Leflunomide-Associated Skin Ulceration

2002 ◽  
Vol 36 (6) ◽  
pp. 1009-1011 ◽  
Author(s):  
Christopher M McCoy
Keyword(s):  
Rheumatoid Arthritis ◽  
White Woman ◽  
Ethinyl Estradiol ◽  
Drug Effect ◽  
Methotrexate Therapy ◽  
Leg Ulcers ◽  
Skin Ulceration ◽  
Skin Breakdown ◽  
Case Summary ◽  
History Of

OBJECTIVE: To report a case of skin ulceration as a result of treatment with leflunomide for rheumatoid arthritis. CASE SUMMARY: A 78-year-old white woman developed bilateral leg ulcers after 6 months of treatment with leflunomide for rheumatoid arthritis. A history of leg ulcers after methotrexate therapy had been documented. Serologic and diagnostic tests did not support an alternate process. Other medications prescribed were oral ethinyl estradiol 0.05 mg/d, felodipine 5 mg/d, and paroxetine 20 mg/d, for which no documented correlation with the skin breakdown could be made. DISCUSSION: This is the first published case describing a possible relationship between the use of the immunosuppressant agent leflunomide and skin ulceration. CONCLUSIONS: Skin breakdown and ulceration is a recognized adverse effect of drugs with immunosuppressant activity such as methotrexate. Leflunomide, a newer agent prescribed in the treatment of rheumatoid arthritis, may now be listed among the drugs in this category associated with this adverse drug effect.

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 Side effects of methotrexate therapy in patients with rheumatoid arthritis

2021 ◽  
Vol 7 (2) ◽  
pp. e38-e38
Author(s):  
Maryam Masoumi ◽  
Javad Balasi ◽  
Seyed Mahdi Aghamiri ◽  
Soroush Moradi ◽  
Mahbube Baghban ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Cross Sectional Study ◽  
Methotrexate Therapy ◽  
Common Disease ◽  
Duration Of Treatment ◽  
Physical Damage ◽  
Cross Sectional ◽  
Rheumatoid Arthritis Severity ◽  
History Of

Introduction: Methotrexate is widely used as the most common disease-modifying anti-rheumatoid drug (DMARD) and is known as the first line treatment for rheumatoid arthritis (RA). Objectives: To assess the side effects of methotrexate in Iranian patients with RA and to compare them with the known side effects from previous studies. Patients and Methods: We conducted a cross-sectional study of 300 patients who fulfilled the EULAR 2010 criteria of RA. The following data were recruited from patients’ profiles; age, body mass index (BMI), duration of treatment with methotrexate, initiating dose, maximum dose and current dose of methotrexate, history of fatty liver disease or hepatitis B and concomitant use of sulfasalazine, leflunomide or hydroxychloroquine. Results: In 149 out of 300 patients (49.66%), Methotrexate therapy was stopped or tapered due to side effects including nausea (23%), flu-like symptoms (8%), hepatotoxicity (12%) and hair loss (6%). The patients with hepatotoxicity had a higher duration of treatment with methotrexate (10.35 compared with 5.83; P<0.001) and also the higher initiating dose of methotrexate (12.91 compared with 12.17; P=0.010). All of the RASS (rheumatoid arthritis severity scale) indexes including disease activity, functional impairment, and physical damage are related to the presence of hepatotoxicity (P<0.001). Conclusion: Methotrexate is an excellent and effective agent for the treatment of RA and its potential side effects during the treatment are dependent on the methotrexate dosage, the level of anti-citrullinated protein antibody (ACPA) and anti-MCV antibodies and concomitant use of other drugs such as leflunomide.

Digestive Enzyme Adjunct to Oral Headache Medication to Improve Absorption and Reduce Vomiting

1997 ◽  
Vol 13 (4) ◽  
pp. 169-173
Author(s):  
Mark B Detweiler
Keyword(s):  
Digestive Enzymes ◽  
White Woman ◽  
Digestive Enzyme ◽  
Drug Efficacy ◽  
Severe Headache ◽  
Common Finding ◽  
Oral Medications ◽  
Case Summary ◽  
Bile Extract ◽  
History Of

