Reactions 1704, p324 - 2 Jun 2018 Hoigne syndrome and chronic anxiety disorders: case report A man [age at the reaction onset not stated] developed Hoigne syndrome and at the age of 28 years he developed chronic anxiety disorder following treatment with procaine benzylpenicillin [Procaine penicillin]. The man was diagnosed with scleroderma and started receiving IM procaine benzylpenicillin injections 2.4mL, in 2011. After 16 injections, he developed he developed symptoms of Hoigne syndrome like blurred vision, dizziness, tinnitus and strong fear of death. These symptoms were accompanied by increased blood pressure, tachycardia and sweating. In an emergency department, the man was treated with hydrocortisone and metoclopramide. After two hours of the hospitalisation, all symptoms disappeared with improvement in his general condition. He was discharged home with a diagnosis of consequences of drugs and biological substances poisoning. In November, after several months of dermatological treatment, he (at 28 years of age) presented to the psychiatrist for help. He suffered from recurrent panic attacks and anticipatory anxiety for the most part of the day. Since, he had left emergency department, the anxiety symptoms, like dizziness, blurred vision, tinnitus, shortness of breath, tightness in the throat, feeling of lack of control, tachycardia and rapid breathing increased gradually. Initially, the panic attacks occurred after a stressful situation, which later, persisted even in situations posing no threat to him. His normal functions became progressively limited due to the fear of another attack. He was unable to work efficiently and stopped driving a car. He could not sleep at night due to the fear of attack and started leaving the house only in the company of someone. His examinations did not show any abnormalities. In the diagnostic tests increased levels of the morning cortisol up to 27.72 µg/dL was noted, which was 11.21 µg/dL, in the afternoon. Consequently, he was prescribed sertraline. After a few months of treatment, he showed partial improvement. He started feeling better and function independently. He resumed his work. The anxiety symptoms also reduced. After a year of treatment, he stopped the drug. He reported no panic attacks, but tension and anxiety occurred periodically. The discomfort associated with excessive excitability of the autonomic nervous system remained. Author comment: "The authors suggested that panic attacks in patients with the history of the Hoigne syndrome were secondary psychiatric complications. They arise within the mechanism of kindling, which is induced by repeated exposure to [procaine benzylpenicillin]." "Acute non-allergic reaction to [procaine benzylpenicillin] given intramuscularly, known as the Hoigne syndrome, is characterized by severe neurological and psychiatric symptoms." Wojciechowska I, et al. Chronic anxiety disorders after acute non-allergic reaction to procaine penicillin - Case study. Postepy Psychiatrii i Neurologii 26: 179-183, No. 3, 2017. Available from: URL: http://doi.org/10.5114/ppn.2017.70549 - Poland 803322978 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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