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 Thyroid Storm Associated with Testicular Choriocarcinoma

2020 ◽  
Author(s):  
Julio César Martínez ◽  
Ernesto Alfonso Ovalle-Zavala
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Antithyroid Drugs ◽  
Rare Occurrence ◽  
Blood Tests ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Β Hcg ◽  
Very High

Thyroid storm is a rare, life-threatening condition that can be caused by various pathologies including serious conditions associated with human chorionic gonadotropin (hCG)-producing tumours. We present the case of a 17-year-old male patient with a 1-month history of dyspnoea and a 3-day history of palpitations and fever. General examination revealed a left testicular mass. Blood tests revealed β-hCG >225,000 mIU/ml, thyroid-stimulating hormone (TSH) 0.02 IU/ml, and thyroxine (T4) 19.07 µg/dl. He was admitted with thyroid storm. Treatment with antithyroid drugs and chemotherapy was started, but the patient died on the third day of admission. This case highlights a rare occurrence of thyroid storm linked to testicular choriocarcinoma, and provides a necessary reminder that, in some instances, hCG at very high levels can exert a thyrotropic effect due to its molecular structure, which is similar to that of TSH.

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.

Angioedema and Maculopapular Eruptions Associated with Carbamazepine Administration

CNS Spectrums ◽  
2006 ◽  
Vol 11 (5) ◽  
pp. 352-354 ◽  
Author(s):  
Alby Elias ◽  
Subramoniam Madhusoodanan ◽  
David Pudukkadan ◽  
James T. Antony
Keyword(s):  
Mood Disorders ◽  
Side Effect ◽  
Immunoglobulin E ◽  
Maculopapular Rash ◽  
Vascular Leakage ◽  
Diagnosis And Treatment ◽  
Indian Woman ◽  
The Third ◽  
Rare Side Effect ◽  
Life Threatening

ABSTRACTCutaneous rashes and eruptions can be caused by many medications, including carbamazepine. The presentation can be varied depending on severity. Cutaneous eruptions occur in 3% of individuals administered carbamazepine. Angioedema, a rare side effect of carbamazepine, involves vascular leakage in dermis and subcutis mediated by immunoglobulin E and/or bradykinins. Angioedema is more common in females and in the third decade of life. We report the case of a 27-year-old Indian woman who developed maculopapular rash and angioedema secondary to carbamazepine administration. The patient responded successfully to withdrawal of the drug and treatment with antihistamines. Due to the potentially life-threatening complications of this condition and the increasing use of anticonvulsants in the treatment of mood disorders, psychiatrists must be aware of the diagnosis and treatment of this condition.

Haemophagocytic lymphohistiocytosis secondary to brucellosis in a young child

2021 ◽  
Vol 14 (3) ◽  
pp. e240759
Author(s):  
Jashan Mittal ◽  
Prawin Kumar ◽  
Jagdish Prasad Goyal ◽  
Abhishek Purohit
Keyword(s):  
Haemophagocytic Lymphohistiocytosis ◽  
Appetite Loss ◽  
Specific Therapy ◽  
Adequate Treatment ◽  
Underlying Condition ◽  
Persistent Fever ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication

Brucellosis is a common zoonotic disease worldwide. It has protean clinical manifestation and sometimes may has a life-threatening complication. A 4-year-old boy presented with a history of fever, myalgia and appetite loss for 3 weeks. On examination, he had hepatosplenomegaly. The initial working diagnosis was an infection, autoimmune disease and malignancy. Investigations showed positive Brucella serology, and he was started on rifampicin and cotrimoxazole. He was further investigated because of persistent fever, which revealed evidence of haemophagocytic lymphohistiocytosis (HLH). He continued treatment for brucellosis, except rifampicin which was replaced with doxycyclin due to a worsening liver function. The child showed complete clinical and biochemical improvement after 6 weeks of therapy. HLH is a life-threatening condition and should be suspected in children with brucellosis, who did not respond to appropriate antibiotics treatment. Secondary HLH does not always require specific therapy; it may improve with adequate treatment of the underlying condition.

scholarly journals Non-occlusive mesenteric ischaemia associated with anorexia nervosa

