Adverse Reaction to a Dietary Supplement in an Elderly Patient

2003 ◽  
Vol 37 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Rebecca B Sleeper ◽  
Shalyn M Kennedy
Keyword(s):  
Elderly Patient ◽  
Acute Hepatitis ◽  
Dietary Supplement ◽  
Abdominal Ultrasound ◽  
Drug Regimen ◽  
Drug Event ◽  
Hepatic Enzymes ◽  
Drug Induced ◽  
History Of ◽  
Antibody Screen

OBJECTIVE To describe the case of an elderly patient who experienced hepatic enzyme elevations and symptoms of hepatitis associated with the administration of a dietary supplement. CASE SUMMARY A 92-year-old white woman with no history of hepatic disease developed jaundice and increased confusion associated with increased hepatic enzymes. The hepatitis panel, abdominal ultrasound, and antinuclear antibody screen indicated no abnormalities. A drug regimen review revealed that the patient was receiving a dietary supplement, Nutrilite Double X Multivitamin–Multimineral. Following discontinuation of the supplement, the patient's symptoms resolved and the hepatic enzymes decreased or returned to the reference range at evaluations occurring 1 week and 1 month after intervention. An objective causality assessment revealed this to be a probable adverse drug event. DISCUSSION While the association of certain herbal preparations with hepatotoxicity has been demonstrated, the potential for this adverse effect is easily overlooked. In this patient, infectious or autoimmune causes of acute hepatitis were ruled out, and drug-induced causes were considered. The resolution of symptoms and laboratory values following discontinuation of the supplement support a relationship between the dietary supplement and this episode of hepatitis. CONCLUSIONS Our case indicates that there was a probable relationship between the dietary supplement Nutrilite Double X Multivitamin–Multimineral and the development of acute hepatitis. Due to the multiingredient formulation of the product, as well as lack of data describing manufacturing procedures, it is difficult to determine which component may be associated with this effect. Over-the-counter supplements should be considered as a part of the differential diagnosis in patients presenting with increased liver enzymes and related symptoms.

scholarly journals Acute Hepatitis due to Garcinia Cambogia Extract, an Herbal Weight Loss Supplement

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Akshay Sharma ◽  
Elisa Akagi ◽  
Aji Njie ◽  
Sachin Goyal ◽  
Camelia Arsene ◽  
...  
Keyword(s):  
Weight Loss ◽  
Acute Hepatitis ◽  
Previous History ◽  
Herbal Supplement ◽  
Drug Induced ◽  
Garcinia Cambogia ◽  
Drug Induced Liver Injury ◽  
Supplement Use ◽  
Life Threatening ◽  
History Of

The Drug Induced Liver Injury Network reports dietary supplements as one of the most important causes of drug induced hepatotoxicity, yet millions of people use these supplements without being aware of their potential life-threatening side effects. Garcinia cambogia (GC) extract is an herbal weight loss supplement, reported to cause fulminant hepatic failure. We present a case of a 57-year-old female with no previous history of liver disease, who presented with acute hepatitis due to GC extract taken for weight loss, which resolved after stopping it and got reaggravated on retaking it. Obtaining a history of herbal supplement use is critical in the evaluation of acute hepatitis.

scholarly journals Acute Hepatitis in a Yemeni Immigrant Associated with Khat: A “Biological Amphetamine” Carried in Cultures

2021 ◽  
Vol 11 (1) ◽  
pp. 167-173
Author(s):  
Harish Patel ◽  
Kishore Kumar ◽  
Rajesh Kumar Essrani ◽  
Masooma Niazi ◽  
Jasbir Makker ◽  
...  
Keyword(s):  
Liver Injury ◽  
Acute Hepatitis ◽  
Viral Infections ◽  
Middle Eastern ◽  
Clinical History ◽  
Physician Patient Relationship ◽  
East African ◽  
Drug Induced ◽  
History Of ◽  
Elevated Transaminases

Viral infections, alcohol, hepatic steatosis, autoimmunity medications and herbal supplements are common etiologies of hepatitis. Khat (Catha Edulis) is a commonly used recreational substance in East African and Middle Eastern countries. Khat has been reported in the literature to be associated with hepatotoxicity, which can present in several forms, including chronic liver disease. The possible pathogenesis of liver injury could be secondary to biochemical components of Khat itself or additives such as pesticides or preservatives. An autoimmune mechanism of liver injury has also been postulated, supported by sparse evidence. We present a case of a Yemeni immigrant with acute hepatitis whose fear about social norms and breaching confidentiality made it challenging to identify Khat as being the underlying cause. A 34-year-old man from Yemen presented with right upper quadrant pain of one day duration. He had predominantly elevated transaminases with mild elevation in bilirubin. His investigations were negative for the viral, metabolic or biliary etiology. A persistent focus on clinical history and the well-established physician–patient relationship revealed a history of Khat use. The liver biopsy finding of lobular hepatitis was compatible with drug-induced liver injury and established the finding of Khat hepatotoxicity. Subsequently, the patient improved with conservative management.

