scholarly journals MON-358 Hypercalcemia During Teriparatide Therapy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jovan Milosavljevic ◽  
Asha Mary Thomas
Keyword(s):  
Vitamin D ◽  
Clinical Practice ◽  
Side Effect ◽  
Rare Event ◽  
Severe Scoliosis ◽  
Track Record ◽  
Discontinuation Of Treatment ◽  
Rare Side Effect ◽  
History Of ◽  
Previously Treated

Abstract Background : Teriparatide (TPTD) is a recombinant PTH analog used as an anabolic agent in the treatment of osteoporosis that stimulates bone formation and activates bone remodeling. The most common side effects are nausea, vomiting, hypertension and dizziness. Transient hypercalcemia is a known adverse effect which is usually seen a few hours after administration and resolves within 16 hours. However, marked late hypercalcemia is a rare event and may be of concern in clinical practice. Clinical Cases : Case 1 is a 54-year-old man with a history of osteoporosis (lumbar spine T-score of -2.8), previously treated with bisphosphonates and who had been on a course of TPTD for about 6 months in but had not been consistent in taking the medication. Prior to subsequently restarting TPTD, his initial labs were notable for a normal Ca 9.3 mg/dl (8.5 - 10.1 mg/dl), vitamin D 25 OH 49 ng/ml (30.0 - 100.0 ng/ml) and PTH 41.3 pg/ml (8.7 - 77.1 pg/ml). Six months into the treatment, he was noted to have asymptomatic hypercalcemia of 11.2 mg/dl approximately 24 hrs after the last TPTD injection. A repeat calcium of 10.7 mg/dl was obtained while still on therapy with TPTD with normal levels of vitamin D 25 OH of 45 ng/ml. Case 2 is a 75-year-old woman with a history of osteopenia and severe scoliosis, who had been on a course of raloxifene and then preventive doses of alendronate previously. Prior to starting TPTD, her Ca levels were normal at 9.3 mg/dl, PTH was 24 pg/ml and vitamin D 25 OH was 33 ng/ml. However, six months into the treatment she was noted to have elevated Ca of 12.5 mg/dl (24 hrs after the last TPTD dose), with low levels of vitamin D 25 OH of 24.2 ng/ml. Ca levels returned to the baseline of 9.3 mg/dl when TPTD was held. Conclusion : Teriparatide has a long track record of safety and does have the rare side effect of hypercalcemia. 1-3% of patients may have mild hypercalcemia after administration. Intake of calcium and vitamin D should be monitored at the start of therapy given these concerns. Although almost never a cause of discontinuation of treatment in clinical practice, it is important to be aware of this side effect in patients who may be at risk of complications of hypercalcemia.

scholarly journals Clozapine-induced stuttering in the absence of known risk factors: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Florence Jaguga
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Side Effect ◽  
Case Reports ◽  
Extrapyramidal Symptoms ◽  
Prior History ◽  
Case Presentation ◽  
Rare Side Effect ◽  
History Of ◽  
Electrophysiological Findings

Abstract Background Stuttering is a rare side effect of clozapine. It has been shown to occur in the presence of one or more factors such as abnormal electrophysiological findings and seizures, extrapyramidal symptoms, brain pathology, and a family history of stuttering. Few case reports have documented the occurrence of clozapine-induced stuttering in the absence of these risk factors. Case presentation A 29-year-old African male on clozapine for treatment-resistant schizophrenia presented with stuttering at a dosage of 400 mg/day that resolved with dose reduction. Electroencephalogram findings were normal, and there was no clinical evidence of seizures. The patient had no prior history or family history of stuttering, had a normal neurological examination, and showed no signs of extrapyramidal symptoms. Conclusion Clinicians ought to be aware of stuttering as a side effect of clozapine, even in the absence of known risk factors. Further research should investigate the pathophysiology of clozapine-induced stuttering.

