iPLEDGE Weaknesses: Is It Time to Address the Flaws?

BACKGROUND

The observance during acne follow-ups that information stored within iPLEDGE was discordant with medical charts prompted this study.

OBJECTIVE

To evaluate the information acquired and stored within iPLEDGE as it compares to medical charts with a goal of assessing the efficacy of iPLEDGE as a database.

METHODS

This is a multicenter retrospective chart review analyzing congruence and discrepancies between medical chart documentation and iPLEDGE data for all patients who received at least a single dose of isotretinoin from the primary investigators between January 2006 and November 2010.

RESULTS

A total of 357 charts were analyzed. Overall congruence between medical chart documentation and iPLEDGE data was observed in only 73.1% of cases. The discrepancy (N=96) was due to a missed dose (prescription recorded in chart but not in iPLEDGE) in 81.4% of cases, or an addition (medication dispensed per iPLEDGE without corresponding chart documentation) in the remainder of cases. Of note, several charts had multiple discrepancies (N=249 total discrepancies).

LIMITATIONS

Retrospective chart review study.

CONCLUSION

Given the large percentage of discordant data, our findings question the efficacy of the iPLEDGE system, which is designed to monitor every dispensed isotretinoin dose.

Multicentric reticulohistiocytosis: contrasting presentations in 2 Hispanic patients

Multicentric reticulohistiocytosis (MR) is a rare debilitating disease that involves the skin and joints. It most commonly affects white individuals but has been reported in other ethnic groups including black individuals, Native Americans, and Asians. The Hispanic population is largely underrepresented in the epidemiology of MR. We describe 2 Hispanic patients with contrasting presentations of MR. Prompt recognition of MR is essential to expedite treatment and prevent potentially disabling sequelae of undiagnosed disease; however, diagnosis can be challenging due to the wide range of clinical presentations of MR as well as variable laboratory findings, especially in patients with skin of color. Our case reports underscore this phenomenon and demonstrate the importance of considering MR in all ethnic groups, including Hispanic patients.

Kaposiform hemangioendothelioma with Kasabach-Merritt syndrome mistaken for child abuse in a newborn

Kaposiform hemangioendothelioma is a rare vascular neoplasm of childhood that may have an alarming and potentially misleading clinical presentation. Awareness of this entity is important to provide appropriate and immediate medical care. We report the case of a 24-day-old female newborn who presented with a large bruiselike lesion on the left leg. A diagnosis of cellulitis suspected to be secondary to child abuse was made and the patient subsequently was placed in foster care; however, the lesion did not resolve after treatment and relocation. On reevaluation at our institution, physical examination revealed a round, 3 x 4-cm, violaceous, indurated, fixed, nonblanching, nontender plaque with an ivory center and peripheral erythema over the anteromedial aspect of the left leg. Biopsy demonstrated a vascular neoplasm consistent with kaposiform hemangioendothelioma (KHE), and laboratory evaluation revealed thrombocytopenia, low fibrinogen levels, and elevated D-dimer levels, confirming a diagnosis of Kasabach-Merritt syndrome (KMS).