2019 ◽  
Vol 12 (5) ◽  
pp. e229703
Author(s):  
Takashi Sakamoto ◽  
Alan Kawarai Lefor ◽  
Tadao Kubota
Keyword(s):  
Anorexia Nervosa ◽  
Distal Ileum ◽  
Interdisciplinary Management ◽  
Emergency Laparotomy ◽  
Diffuse Peritonitis ◽  
Chronic Haemodialysis ◽  
Mesenteric Ischaemia ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition that requires emergent intervention and anorexia nervosa is a chronic eating disorder that requires careful medical and nutritional management. A 54-year-old woman with a history of anorexia nervosa and undergoing chronic haemodialysis developed abdominal pain and called an ambulance. On arrival, she was in shock and abdominal examination was consistent with diffuse peritonitis. Computed tomography scan suggested ischaemia from the distal ileum to the ascending colon. Emergency laparotomy revealed NOMI from the distal ileum to the transverse colon. The treatment strategy included staged operations and careful medical management to optimise nutritional support and electrolyte management with survival of the patient. NOMI and anorexia nervosa are both difficult to manage. Meticulous interdisciplinary management can result in a good outcome.

Salicylate Intoxication

1997 ◽  
Vol 12 (2) ◽  
pp. 66-78 ◽  
Author(s):  
Luke Yip ◽  
Michael S. Jastremski ◽  
Richard C. Dart
Keyword(s):  
Life Support ◽  
Care Facility ◽  
Health Care Facility ◽  
Poison Control ◽  
Electrolyte Balance ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Salicylate Intoxication ◽  
Base Management

Aspirin (acetylsalicylic acid) is one of the most widely used over-the-counter medications. Because of its availability and widespread use, aspirin has a long history of human toxicity from accidental or intentional overdosing. According to the American Association of Poison Control Centers aspirin was implicated in 19083 exposures in 1995, with 11800 cases treated in a health care facility, and 52 associated deaths. Aspirin toxicity may be a life-threatening condition that produces multiple system organ failure requiring treatment in an intensive care unit. Managing a patient with salicylism will challenge the skills of the critical care team, especially in the areas of life support, fluid and electrolyte balance, and acid-base management. This article reviews the physiology, pathophysiology, acute and chronic salicylism in children and adults, and management of salicylate intoxication.

scholarly journals A rare cause of neutropenic enterocolitis: Propylthiouracil-induced agranulocytosis

2018 ◽  
Vol 25 (5) ◽  
pp. 286-289 ◽  
Author(s):  
Vermi Degerli ◽  
Fulya Yilmaz Duran ◽  
Mustafa Kucuk ◽  
Ibrahim Atasoy
Keyword(s):  
Abdominal Pain ◽  
Complete Blood Count ◽  
Multiple Organ ◽  
Antithyroid Drugs ◽  
Gastrointestinal Complication ◽  
Emergency Physicians ◽  
Neutropenic Enterocolitis ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
History Of

Introduction: Neutropenic enterocolitis is a life-threatening gastrointestinal complication of neutropenia that is rarely seen in adults. Neutropenic enterocolitis is more common in oncology patients, especially in those with leukemia. Antithyroid drugs are widely used to treat hyperthyroidism, but they can rarely cause agranulocytosis. Although the pathophysiology is not well understood, high clinical suspicion and immediate and appropriate treatment responses are essential to reduce the mortality rate of neutropenic enterocolitis. Case presentation: We present a case of a 57-year-old male patient who developed neutropenic enterocolitis as a result of agranulocytosis caused by the use of propylthiouracil. He had history of hyperthyroidism and was on propylthiouracil. He presented to the emergency department with abdominal pain but eventually died due to rapid deterioration of sepsis and multiple organ failure despite medical and surgical treatment. Discussion: Thioamides can cause agranulocytosis which can result in serious complication including neutropenic enterocolitis. Complete blood count must be monitored in patients receiving thioamides, and these patients should be educated on symptoms of agranulocytosis. Conclusion: Since patients with neutropenic enterocolitis are often evaluated first by emergency physicians, emergency physicians must be vigilant for neutropenic enterocolitis in patients with neutropenia and abdominal pain.

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.

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