A Useful Diagnostic Method for Drug-induced Pneumonitis

1994 ◽  
Vol 22 (03n04) ◽  
pp. 329-336 ◽  
Author(s):  
Akira Kawasaki ◽  
Yutaka Mizushima ◽  
Hitoshi Kunitani ◽  
Masanobu Kitagawa ◽  
Masashi Kobayashi
Keyword(s):  
Bronchoalveolar Lavage Fluid ◽  
Challenge Test ◽  
Lavage Fluid ◽  
Peripheral Blood Lymphocytes ◽  
Lymphocyte Stimulation Test ◽  
Drug Induced ◽  
Chief Complaints ◽  
History Of ◽  
Chest X Ray

A 51 year-old male was admitted to our hospital with chief complaints of fever, dry cough and dyspnea. Chest X -ray films and his history of taking Chinese medicine for liver dysfunction were suggestive of drug-induced pneumonitis. Lymphocyte stimulation test (LST) to causative Chinese medical drugs of Sho-saiko-to and Dai-saiko-to was negative with peripheral blood lymphocytes (PBL), but was positive with Iymphocytes from bronchoalveolar lavage fluid (BALF). In vivo challenge test for Sho-saiko-to was positive. The LST with BALF-lymphocytes proved to be very useful in making a diagnosis of drug-induced pneumonitis.

Persistently raised aspartate aminotransferase (AST) due to macro-AST in a rheumatology clinic

Diagnosis ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Wycliffe Mbagaya ◽  
Joanne Foo ◽  
Ahai Luvai ◽  
Claire King ◽  
Sarah Mapplebeck ◽  
...  
Keyword(s):  
Liver Function ◽  
Aspartate Aminotransferase ◽  
Normal Liver ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Analytical Investigation ◽  
Normal Liver Function ◽  
Rheumatology Clinic ◽  
History Of ◽  
Liver Biopsies

AbstractMacrocomplexes between immunoglobins and aspartate aminotransferase (macro-AST) may result in persistently increased AST concentration. The presence of macro-AST in patients has been implicated in unnecessary investigations of abnormal liver function tests. We report the case of a 44-year-old female who presented to the rheumatology clinic with a 12-months’ history of constant widespread pain affecting her limbs and was found to have an elevated AST concentration. Further information from her GP revealed a 14-years’ history of elevated AST with otherwise normal liver function. Previous abdominal ultrasound and two liver biopsies carried out 2 years apart were normal. This prompted further analytical investigation by the biochemistry department which identified macro-AST as the cause. This case illustrates that persistently raised isolated AST concentration with no other abnormal indices may warrant macroenzyme analysis potentially avoiding unnecessary invasive investigations.

scholarly journals Melioidosis: A Rare Cause of Liver Abscess

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Peter Franz M. San Martin ◽  
Catherine S. C. Teh ◽  
Ma. Amornetta J. Casupang
Keyword(s):  
Liver Abscess ◽  
Burkholderia Pseudomallei ◽  
Abdominal Ultrasound ◽  
Open Drainage ◽  
High Grade Fever ◽  
Rare Presentation ◽  
Culture Studies ◽  
Moderate Growth ◽  
Male Farmer ◽  
History Of

Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth ofBurkholderia pseudomalleiin which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound.Discussion. Diagnosis of melioidosis, a known “great masquerader,” relies heavily on culture studies. Consensus with regard to the management of liver abscess caused byBurkholderia pseudomalleihas not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence.

Phlegmonous gastritis in 2 yearling horses

2022 ◽  
pp. 104063872110650
Author(s):  
Julie B. Engiles ◽  
Francisco A. Uzal ◽  
Mauricio A. Navarro ◽  
Virginia B. Reef ◽  
Susan J. Bender
Keyword(s):  
Clinical Signs ◽  
Poor Response ◽  
Abdominal Ultrasound ◽  
Mucosal Injury ◽  
Response To Treatment ◽  
Bacterial Populations ◽  
Proliferative Enteropathy ◽  
Mucosal Involvement ◽  
Phlegmonous Gastritis ◽  
History Of