Dermal Discoloration Secondary to Triamcinolone Acetonide Injection Observed in Patients with Autoimmune Disorders

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
James A. Wright ◽  
Jessica A. Wenz ◽  
Gabrielle Jackson Madrigal
Keyword(s):  
Psoriatic Arthritis ◽  
Side Effects ◽  
Autoimmune Disease ◽  
Triamcinolone Acetonide ◽  
Current Literature ◽  
Side Effect ◽  
Inflammatory Conditions ◽  
Rare Side Effect ◽  
History Of ◽  
Synthetic Glucocorticoid

Triamcinolone acetonide is a synthetic glucocorticoid used to treat numerous acute and chronic inflammatory conditions. The various side effects of this drug from parenteral administration are well documented in the literature. In this study, three patients present with a rare side effect of violaceous dermal pigmentation. To the best of the authors' knowledge, this finding is rarely presented in the current literature. The purpose of this study is to provide awareness of a less-documented, delayed side effect from triamcinolone acetonide administration. Although all patients presenting in this study had a known history of autoimmune disease (eg, lupus, psoriatic arthritis) further research is needed to suggest a possible association between dermal violaceous change and the use of triamcinolone.

scholarly journals Erectile Dysfunction as Rare Side Effect in the Simultaneous Intrathecal Application of Morphine and Clonidine

2012 ◽  
Vol 4;15 (4;8) ◽  
pp. E523-E526
Author(s):  
Gershom Koman
Keyword(s):  
Erectile Dysfunction ◽  
Pain Relief ◽  
Side Effect ◽  
Life Quality ◽  
Chronic Neuropathic Pain ◽  
Combined Application ◽  
Rare Side Effect ◽  
Provide Pain Relief ◽  
History Of ◽  
Systemic Application

We report on the case of a 52-year-old man who presented with a history of chronic neuropathic pain treated with intrathecal application of morphine for many years. In spite of significant dose escalation, considerable pain relief had not been achieved. Ziconotide had been tried but not only did it not provide pain relief, but it also caused severe side effects in this patient. A combination of morphine and clonidine was delivered by a programmable pump, slowly increasing the clonidine rate over several weeks. For ease of transition and minimization of hospitalization, which was a special concern to this patient, combining clonidine and morphine was chosen over monotherapy with hydromorphone, with both possibilities being described as equal alternatives in the literature. Considerable pain relief was achieved during week 2 at a clonidine dose of 0.040 mg/d, thereby decreasing the visual analog score (VAS) from 10 to 4. Yet, after developing erectile dysfunction and relative hypotension soon after beginning clonidine treatment, the patient decided not to continue with the combined application of morphine and clonidine. Treatment was therefore switched back to the former monotherapy with morphine. Thereafter, erectile dysfunction disappeared and blood pressure returned to habitual high levels. Although common in systemic application, erectile dysfunction caused by the intrathecal application of clonidine has not been described yet in the literature. In this patient, this rare side effect decisively impaired life quality, subjectively outweighing the considerable pain relief which could be achieved after formerly inefficacious treatment. Further and prospective investigation might be needed to estimate the connection of erectile dysfunction to intrathecal application of clonidine. Key words: intrathecal, erectile dysfunction, morphine, chronic pain, drug pump

scholarly journals Gynecomastia in a Rheumatoid Arthritis patient: A rare side effect of Methotrexate therapy. (Preprint)

2016 ◽  
Author(s):  
Soorih Shaikh ◽  
Sarwan Shaikh
Keyword(s):  
Rheumatoid Arthritis ◽  
Rheumatoid Arthritis Patient ◽  
Male Patient ◽  
Side Effect ◽  
Methotrexate Therapy ◽  
Folate Supplementation ◽  
Rare Side Effect ◽  
History Of ◽  
Male Patients

