Neonatal Cholestatic Hepatitis from Carbamazepine Exposure during Pregnancy and Breast Feeding

2002 ◽  
Vol 36 (4) ◽  
pp. 644-647 ◽  
Author(s):  
Bernhard Frey ◽  
Christian P Braegger ◽  
Daniela Ghelfi
Keyword(s):  
Breast Feeding ◽  
Liver Dysfunction ◽  
Product Information ◽  
Case Reports ◽  
Diagnostic Procedures ◽  
Cholestatic Hepatitis ◽  
Case Summary ◽  
Epileptic Mother ◽  
Exposure During Pregnancy ◽  
Second Period

OBJECTIVE: To report a case of transient cholestatic hepatitis occurring in an infant between the third and seventh weeks of life, most likely due to carbamazepine exposure during pregnancy and breast feeding. CASE SUMMARY: A boy, born to an epileptic mother who had been treated with carbamazepine monotherapy throughout pregnancy and breast feeding, experienced asphyxia at birth with transient hepatic dysfunction in the first week of life. After full recovery from asphyxia, he experienced a second period of liver dysfunction, presenting as cholestatic hepatitis that lasted approximately 5 weeks. Infectious and metabolic etiologies as well as extrahepatic biliary atresia were excluded. DISCUSSION: Carbamazepine is known to induce hepatic damage in children and adults. As the drug crosses the placenta and is excreted into breast milk, infants of mothers taking carbamazepine might also develop liver dysfunction. In addition to the present case, there are 2 well-documented case reports of cholestasis in association with transplacental and transmammary carbamazepine exposure. CONCLUSIONS: Carbamazepine-induced hepatitis may occur in association with prenatal exposure and breast feeding. This may expose infants to unnecessary diagnostic procedures, and should therefore be mentioned in the company's product information.

scholarly journals ‘Failure’ of laser prophylaxis in an eye with stickler syndrome

2021 ◽  
Vol 11 (4) ◽  
pp. 110-111
Author(s):  
Michael P Blair
Keyword(s):  
Vision Loss ◽  
Clinical Course ◽  
Case Reports ◽  
Visual Outcome ◽  
Stickler Syndrome ◽  
Connective Tissue Disorders ◽  
Macular Function ◽  
Giant Retinal Tear ◽  
Case Summary

Background: Stickler syndrome is one of the most common inherited connective tissue disorders and is an important cause of pediatric vision loss due to a high risk of retinal detachment in these patients. Methods: Case report. Case summary: This case reports describes the clinical course of a 10 year old boy with Sticklers Syndrome who underwent bilateral peripheral laser prophylaxis. During routine follow up, he was found to have an asymptomatic giant retinal tear (GRT) with limited sub-retinal fluid expansion due to prior prophylactic laser. He underwent surgery with vitrectomy and scleral buckle with vision remaining at 20/25 at 6 month follow up. Conclusion: Although the utility of laser prophylaxis in Stickler patients is debated, this case demonstrates that after laser prophylaxis, even if GRT develops, expansion can be limited. Laser prophylaxis along with frequent examinations, can prevent development of PVR and complex detachments and preserve macular function with excellent visual outcome.

scholarly journals The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

2020 ◽  
Author(s):  
Nadeem Jimidar ◽  
Patrick Lauwers ◽  
Emmanuela Govaerts ◽  
Marc Claeys
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Case Reports ◽  
Gunshot Wounds ◽  
Computed Tomography Scan ◽  
Imaging Studies ◽  
Left Chest ◽  
Case Summary ◽  
Tomography Scan

Abstract Background Hamman’s sign is a rare phenomenon. Louis Hamman described this pathognomonic clicking chest noise in association with pneumomediastinum in 1937. This typical noise can also be present in left-sided pneumothorax. Clinical cases already mention this pericardial knock in 1918 in gunshot wounds of the left chest and in 1928 in cases of spontaneous left-sided pneumothorax. However, the sound itself has only rarely been recorded. Case summary We describe a case of a young man with no significant medical history who was referred to the hospital with chest pain and audible clicks, documented with his smartphone. Imaging studies including chest radiograph and computed tomography scan revealed a left-sided pneumothorax. The patient underwent semi-urgent insertion of a thorax drain. His clinical outcome was excellent. Discussion In recent years only a few case reports describe Hamman’s sign, as it is rare and happens only transiently. This case report includes the audible clicks recorded by the patient with his smartphone. We stress the importance of thoracic clicking sounds as key symptom in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse.

