Fulminant Hepatic Failure Associated with Propylthiouracil

OBJECTIVE: To report 2 fatal cases of fulminant hepatic failure associated with propylthiouracil treatment against hyperthyroidism. CASE SUMMARY: Two women, 30 and 32 years old with no previous liver disease, were treated with propylthiouracil against Graves' disease. Both patients developed jaundice after a 4- and 5-month treatment period, respectively. The disease was similar to viral hepatitis, with a progressive course to severe liver dysfunction and death, along with multisystem organ failure despite extensive therapeutic measures. One of the patients was pregnant and subsequently miscarried. Neither patient had a history of alcoholism, drug abuse, blood transfusion, or exposure to hepatitis A, B, or C. Extrahepatic obstruction was ruled out with an abdominal ultrasonogram. Serologic studies and immunologic tests were negative. A submassive necrosis was shown in a postmortem histologic study. DISCUSSION: Naranjo probability scale criteria applied to both cases confirm the adverse reactions as probable. These cases fit the requirements of drug hepatotoxicity proposed by Hanson and the Council of the International Organization of Medical Sciences. Eight deaths associated to propylthiouracil were found in our review of the medical literature up to December 2000. CONCLUSIONS: Despite the widespread use of propylthiouracil, fulminant hepatitis with death is exceptionally rare; these 2 cases could be added to the fatal outcomes published to date.

Download Full-text

Statin-Associated Bilateral Foot Myopathy

Journal of Pharmacy Practice ◽

10.1177/0897190019857851 ◽

2019 ◽

Vol 33 (6) ◽

pp. 899-902 ◽

Cited By ~ 1

Author(s):

Mary Caitlin Baggett ◽

Diane Nykamp

Keyword(s):

Cardiovascular Risk ◽

Lipid Lowering ◽

Common Side Effect ◽

Probability Scale ◽

Case Summary ◽

History Of ◽

Muscle Groups ◽

Artery Disease ◽

Alternative Lipid ◽

Statin Use

Objective: To report a case of statin-induced bilateral foot myopathy that resulted from 2 different statins. Case Summary: A 44-year-old Caucasian male with a history of ventricular fibrillation cardiac arrest, hyperlipidemia, and coronary artery disease experienced bilateral foot pain, weakness, and soreness while taking atorvastatin 20 mg daily. The pain subsided within weeks of discontinuing atorvastatin but returned years later after the initiation of rosuvastatin. The Naranjo probability scale indicates that this is a definite association between bilateral foot myopathy and statin use. Discussion: There is an association with statin use and lowering cardiovascular risk in patients with dyslipidemia and cardiovascular disease. However, statin metabolites can accumulate in the myocytes of muscle groups to cause a common side effect of myopathy. Statin myopathy typically occurs in large, bilateral, or proximal muscle groups, such as the thighs, back, calves, or buttocks. This patient was unusual in that his muscle symptoms only occurred in his feet and was severe enough to affect his ambulation. Conclusion: Stain-associated muscle symptoms have been reported to lessen medication adherence. There is also a risk with muscle symptoms that the patient could develop rhabdomyolysis, a rare but serious condition. Recognizing statin-associated muscle symptoms even in uncommon locations is important, so that alternative lipid-lowering strategies can be implemented to lower cardiovascular risk.

Download Full-text

Nightmare and Abnormal Dreams: Rare Side Effects of Metformin?

Case Reports in Endocrinology ◽

10.1155/2018/7809305 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Theo Audi Yanto ◽

Ian Huang ◽

Felicia Nathania Kosasih ◽

Nata Pratama Hardjo Lugito

Keyword(s):

Side Effects ◽

Extended Release ◽

Adverse Reactions ◽

Antidiabetic Agent ◽

Probability Scale ◽

Case Presentation ◽

Gastrointestinal Side Effects ◽

History Of ◽

Negative Feelings ◽

Unpleasant Experience

Background. Metformin is widely known as an antidiabetic agent which has significant gastrointestinal side effects, but nightmares and abnormal dreams as its adverse reactions are not well reported. Case Presentation. Herein we present a case of 56-year-old male patient with no known history of recurrent nightmares and sleep disorder, experiencing nightmare and abnormal dreams directly after consumption of 750 mg extended release metformin. He reported his dream as an unpleasant experience which awakened him at night with negative feelings. The nightmare only lasted for a night, but his dreams every night thereafter seemed abnormal. The dreams were vivid and indescribable. The disappearance and occurrence of abnormal dreams ensued soon after the drug was discontinued and rechallenged. The case was assessed using Naranjo Adverse Drug Reaction (ADR) probability scale and resulted as probable causality. Conclusion. Metformin might be the underlying cause of nightmare and abnormal dreams in this patient. More studies are needed to confirm the association and causality of this findings.

