases of tuberculosis have been reported following infliximab therapy. Another potential side effect is an increased risk of lymphoma. Its occurrence remains controversial. 

Non-dose-related or idiosyncratic adverse effects of ethosuximide are extremely uncommon. Skin rashes have been reported, including at least one case of Stevens-Johnson syndrome. A few patients have had eosinophilia, thrombocytopenia, leukopenia, or pancytopenia it is not entirely certain that ethosuximide was the causal agent. The development of systemic lupus erythematosus has also been reported, but other drugs may have been involved. 

In addition to penicillamine nephropathy, other side effects of the drug may be related to the widespread deposition of immune complexes (Figure 3). Dense, granular immunoglobuhn deposits have been identified at the epidermodermal junction in 4 rheumatoid arthritis patients who developed toxic reactions, such as severe rashes, thrombocytopenia, aplastic anemia, and proteinuria. Three of 4 penicillamine-induced systemic lupus erythematosus syndrome patients had similar findings on skin biopsy [161]. 

Although ethosuximide is thought to be the least toxic of the succinimides, it can cause gastrointestinal disturbances and dose-related CNS effects, such as drowsiness, dizziness, ataxia, sleep disturbances and depression. Idiosyncratic hypersensitivity reactions include severe rashes, leukopenia, agranulocytosis (some fatal), systemic lupus erythematosus, and parkinsonian-like symptoms. In addition to being less toxic than trimethadione, ethosuximide offers a wider range of protection against different kinds of absence seizures. 

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