UNSTRUCTURED A 51-year-old male patient with a 3-year history of Rheumatoid Arthritis developed gynecomastia 2-3 months after starting Methotrexate therapy, without folate supplementation. Two months after stopping MTX therapy and initiating folate supplementation, gynecomastia started resolving. Very few cases of gynecomastia due to MTX therapy have been reported worldwide. Although it is a rare yet a significant occurrence and should always be considered in male patients with Rheumatoid Arthritis.

scholarly journals RIFAXIMIN INDUCED HYPONATREMIA: A CASE REPORT

2016 ◽  
Vol 9 (9) ◽  
pp. 1 ◽  
Author(s):  
Shalini Upadhyay ◽  
Prabhat Agrawal ◽  
Manish Bansal ◽  
Anjalika Gupta
Keyword(s):  
Irritable Bowel Syndrome ◽  
Case Report ◽  
Clinical Practice ◽  
Side Effects ◽  
Side Effect ◽  
Aged Woman ◽  
Rare Side Effect ◽  
Middle Aged Woman ◽  
The Common ◽  
Irritable Bowel

ABSTRACTRifaximin is one of the common drugs used in clinical practice in the management of traveler’s diarrhea, irritable bowel syndrome (IBS), and hepaticencephalopathy. Hyponatremia is one of the rare side effects of this drug. We hereby present the case of a middle-aged woman who was a known caseof IBS: Diarrhea predominant who developed symptoms of hyponatremia after a short duration of rifaximin treatment, no other cause of hyponatremiawas found on evaluation, so we suspect this as a rare side effect of rifaximin therapy.Keywords: Rifaximin, Hyponatremia, Irritable bowel syndrome.

scholarly journals When Your Pituitary Fails - A Rare Case of Pituitary Dysfunction Due to Nivolumab and Ipilimumab

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A620-A621
Author(s):  
Areej Khan ◽  
Muhammad Ahmed Khan ◽  
Brian Phillips
Keyword(s):  
Adrenal Insufficiency ◽  
Side Effect ◽  
Rare Case ◽  
Case Description ◽  
Acth Level ◽  
Significant Side Effect ◽  
Pituitary Dysfunction ◽  
Rare Side Effect ◽  
History Of ◽  
Persistent Hypotension

Abstract Introduction: Immunomodulators like Nivolumab and Ipilimumab are important regimens in many malignancies. However, their use is linked with the rare side effect of pituitary dysfunction that if screened and treated can prevent misdiagnosis. Case Description: A 56-year-old male with a history of renal cell carcinoma status post bilateral partial nephrectomy with metastasis to the lung on Nivolumab/Ipilimumab presented with dizziness. He endorsed difficulty with balance, nausea, decreased appetite, feeling dehydrated and recent blood pressure readings in the 90s. Vitals on presentation were stable. An MRI, from 2 weeks ago, showed a slightly enlarged sella but no metastatic disease. The next day, he became hypotensive with minimal response to fluids and was started on Midodrine. However, considering his persistent hypotension, his cortisol level was checked and found to be profoundly low (<1). Literature review of his immunomodulator revealed the possibility of central adrenal insufficiency. In addition, he was noted to have a low TSH (0.02) with normal FT4 (1.08). Subsequently, his ACTH level was also found to be low (<1.5) which further elucidated a central cause for his adrenal insufficiency. Therefore, he was ultimately treated with PO hydrocortisone with plans to taper off in the next few weeks. Conclusion: This case demonstrates a rare yet significant side effect of Nivolumab/Ipilimumab therapy. Timely diagnosis and therapy can alleviate symptoms due to associated hormonal deficiencies. Moving forward it will be interesting to see if starting prophylactic steroids or routine screening will allow us to diagnose pituitary dysfunction due to Nivolumab/Ipilimumab earlier.