Download Full-text

Bevacizumab-Induced Oral Mucositis in Background of Cutaneous Plaque-Type Psoriasis

Annals of Pharmacotherapy ◽

10.1345/aph.1r350 ◽

2012 ◽

Vol 46 (11) ◽

pp. e32-e32 ◽

Cited By ~ 5

Author(s):

Andra M Popa ◽

Kelly Valla ◽

Latha Radhakrishnan ◽

Sandra Cuellar ◽

J Lee Villano

Keyword(s):

Oral Mucositis ◽

Mucosal Damage ◽

Glioneuronal Tumor ◽

Probability Scale ◽

Imaging Studies ◽

Continuous Therapy ◽

Psoriatic Disease ◽

Plaque Type ◽

Case Summary ◽

History Of

OBJECTIVE: To report the serial development of oral mucositis following infusion of bevacizumab in a young woman with a malignant brain tumor and history of cutaneous psoriasis. CASE SUMMARY: A 29-year-old woman with a history of active cutaneous psoriasis and a malignant glioneuronal tumor was treated with bevacizumab for 2.5 years. With each infusion of bevacizumab, she developed oral mucositis within 36 hours. She received temozolomide as part of concurrent therapy with radiation and as maintenance therapy; it was discontinued after continuous therapy for 1.5 years. Bevacizumab 10 mg/kg was added after 7 cycles of maintenance temozolomide, as the tumor had minimal response and evidence of increased perfusion with angiogenesis on imaging studies. All medication, including temozolomide, was evaluated and eventually discontinued, with the exception of bevacizumab, which remained the drug suspected of causing the mucositis. DISCUSSION: Oral mucositis is a frequent adverse effect of cytotoxic chemotherapy, but has not been reported with bevacizumab. The Naranjo probability scale indicated a probable adverse drug reaction. This likely indicates that bevacizumab is one of many drugs known to induce exacerbation of psoriatic disease. We speculate that oral mucositis developed as bevacizumab-induced generation of proinflammatory cytokines within the vascular endothelium, leading to mucosal damage and ulceration. In addition, interruption of reparative angiogenic pathways with bevacizumab likely contributed to the severity of mucositis. CONCLUSIONS: Clinicians should be aware that bevacizumab can potentially exacerbate psoriatic disease.

Download Full-text

Constipation, Polyuria, Polydipsia, and Edema Associated with Orlistat

Annals of Pharmacotherapy ◽

10.1345/aph.1a452 ◽

2002 ◽

Vol 36 (7-8) ◽

pp. 1168-1170 ◽

Cited By ~ 3

Author(s):

Kathleen A Packard ◽

Richard L Wurdeman ◽

Antonio P Reyes

Keyword(s):

Adverse Effects ◽

Adverse Reactions ◽

Careful Consideration ◽

Temporal Association ◽

Probability Scale ◽

Case Summary ◽

Pedal Edema ◽

Leg Edema ◽

Event Based ◽

Fecal Urgency

OBJECTIVE: To report the occurrence of a novel group of adverse effects associated with initiation and rechallenge of orlistat. CASE SUMMARY: A 42-year-old white woman developed symptoms of constipation, polyuria, polydipsia, and increased lower-leg edema after 2 weeks of treatment with orlistat 120 mg 3 × daily. The drug was discontinued for 4 days and the symptoms resolved. On reinstitution of the orlistat treatment, the symptoms reappeared within 2 days. Thereafter, the medication was permanently discontinued. DISCUSSION: Common gastrointestinal adverse reactions associated with orlistat use include fecal urgency and abdominal pain and discomfort. Pedal edema has also been reported to occur, although less frequently. No reports were discovered documenting the occurrence of constipation, polydipsia, and polyuria associated with the use of orlistat. Despite careful consideration of other possible causes of these symptoms, the temporal association between initiation, discontinuation, and rechallenge of orlistat and the patient's symptoms suggest a medication-related adverse event. Based on the Naranjo probability scale, the likelihood that orlistat was the cause of this cluster of adverse effects is possible. CONCLUSIONS: It is important for the healthcare provider to be aware of these adverse effects to promptly evaluate and differentiate between possible causes of similar reactions.