Amlodipine Induced Gum Hypertrophy – A Rare Case Report

2021 ◽  
Vol 16 ◽  
Author(s):  
Suryanarayana Challa Reddy ◽  
Naresh Midha ◽  
Vivek Chhabra ◽  
Deepak Kumar ◽  
Gopal Krishna Bohra
Keyword(s):  
Calcium Channel ◽  
Side Effect ◽  
Antihypertensive Drugs ◽  
Case Reports ◽  
Diagnostic Procedures ◽  
Channel Blockers ◽  
Gingival Hyperplasia ◽  
Drug Induced ◽  
Duration Of Action ◽  
Gingival Overgrowth

Background: DIGO or drug-induced gingival overgrowth occurs as a side effect of certain drugs. Until now, the etiology of drug-induced gingival overgrowth is not clearly understood. Among the calcium channel blockers, nifedipine has been shown to be most frequently associated with drug-induced gingival hyperplasia. Amlodipine is a comparatively newer calcium channel blocker that witha longer duration of action and lesser side effects as compared to nifedipine. There are only certain case reports of amlodipine-induced gum hyperplasia. Case presentation: We report a case of amlodipine-induced gum hyperplasia in a 66-year-old hypertensive patient taking amlodipine at a dose of 5 mg once a day. There was significant regression of gum hypertrophy after substitution of amlodipine by Losartan. Conclusion: Amlodipine is one of the commonly prescribed antihypertensive drugs, and gingival hyperplasia is one overlooked side effect in patients taking amlodipine. Awareness of this potential side effect of amlodipine may be helpful to reduce the anxiety of patients and the cost of diagnostic procedures.

Possible Interaction Involving Phenytoin, Dexamethasone, and Antineoplastic Agents: A Case Report and Review

1996 ◽  
Vol 30 (5) ◽  
pp. 520-526 ◽  
Author(s):  
Wendy A Gattis ◽  
D Byron May
Keyword(s):  
Pharmacokinetic Model ◽  
Case Reports ◽  
Chemotherapeutic Agents ◽  
Gastrointestinal Toxicity ◽  
Population Parameters ◽  
Medline Search ◽  
Patient Falls ◽  
Case Summary ◽  
Study Selection ◽  
Chemotherapy Agents

OBJECTIVE: TO describe a patient with subtherapeutic phenytoin concentrations and to review the literature regarding a possible interaction between phenytoin and chemotherapeutic agents as well as dexamethasone. CASE SUMMARY: A 29-year-old white man with brain metastases secondary to malignant melanoma consistently had suboptimal phenytoin concentrations while receiving chemotherapy consisting of cisplatin, carmustine, dacarbazine, and tamoxifen. In addition, this patient received dexamethasone, which may have influenced his phenytoin concentrations. DATA SOURCES AND STUDY SELECTION: Case reports were identified through a MEDLINE search and by cross referencing the articles identified. DISCUSSION: The available literature addressing suboptimal phenytoin concentrations in the setting of chemotherapy is reviewed. Aggressive dosing of phenytoin may be required to achieve therapeutic concentrations in patients who are concurrently receiving chemotherapy and/or dexamethasone, especially in patients who fall outside the predictive pharmacokinetic model for phenytoin. CONCLUSIONS: Subtherapeutic phenytoin concentrations may be decreased secondary to several proposed mechanisms: (1) the patient falls outside the predicted pharmacokinetic population parameters for phenytoin, (2) phenytoin absorption is decreased secondary to chemotherapy-induced gastrointestinal toxicity, and (3) metabolism of phenytoin is increased secondary to chemotherapy agents.

Erythromycin Base-Induced Rash and Liver Function Disturbances

1992 ◽  
Vol 26 (12) ◽  
pp. 1522-1523 ◽  
Author(s):  
Haim Shirin ◽  
Jonathan M. Schapiro ◽  
Nadir Arber ◽  
Jack Pinkhas ◽  
Yeheskel Sidi ◽  
...  
Keyword(s):  
Liver Function ◽  
Adverse Effects ◽  
Marked Improvement ◽  
Erythema Nodosum ◽  
Streptococcal Infection ◽  
Case Reports ◽  
Case Summary ◽  
Extensive Evaluation ◽  
Erythromycin Base ◽  
Initiation Of Therapy

OBJECTIVE: To report a case of erythromycin base-induced rash and liver function disturbances. CASE SUMMARY: A patient with erythema nodosum and high antistreptolysin-O titers was treated with erythromycin on the assumption that occult streptococcal infection was the cause of the erythema nodosum. Forty-eight hours after the initiation of therapy the patient developed fever, severe generalized rash, pruritus, and cholestatic and hepatocellular liver function disturbances. Extensive evaluation to determine the cause of liver function disturbances was unrevealing. Marked improvement was noticed within days after cessation of erythromycin. DISCUSSION: Case reports in the literature on the adverse effects of erythromycin and its derivatives were reviewed. The possible immunologic mechanism involved is postulated. CONCLUSIONS: Erythromycin base must be added to the list of erythromycin derivatives that can cause rash and liver function disturbances. The concomitant appearance of fever, rash, jaundice, and liver function disturbances raises the possibility of hypersensitivity as the mechanism for the liver disturbances.

