Gamma-hydroxybutyric acid-induced organic delirium complicated by polydrug use successfully treated with electroconvulsive therapy: a case report

Abstract Background Patients with gamma-hydroxybutyric acid withdrawal symptoms are at high risk of developing organic delirium, which can be fatal. The recommended first-line treatment is benzodiazepines, but treatment-resistant cases are frequent. Here we describe a case of successful bilateral electroconvulsive therapy in a patient with severe and highly agitated acute organic delirium induced by gamma-hydroxybutyric acid withdrawal and complicated by polydrug use resistant to first-line treatment. To our knowledge, this is the first report on the effect of electroconvulsive therapy on treatment-resistant delirium caused by gamma-hydroxybutyric acid withdrawal. Case presentation A 21-year-old Danish man diagnosed with untreated attention deficit hyperactivity disorder developed severely agitated acute organic delirium caused by gamma-hydroxybutyric acid withdrawal in a Danish psychiatric ward. The patient was subjected to physical restraints and transferred to the intensive care unit for treatment. During the next 10 days, the patient showed no clinical improvement despite first-line, high-dose benzodiazepines along with intense supportive treatment with propofol, phenobarbital, and antipsychotics. On day 11, bilateral frontotemporal electroconvulsive therapy treatment was initiated and full clinical recovery was obtained after four sessions. Discussion The full clinical remission after four electroconvulsive therapy sessions, strongly supports that electroconvulsive therapy may be an effective treatment when severe delirium induced by gamma-hydroxybutyric acid withdrawal is resistant to conventional first-line treatment with benzodiazepines. Moreover, this case illustrates that clinically effective seizures were achieved despite intensive concurrent exposure to anticonvulsive drugs. Therefore, this case report encourages consideration of electroconvulsive therapy in patients with gamma-hydroxybutyric acid delirium who are resistant to psychopharmacological treatment.

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Refractory eosinophilic fasciitis successfully treated with infliximab: A case report

Journal of Scleroderma and Related Disorders ◽

10.1177/23971983211004399 ◽

2021 ◽

pp. 239719832110043

Author(s):

Paulina Śmigielska ◽

Justyna Czarny ◽

Jacek Kowalski ◽

Aleksandra Wilkowska ◽

Roman J. Nowicki

Keyword(s):

Case Report ◽

Connective Tissue ◽

Treatment Failure ◽

Immunosuppressive Drugs ◽

Unknown Etiology ◽

High Dose ◽

Eosinophilic Fasciitis ◽

Line Treatment ◽

First Line ◽

First Line Treatment

Eosinophilic fasciitis is a rare connective tissue disease of unknown etiology. Therapeutic options include high-dose corticosteroids and other immunosuppressive drugs. We present a typical eosinophilic fasciitis case, which did not respond to first-line treatment, but improved remarkably after infliximab administration. This report demonstrates that in case of initial treatment failure, infliximab might be a relatively safe and effective way of eosinophilic fasciitis management.

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Chronic myeloid leukemia on imatinib with recurrent sub-dural haemorrhage

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214729 ◽

2021 ◽

Vol 9 (12) ◽

pp. 3726

Author(s):

Ambati Bhavani ◽

Palanki Satya Dattatreya ◽

Vinukonda Shyamala

Keyword(s):

Case Report ◽

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitor ◽

Rare Complication ◽

High Dose ◽

Line Treatment ◽

First Line ◽

Low Incidence ◽

First Line Treatment

Imatinib is an FDA approved first-line treatment for Philadelphia-positive CML. It is a selective tyrosine kinase inhibitor specifically targeting BCR-ABL, c-KIT, PDGFRA. It has been reported with low incidence of adverse effects and high tolerability, with haemorrhagic events being a rare complication. We report here a case of 51-year-old female patient with chronic myeloid leukemia who was on high dose imatinib experienced recurrent sub-dural haemorrhage. This case report emphasizes on the need to consider Sub dural haemorrhage as an unusual cause of headache associated with vomiting in a patient taking high dose of imatinib.

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595 EFFICACIES OF HYBRID, HIGH-DOSE DUAL AND BISMUTH QUADRUPLE THERAPIES IN THE FIRST-LINE TREATMENT OF H PYLORI INFECTION — A MULTICENTER RANDOMIZED CONTROLLED TRIAL

Gastroenterology ◽

10.1016/s0016-5085(21)01027-1 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-115-S-116

Author(s):

Ping-I Hsu ◽

Jyh-Chin Yang ◽

Seng-Kee Chuah ◽

Kuan-Yang Chen ◽

Yu-Hwa Liu ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

High Dose ◽

Line Treatment ◽

First Line ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

H Pylori ◽

First Line Treatment

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Current Treatment Approaches to Newly Diagnosed Multiple Myeloma

Oncology Research and Treatment ◽

10.1159/000520504 ◽

2021 ◽

Vol 44 (12) ◽

pp. 690-699

Author(s):

Susanne Ghandili ◽

Katja C. Weisel ◽

Carsten Bokemeyer ◽

Lisa Beatrice Leypoldt

Keyword(s):

Multiple Myeloma ◽

Monoclonal Antibody ◽

Plasma Cell ◽

Cell Clone ◽

Unmet Need ◽

Continuous Treatment ◽

High Dose ◽

Line Treatment ◽

First Line ◽

First Line Treatment

Background: Multiple myeloma is a so far incurable malignant plasma cell disorder. During the past 2 decades, treatment paradigms substantially changed when novel drugs were introduced initially in treatment of relapsed disease and subsequently also in first-line treatment. Summary: Up to now, first-line treatment differs between patients initially classified as transplant eligible and those who are considered as nontransplant eligible. Transplant-eligible patients receive a primary proteasome inhibitor (PI)-based induction which is being combined with an immunomodulating agent and a CD38-directed monoclonal antibody followed by high-dose melphalan therapy and autologous stem cell transplantation with subsequent maintenance treatment with lenalidomide. Patients who are considered as nontransplant eligible receive upfront treatment preferentially with a continuous combination treatment either with a CD38-directed monoclonal antibody in combination with the immunomodulating agent lenalidomide or a lenalidomide-PI combination followed by lenalidomide maintenance. Key Messages: Primary goal of the initiated treatment is to induce a rapid and deep remission which ideally leads to an eradication of the residual plasma cell clone in sense of a minimal residual disease negativity. Achievement of long-term remission with limited toxicity despite continuous treatment strategies and maintenance or improvement of life-quality is key. Despite successful treatment options, specific difficult-to-treat subgroups, especially patients with high-risk myeloma remain with inferior prognosis and a clear unmet need for novel therapeutic strategies. Future concepts will evaluate cellular treatments and other innovative immunotherapies in first-line treatment in curative intention.

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