Download Full-text

Fulminant Hepatic Failure Possibly Related to Ciprofloxacin

Annals of Pharmacotherapy ◽

10.1177/106002809202600504 ◽

1992 ◽

Vol 26 (5) ◽

pp. 636-639 ◽

Cited By ~ 40

Author(s):

Bradford K. Grassmick ◽

Victoria Tutag Lehr ◽

Alistair S. Sundareson

Keyword(s):

Fulminant Hepatic Failure ◽

Hepatic Failure ◽

Case Reports ◽

Data Extraction ◽

Hepatic Function ◽

Data Synthesis ◽

The Past ◽

Serum Aspartate Aminotransferase ◽

History Of ◽

Oral Ciprofloxacin

OBJECTIVE: To report a case of hepatic failure in a patient who was receiving oral ciprofloxacin. DATA SOURCES: Case reports, review articles, and relevant laboratory studies identified by MEDLINE. DATA EXTRACTION: Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors. DATA SYNTHESIS: A 66-year-old man was admitted for hip arthroplasty and developed fulminant hepatic failure during oral ciprofloxacin therapy. Ciprofloxacin was started on postoperative day 13 for treatment of a urinary tract infection. Over the next three days he became confused and hypoglycemic. His prothrombin time increased to >90 s. Serum aspartate aminotransferase and alanine aminotransferase concentrations were markedly elevated. The patient died on postoperative day 20. Postmortem examination of the liver revealed extensive centrilobular necrosis. A skin biopsy was consistent with a drug reaction. It is unknown whether the patient had received a quinolone compound in the past or had a history of exposure to hepatotoxins. CONCLUSIONS: It cannot be concluded that ciprofloxacin directly caused hepatic failure in this patient. It is possible that the drug evoked a hypersensitivity reaction or exacerbated a preexisting hepatotoxicity. A detailed patient history and evaluation of hepatic function should be obtained prior to initiating ciprofloxacin therapy. A nonquinolone antimicrobial may be a safer alternative for patients with hepatic dysfunction.

Download Full-text

Probable Amlodipine-Induced Angioedema

Annals of Pharmacotherapy ◽

10.1345/aph.1l527 ◽

2009 ◽

Vol 43 (4) ◽

pp. 772-776 ◽

Cited By ~ 15

Author(s):

Jessica Southward ◽

Elizabeth Irvine ◽

Marina Rabinovich

Keyword(s):

Autoimmune Disease ◽

Hemorrhagic Stroke ◽

Past History ◽

Case Reports ◽

Channel Blockers ◽

Probability Scale ◽

Careful Evaluation ◽

Thyroid Autoimmune Disease ◽

Case Summary ◽

History Of

Objective: To report a case of angioedema likely associated with amlodipine administration in a patient with a right thalamic hemorrhagic stroke. Case Summary: A 50-year-old female experienced angioedema during hospitalization for s right thalamic hemorrhagic stroke. She had no past history of angioedema and all of her medications were assessed for risk of angioedema. After careful evaluation, case reports linking calcium channel blockers (CCBs) and angioedema led to further examination of amlodipine as a cause. Amlodipine therapy had been initiated 24 hours prior to the development of angioedema, which then resolved 72 hours after discontinuation of the drug. In total, the patient experienced oropharyngeal swelling for 10 days. Discussion: In determining a cause for the patient's angioedema we eliminated genetic, allergic, physically induced, thyroid autoimmune disease-associated, and medication-induced causes. Three case reports describing 7 patients have linked the CCBs verapamil, diltiazem, and nifedipine with angioedema. The onset and resolution of symptoms in our patient were very similar to those seen in other case reports. Application of the Naranjo probability scale found a probable link between amlodipine and angioedema. Conclusions: Although few reports of CCB-induced angioedema exisi, to our knowledge, this is the first reported case to suggest a link between angioedema and amlodipine therapy. Clinicians should consider amlodipine as a potential cause of angioedema.

Download Full-text