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Old 10-03-2012
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Question PPD positive

A health care worker is starting residency with five other PPD positive residents . All of the residents are started on isoniazid .She develops bilateral joint pain in hands and feet ,pleuritic chest pain and a rash

Which of the following is the most likely explanation why she is the only one to have this reaction?

A. Alcoholism
B. Decreased acetylation rate
C. Decreased renal clearance
D. P450 mutation
E. Tobacco smoking

Add reasoning and also explain what is happening to the patient
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B. Decreased acetylation rate

may be she is slow acetylator of INH.....slow metabolism of drug and thus side effects.......drug induced lupus is happpening to patient .......
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Slow acetylators will invariable develop Lupus wannabe syndrome, the others dont because they are normal.
This is step 1 stuff, i remember the french guy talking about this a lot.

Also remember SLE wannabe syndrome doesnt affect the kidney.
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Quote:
Originally Posted by XpaezX View Post
Also remember SLE wannabe syndrome doesn't affect the kidney.
and the Brain............
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Old 10-04-2012
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Answer B

This patient has drug induced lupus .This presents with after the use of drugs such as hydralazine, quinidine procainamide,phenytoin and D penicillamine. This occurs in patients with decreased acetylation rate.acetylation allows isoniazid to be excreted If it is not acetylated then it builds up and u get adverse effect
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