Clotiazepam

Allergic reactions to benzodiazepines are relatively rare.Besides airborne (occupational) allergic contact dermatitis, which has been frequently reported about, both immediate and delayed-type hypersensitivities have been described, the latter including, among others, fixed drug eruption, generalized reactions, and Stevens-Johnson′s syndrome.A 40-yr-old man was admitted to the allergy unit of the Civitanova Marche hospital with a history of two episodes of an itchy eczematous rash of the face and 1 episode of lip edema, both occurring after the oral intake of alprazolam.The patient had started treatment with alprazolam about 10 mo before the reactions started to occur.Patch tests with the oral liquid formulations of alprazolam (0.75 mg/mL), diazepam (5 mg/mL) delorazepam (1 mg/mL), lormetazepam (2.5 mg/mL), bromazepam (2.5 mg/mL), triazolam (0.375 mg/mL), clotiazepam (10 mg/mL) and lorazepam (2 mg/mL) were performed.Even if the clin. picture was not typical, clin. history and patch test results were suggestive of a delayed-type hypersensitivity to alprazolam, with eventually cross-reactivity to diazepam, delorazepam, lormetazepam ad bromazepam.In our case, patch tests showed a good neg. predictive value since the patients tolerated lorazepam, clotiazepam and midazolam which were patch-test neg.Delayed-type allergy to benzodiazepines should be taken in consideration when the clin. history is highly suggestive, even when the clin. picture is atypical.

The jumping stump phenomenon is a peripherally induced movement disorder that is due to peripheral nerve damage. We report on a very resistant case in which different treatment strategies were applied.

To inform physicians about this condition, its implications, and treatment options.

Case report of a 52-year-old man with a transtibial amputation, experiencing very painful involuntary muscle contractions in the residual limb.

Various drug treatments, including baclofen, diazepam, clonazepam, clotiazepam, pramipexole, and pregabalin, peroneal nerve block, prosthesis modifications, and physiotherapy were ineffective for our patient. Botulinum toxin A treatment showed temporary decrease of symptoms but was not repeated because of high cost for the patient and his fear of injections. In our case, tibial nerve neuroma had no ectopic trigger zone, so local treatment was not indicated. Surgical interventions, based on contraction location and muscle tension, were partially successful. Eventually, due to serious functional and psychological impact, a transfemoral amputation was performed, with complete resolution of symptoms but recurrence later that year. Relapse was correlated with recurrence of local residual limb pain.

Treating this phenomenon remains challenging because pathophysiology is still not fully understood, and the available literature is limited. A multiprofessional and interdisciplinary treatment approach is recommended, and botulinum toxin treatment is promising.