scholarly journals The Thionamide Paradox: Thyrotoxicosis With Neutropenia as Initial Presentation of Grave’s Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A959-A960
Author(s):  
Valentina Celis ◽  
Alex Manzano
Keyword(s):  
Side Effect ◽  
Stable Condition ◽  
Deficiency Anemia ◽  
Antithyroid Drugs ◽  
Free T4 ◽  
Lugol Solution ◽  
Rare Side Effect ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Abstract Hyperthyroidism typically presents with symptoms such as tremors, palpitations, weight loss, heat intolerance and anxiety. Although rare, anemia, leukopenia or thrombocytopenia may develop as an unusual manifestation of thyrotoxicosis. Hematologic derangements have been reported as a side effect of antithyroid drugs (ATD) as well, and while ATD associated agranulocytosis is uncommon, it is a life-threatening condition. A 49-year-old Hispanic female with history of iron deficiency anemia came to the emergency department (ED) with a chief complaint of palpitations. Also reported fatigue, myalgias, headache and anxiety of 1 week duration. Upon​ arrival to the ED she was tachycardic, appeared anxious and diaphoretic. Physical examination revealed a very discrete, non-tender goiter. Bloodwork showed hemoglobin 9.1 g/dL (12.0-16.0), WBC 2.30 c/µ​L (4.8-10.8),​ ANC 1.04 c/µ​L​ (1.80-7.20), ALC 0.88 c/µ​L​ (1.20-4.0), PLT 209 c/µ​L​ (150-450). TFTs were pertinent for TSH 0.007 UIU/mL (0.35-3.74), free T4 5.11 ng/dL (0.76-1.46) and total T3 555 ng/dL (60-181). She received initial treatment with hydrocortisone 300 mg and PTU 300 mg. She was admitted and started on propranolol 40 mg TID and prednisone 20 mg daily, but further doses of ATD were initially held due to concerns for her marked leukopenia. She subsequently became acutely psychotic with psychomotor agitation, visual and auditory hallucinations. CT of the brain revealed no acute abnormalities. She was started on olanzapine 2.5 mg daily for hyperthyroidism induced psychosis, along with methimazole 20 mg daily, KI (Lugol solution) 0.35 mL BID and cholestyramine 4g BID. Further workup of leukopenia showed no dysplastic​ cells on​ peripheral smear, normal vitamin B12 and folate levels, and negative HIV. She displayed marked improvement, denied ongoing hallucinations after 72 hours of initiating ATD, and WBC subsequently normalized. Thyroid workup was diagnostic for GD with positive TRAB and TSI. She was discharged in stable condition on methimazole 40 mg daily. Agranulocytosis is a rare side effect of ATD (prevalence ~0.5%) and average time of onset is usually within 2-3 months after starting therapy. Although the majority of cases of hematologic alterations in GD are seen as a complication of ATD, our patient presented with the peculiarity that leukopenia (with both neutropenia and lymphopenia) was associated to untreated hyperthyroidism. This case illustrates the fact that in patients presenting with hyperthyroidism and leukopenia, treatment with ATD has proven to result in achievement of euthyroid state along with a sustained improvement in blood cell levels. Despite its rarity, agranulocytosis has become essentially ingrained to ATD amongst medical professionals. Clinicians should be aware that neutropenia is an uncommon feature of uncontrolled hyperthyroidism and feel confident with initiating ATD in this setting.

scholarly journals Natural History of Paclitaxel-associated Acute Pain Syndrome: A Case Report of Rare Side Effect of Paclitaxel

2021 ◽  
Vol 9 (C) ◽  
pp. 239-242
Author(s):  
Siti Salima ◽  
Ali Budi Harsono ◽  
Aisyah Aisyah ◽  
Kemala Mantilidewi
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Acute Pain ◽  
Side Effect ◽  
Supportive Therapy ◽  
Pain Syndrome ◽  
Rare Side Effect ◽  
History Of ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

