Eosinophilic syndrome with methylphenidate abuse

Drug-induced eosinophilic lung disease

For most patients who have suspected drug-induced eosinophilic lung disease, the history provides a presumptive diagnosis that can be confirmed by pulmonary findings and eosinophilia after cessation of the drug. As new drugs are developed and released for clinical use, many will result in eosinophilic lung disease in susceptible patients. Therefore, development of pulmonary abnormalities in conjunction with blood or lung eosinophilia after prescription ofa newly released medication should raise the possibility of drug-induced lung disease, even if that medication has not yet been reported to cause eosinophilic lung disease. In all patients, the diagnosis requires exclusion of other causes of eosinophilic lung disease by history, and, if necessary, laboratory testing or lung biopsy.

Methylphenidate: increased abuse or appropriate use?

OBJECTIVE

To address the question of the significant increase in methylphenidate (MPD) prescriptions being written and to make recommendations for health care providers involved in providing care for patients with attention deficit hyperactivity disorder (ADHD) and their families.

DATA SOURCES

Medline search 1966-1998 for professional articles using the following search terms--methylphenidate, children, adolescents, abuse; Internet search using MPD, Ritalin, and ADHD; and Paper Chase search using methylphenidate.

DATA EXTRACTION

The available literature regarding potential abuse or diversion of MPD consists of case reports, review articles, newspaper articles, and a Drug Enforcement Administration (DEA) publication. All available literature sources were used.

DATA SYNTHESIS

Although the media and DEA report significant abuse and diversion of prescribed MPD, a review of the available literature did not reveal data to substantiate these claims. Nonetheless, there are reasons to suspect that abuse and diversion occur. A potential contributing factor to abuse is the reported similarities in pharmacodynamics and pharmacokinetics between MPD and cocaine. Recommendations are made to decrease the possibility of abuse and diversion of prescribed MPD.

CONCLUSION

A balanced middle ground must be found regarding the benefits of MPD and its abuse potential. Education of clinicians, patients, and family members is key in ensuring that MPD is used appropriately.

Rheumatic manifestations of diseases associated with substance abuse

Rheumatic manifestations of substance abuse are uncommon but recognized complications. Repeated injections of drugs and adulterants represent repeated antigenic challenge. The population at greatest risk is that of young males, although females with eating disorders are more apt to develop myopathy, clubbing, or periostitis. Alcohol, the most common substance abused, is associated more often with myopathy. In IV drug abusers, hepatitis B viral infection, bacterial endocarditis, primary skeletal infections, and venous complications are most common in that order. However, the spectrum may evolve as the pattern of substance abuse changes. First, the frequency of cocaine dependence is rapidly approaching that of alcohol. Two regular cocaine users are reported as having Raynaud's phenomenon and abnormal serologies. Second, synthesis of lookalike drugs may produce new associations, such as parkinsonism after IV N-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Third, the increased use of ipecac and purgatives in eating disorders is an important consideration in young women with otherwise unexplained myopathy or arthritis. Finally, patients with AIDS are presenting with autoimmune phenomena or a spectrum of unusual infections that change as the epidemic evolves. Increased recognition of these symptom complexes may lead to earlier, more accurate diagnoses and avoidance of unnecessary diagnostic evaluations and delays in treatment.