Objective: To report a case in which a digestive enzyme complex (Nature's Plus Digestive Enzymes: pancreatin, pepsin, ox bile extract, malt diatase, and papain) apparently improved the absorption and efficacy of an oral headache medication and alleviated vomiting associated with the headache. Case Summary: A 47-year-old white woman with a history of adverse drug reactions and allergies had been experiencing one to four disabling headaches per week for 2 years. One or two headaches each week would be accompanied by vomiting. This patient experienced adverse effects with most standard headache medications. For 40 months since taking a complex of digestive enzymes as an adjunct to her headache medication, the patient's vomiting has been eliminated, and her postheadache symptoms have been reduced. Discussion: Altered digestive processes are a common finding in severe headache episodes. Exogenous digestive enzymes may facilitate the absorption of oral medication during gastric disruption and consequently increase drug efficacy and the relief of symptoms. Conclusions: Digestive enzymes merit further study to ascertain their effectiveness in increasing the absorption and efficacy of oral medications prescribed for headaches accompanied by emesis.

scholarly journals Syncope on Steroids

2001 ◽  
Vol 12 (3) ◽  
pp. 173-174
Author(s):  
Warren Davidson ◽  
Nadia Zalunardo ◽  
Shawn Gill ◽  
Robert Wakefield
Keyword(s):  
Rheumatoid Arthritis ◽  
Medical History ◽  
White Woman ◽  
Medical Attention ◽  
The Past ◽  
Necrotizing Scleritis ◽  
History Of

An 83-year-old white woman sought medical attention because of a three-day history of slurred speech and an episode of syncope. Her medical history included long-standing rheumatoid arthritis treated with prednisone for the past five years (60 mg/day at presentation). In addition, cyclosporin (200 mg/day) had been started 16 months earlier for necrotizing scleritis.

Respiratory Failure following Oral Administration of Metoclopramide

1998 ◽  
Vol 32 (10) ◽  
pp. 1017-1020 ◽  
Author(s):  
Robert MacLaren ◽  
Catherine A Shields
Keyword(s):  
Respiratory Failure ◽  
Oral Administration ◽  
Asthma Exacerbation ◽  
White Woman ◽  
Pulmonary Dysfunction ◽  
Cholinergic Activity ◽  
Short Bowel ◽  
Case Summary ◽  
History Of ◽  
Line Sepsis

OBJECTIVE: To report a case of respiratory failure, possibly due to anaphylaxis or asthma exacerbation, following the administration of metoclopramide. CASE SUMMARY: A 32-year-old white woman with a history of severe asthma and short-bowel syndrome was admitted for Hickman catheter line sepsis. Two doses of oral metoclopramide 10 mg in solution were administered for nausea and vomiting. Transient dyspnea followed the first dose of metoclopramide, but respiratory failure requiring intubation followed the second dose. DISCUSSION: Respiratory failure has been reported with metoclopramide-induced movement disorders. Three other cases of respiratory failure from anaphylaxis or asthma exacerbation following metoclopramide administration have been reported. Respiratory failure in our patient may be due to anaphylaxis or bronchoconstriction from metoclopramide-induced cholinergic activity of the vagus nerve, possibly through inhibition of acetylcholinesterase. CONCLUSIONS: The use of metoclopramide in patients with pulmonary dysfunction may warrant caution.

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

scholarly journals Palisaded neutrophilic and granulomatous dermatitis following a long-standing monoclonal gammopathy: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2097956
Author(s):  
Dorsa Zabihi-pour ◽  
Bahar Bahrani ◽  
Dalal Assaad ◽  
Jensen Yeung
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Connective Tissue ◽  
Monoclonal Gammopathy ◽  
Inflammatory Dermatosis ◽  
Case Summary ◽  
Underlying Causes ◽  
Granulomatous Dermatitis ◽  
Skin Biopsies ◽  
Underlying Diseases

Background: Palisaded neutrophilic granulomatous dermatitis is a rare inflammatory dermatosis with possible underlying systemic conditions including rheumatoid arthritis, autoimmune connective tissue disease, and malignancies. Case Summary: We report a case of an 84-year-old man presenting with a 3-week eruption of asymptomatic annular plaques on his neck, which progressed to involve his back and legs. Skin biopsies confirmed a diagnosis of palisaded neutrophilic granulomatous dermatitis, and he was treated with prednisone. Full workup related to potential underlying causes of palisaded neutrophilic granulomatous dermatitis was completed. Conclusion: Palisaded neutrophilic granulomatous dermatitis may precede the onset of underlying systemic conditions or occur concomitantly. Following the diagnosis, clinicians should perform a comprehensive focused history, physical examination, and laboratory investigation related to the associated underlying diseases.

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