BACKGROUND: One of the harshest side effects following anticancer agent treatments is chemotherapy-induced neuropathic pain. After surgical staging, chemotherapy combination of paclitaxel carboplatin could be a choice of therapy for Stage II or more advanced stage of ovarian cancer. Different side effects may appear after the application of paclitaxel. CASE REPORT: Here, we show an uncommon case of paclitaxel-acute pain syndrome (P-APS), and how we deal with such cases according to our experiences. One uncommon side effect is P-APS, which can be treated effectively with the administration of non-steroidal anti-inflammatory drugs, corticosteroid, and supportive therapy. CONCLUSION: One uncommon side effect of Paclitaxel induced neuropathic can be treated effectively with the administration of non-steroidal anti inflammatory drugs, corticosteroid, and supportive therapy.

scholarly journals Critical Hypomagnesemia and Seizure Induced by Chronic Use of Proton Pump Inhibitors (PPIs)

2019 ◽  
Vol 6 ◽  
pp. 3-4
Author(s):  
Gheith Yousif
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Side Effect ◽  
Seizure Activity ◽  
Magnesium Level ◽  
Low Magnesium ◽  
Rare Side Effect ◽  
History Of ◽  
Alternative Medications ◽  
Chronic Use

Background: Chronic use of proton pump inhibitors (PPIs) may lead to severe hypomagnesemia, although it is a rare side effect. Hypomagnesemia related to PPIs use less reported compared to other side effects. Critically low magnesium level may lead to fatal seizure activity, which could lead to death if went undiagnosed. Case presentation: This is a report of a 49 yearold female with a history of gastroesophageal reflux disease (GERD) presented to our emergency department with a seizure activity and critically low magnesium level (< 0.5 mg/dL). Initially the patient was hemodynamically unstable, required intubation, and admitted to the medical intensive care unit (MICU). After further management in MICU, patient stabilized and transferred to the inpatient regular medical floor. Most of the potential common causes of her low magnesium level were thoroughly investigated and ruled out except for PPIs use (as she was a chronic user). The patient was advised to discontinue her PPIs and to use alternative medications because of lifethreatening side effect "hypomagnesemia"and based on the riskbenefit balance (as the risk overweight the benefits in this situation). No further hypomagnesemic episodes reported after the second admission to the ICU unit when PPIs were discontinued completely. Conclusion: Although PPIs use is beneficial for patients with GERD especially those with gastritis, but may lead to lifethreatening hypomagnesemia in rare occasions. Physicians should be aware of this side effect in all patients with chronic PPIs use. In addition, we recommend that patients who developed this rare side effec need to use alternative medications to prevent recurrence an fatal consequences. Further research is needed to determine the incidence and the association between the development of hypomagnesemia and the use of different types of gastric acid suppressants.

scholarly journals Anaphylactic reaction due to cefuroxime axetil: A rare cause of anaphylaxis

2016 ◽  
Vol 29 (4) ◽  
pp. 731-733 ◽  
Author(s):  
Pablo del Villar-Guerra ◽  
Blanca Moreno Vicente-Arche ◽  
Sara Castrillo Bustamante ◽  
Carlos Santana Rodríguez
Keyword(s):  
Clinical Practice ◽  
Anaphylactic Reaction ◽  
False Positive ◽  
Rare Event ◽  
Cefuroxime Axetil ◽  
Detailed History ◽  
Significant Percentage ◽  
Prick Test ◽  
History Of ◽  
Diagnostic Approaches

One of the most used cephalosporins in clinical practice is cefuroxime axetil. Anaphylaxis due to the administration of cefuroxime is considered a rare event. We report a case of anaphylactic reaction after the administration of cefuroxime in a child who had tolerated the drug in past exposures. Diagnostic workup is recommended for all patients with at least a moderate anaphylactic reaction (hypotension, tachycardia, bronchial hyperreactivity). This should include a detailed history of the event, previous allergies, and underlying conditions. Unfortunately, all currently available diagnostic approaches (IgE, skin-prick-test, tryptase) leave a significant percentage of non-diagnostic results and false positive or negative outcomes.

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