Dapsone-Induced Methemoglobinemia

1998 ◽  
Vol 32 (5) ◽  
pp. 549-553 ◽  
Author(s):  
Kristina E Ward ◽  
Michelle W McCarthy
Keyword(s):  
Case Reports ◽  
Pneumocystis Carinii ◽  
Unknown Etiology ◽  
Case Summary ◽  
Aerosolized Pentamidine ◽  
Immunosuppressed Patients ◽  
Cadaveric Kidney ◽  
Unclear Etiology ◽  
Therapeutic Doses ◽  
Rule Out

OBJECTIVE: To report a case of methemoglobinemia in a patient receiving dapsone for prophylaxis of Pneumocystis carinii pneumonia (PCP). CASE SUMMARY: A 69-year-old white woman was hospitalized to rule out sepsis. Two years prior to this admission, the patient received an orthotopic liver transplant after which she required hemodialysis three times weekly. Because of intolerance to trimethoprim/ sulfamethoxazole and aerosolized pentamidine, she was prescribed dapsone therapy on hospital day 13, that was continued for 11 days. On hospital day 45 the patient received a cadaveric kidney transplant, and dialysis treatments were scheduled only as needed. One week after the transplant, dapsone therapy was resumed. Nine days into this course of dapsone, the patient developed dyspnea and oxygen desaturation of unknown etiology. The patient was evaluated for and diagnosed with methemoglobinemia. She received two doses of intravenous methylene blue and one dose of oral activated charcoal due to fluctuating methemoglobin concentrations. DISCUSSION: The elimination of dapsone is not completely understood. Several case reports of dapsone-induced methemoglobinemia are present in the literature. Most have occurred in patients who have accidentally or deliberately overdosed. Cases of methemoglobinemia in patients receiving therapeutic doses of dapsone are discussed. CONCLUSIONS: The growing numbers of immunosuppressed patients due to transplantation or HIV may result in increased dapsone use for the prevention of PCP. Clinicians should be aware of the adverse effects associated with dapsone therapy, and patients with dyspnea and hypoxemia of unclear etiology should be evaluated for methemoglobinemia.

scholarly journals Who ′Nose′, is it the ARNi?: A Case Series of Persistent Nasal Pruritus in Heart Failure Patients receiving Sacubitril/Valsartan

2021 ◽  
Author(s):  
Jaclyn Gan ◽  
Haunnah Rheault ◽  
Yee Weng Wong
Keyword(s):  
Heart Failure ◽  
Adverse Effect ◽  
Product Information ◽  
Case Series ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Mortality And Morbidity ◽  
Case Summary

Abstract Background Sacubitril/valsartan is approved for the treatment of chronic heart failure with reduced left ventricular ejection fraction (HFrEF) of less than or equal to 40% to decrease mortality and morbidity. Nasal pruritus is not a recognised adverse effect in the product information. In this case series, we encountered three patients presented with nasal pruritus that improved after discontinuation of sacubitril/valsartan. Case Summary Three patients aged 58-73 years-old presented with pruritus at the nasal septum post-initiation of sacubitril/valsartan. The pruritus did not subside despite the use of anti-histamines. Within 3-6 months, all individuals discontinued sacubitril/valsartan with complete resolution of their nasal pruritus. Discussion Many physicians may not aware of this unusual but reversible adverse effect of sacubitril/valsartan. Despite the positive prognostic value of sacubitril/valsartan, the constant nasal pruritus had impacted the quality of life of our patients, leading them to discontinue sacubitril/valsartan permanently.

scholarly journals Orbital tuberculosis diagnosed by immunohistochemistry: case reports

2004 ◽  
Vol 46 (5) ◽  
pp. 291-294 ◽  
Author(s):  
Bráulio F.T. Oliveira ◽  
Fernanda C. Takay ◽  
Tatiana M. Shida ◽  
Ruth M. Santo ◽  
Abelardo C. Souza Jr. ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Case Reports ◽  
Correct Diagnosis ◽  
Public Health Problem ◽  
Immunohistochemical Analysis ◽  
Diagnostic Procedures ◽  
Tertiary Hospital ◽  
Ocular Manifestation ◽  
Orbital Tuberculosis ◽  
De Medicina

PURPOSE: To describe three cases of orbital tuberculosis, with their clinical characteristics and respective diagnostic procedures, showing the importance of histopathology for the correct diagnosis. PATIENTS AND METHODS: Three patients diagnosed and treated for orbital tuberculosis, in the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" during the years of 1999 and 2001. RESULTS: All of the patients were female and referred a chronic evolution of swelling of one eyelid associated or not with other symptoms. They had not HIV infection. Two of them had positive epidemiology for tuberculosis. However, the search for systemic evidence of the disease and staining for bacilli (Ziehl-Neelsen method) were negative in all three patients. In all the cases, only the biopsy with immunohistochemical analysis could confirm the diagnosis. COMMENTS: Orbital involvement is a rare ocular manifestation of tuberculosis. Even in a tertiary hospital, few cases, if any, are diagnosed per year. However, the global incidence and prevalence of M. tuberculosis infections is not under control yet, and it has been a serious public health problem. Thus, one must be aware of the possibility of tuberculosis among the orbital diseases.

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