1. Hoigne syndrome: a report of 3 cases Auditory hallucination
Barbarroja-Escudero J, Sanchez-Gonzalez MJ, Antolin-Amerigo D, Rodriguez-Rodriguez M, Alvarez-Mon M
Servicio de Enfermedades del Sistema Inmune-Alergia. Hospital Universitario Príncipe de Asturias. Departamento de Medicina y Especialidades Médicas. Universidad de Alcalá. Alcalá de Henares (Madrid). Spain
Background
Hoigne syndrome is a non-allergic drug-induced disorder, rapid in onset and short in duration, manifested mainly by psycho-sensorial symptoms (1,2). They usually appear immediately after intramuscular injection of penicillin (both procaine and benzathine) (1,2,3). However, other drugs (i.e. clarithromycin, gentamicin, lidocaine, or prednisolone) can also be the cause (3,4). Nowadays, we continue addressing cases despite the limited use of this route of administration.
Method
Anxiety
Diplopia
Visual hallucination
Auditory hallucination
Results
Serum IgE specific and cutaneous tests for penicillin G, penicillin V, amoxicillin, ampicillin, and cefaclor were negative.
Serum baseline tryptase was in the reference range.
Suspecting that this picture could be a pseudoanaphylactic reaction, we performed a challenge test with oral penicillin with good tolerance, the rechallenge test one month later was negative too.
Conclusion
Not all the systemic symptoms that appeared after administration of intramuscular drugs are true allergic reactions.
It is required to keep in mind various diagnostic possibilities, as some drugs can be the unique possible treatment.
Anamnesis is essential to carry out an accurate diagnosis.
References
Kline C, Highsmith L. Toxic psychosis resulting from penicillin. Ann Intern Med 1948:28:1057–8.
Hoigné R, Schock K. Anaphylactic shock and acute nonallergic reactions following procaine-penicillin. Schweiz Med Wochenschr 1959;89:1350–6.
Gaig P, Paniagua MJ. Síndrome de Hoigné. Allergol Immunopathol 2005;33:57–8.
Baran R. Proximal nail fold intralesional steroid injection responsible for Hoigné syndrome. J Eur Acad Dermatol Venereol 2014;28:1563–5.