Phlegmonous gastritis was diagnosed in 2 yearling fillies that were presented with a 1-wk history of fever, lethargy, and hypoproteinemia, associated with a previous diagnosis of equine proliferative enteropathy based on clinical signs and PCR assay detection of Lawsonia intracellularis in fecal samples. Abdominal ultrasound revealed enlargement of the stomach and expansion of its submucosal layer with hypoechoic fluid, as well as thickened hypomotile small intestinal segments. Given the poor prognosis and poor response to treatment, both horses were euthanized, one on the day of presentation and the other after 3 wk of intensive medical management including a combination of antimicrobials, analgesics, and intravenous colloids. At autopsy, acute mural gastritis characterized by severe submucosal edema with suppurative inflammation (i.e., phlegmonous gastritis) and necroulcerative enteritis compatible with the necrotizing form of equine proliferative enteropathy were identified in both horses. The gastric inflammation was associated with thrombosis and mixed bacterial populations, including Clostridium perfringens, that were confined to the submucosa without evidence of mucosal involvement; toxin genes compatible with C. perfringens type C were identified in one case. Human phlegmonous gastritis is an uncommon, often-fatal pyogenic infection that is often associated with mucosal injury, bacteremia, or immunocompromise. Our finding of this unusual gastric lesion in 2 horses with similar signalment, clinical disease, and spectrum of postmortem lesions suggests a similar etiopathogenesis that possibly involves local, regional, or distant hematogenous origin, and should be considered a potential complication of gastrointestinal mucosal compromise in horses.

Drug-induced neuropsychiatric adverse events using post-marketing surveillance

2021 ◽  
Vol 16 ◽  
Author(s):  
Tomohito Wakabayashi ◽  
Takahiro Nakatsuji ◽  
Hiroko Kambara ◽  
Iku Niinomi ◽  
Saki Oyama ◽  
...  
Keyword(s):  
Spontaneous Reporting ◽  
Abnormal Behavior ◽  
Drug Event ◽  
Reporting Odds Ratio ◽  
Neuraminidase Inhibitors ◽  
Disproportionality Analysis ◽  
Drug Induced ◽  
Real World Setting ◽  
Post Marketing Surveillance ◽  
Post Marketing

Background: Several studies reported that abnormal behavior was noted in pediatric patients receiving several drugs including neuraminidase inhibitors (NIs). However, information on drugs associated with abnormal behavior in a real-world setting remains limited. The purpose of this study was to clarify drugs associated with abnormal behavior using a spontaneous reporting system database. Methods: We performed a retrospective pharmacovigilance disproportionality analysis using the Japanese Adverse Drug Event Report database. Adverse event reports submitted to the Pharmaceuticals and Medical Devices Agency were analyzed. Drug associated with abnormal behavior were estimated using disproportionality analysis with calculation of the reporting odds ratio and 95% confidence interval. Results: A total of 1,144 reports of abnormal behavior were identified. Signals were detected showing the association of 4 including neuraminidase inhibitors (oseltamivir, zanamivir, laninamivir, and peramivir) with abnormal behavior, and these signals were stronger for oseltamivir than other neuraminidase inhibitors. Signals were also detected for acetaminophen and montelukast. Conclusion: Our results should raise physicians’ awareness of drugs associated with abnormal behavior, but further investigation of these medications is warranted.

Severe Hemolytic Reaction Due to Anti-JK3

1999 ◽  
Vol 123 (10) ◽  
pp. 949-951
Author(s):  
Carol S. Marshall ◽  
Denis Dwyre ◽  
Robin Eckert ◽  
Liisa Russell
Keyword(s):  
The United States ◽  
Cell Phenotype ◽  
Prior History ◽  
Ethnic Variability ◽  
Hemolytic Transfusion Reaction ◽  
History Of ◽  
Rare Phenotype ◽  
Antibody Screen

Abstract A 35-year-old gravida 3, para 3 Filipino woman with a negative antibody screen, no prior history of transfusion, and no hemolytic disease of the newborn in her children suffered a massive postpartum hemorrhage requiring transfusion. A severe hemolytic transfusion reaction occurred 5 days after delivery. Subsequently, a panagglutinin on a routine antibody identification panel was identified as anti-Jk3. The patient's red blood cell phenotype was Jk(a−b−) and all of her children were Jk(a−b+), yet the antibody that formed reacted with equal strength against all Jka- or Jkb-positive cells. The rare Jk(a−b−) phenotype is more common in Polynesians. Anti-Jk3, like other Kidd system antibodies, is difficult to detect because in vivo production may be absent between provocative episodes and because these antibodies often show weak in vitro reactions. The increasing numbers of Pacific Islanders in the United States could result in more frequent encounters with this rare phenotype. Increased awareness of ethnic variability in blood phenotypes and of the capricious nature of Kidd antibodies can help pathologists and technologists deal more effectively with these cases.

scholarly journals Ulcerative Colitis and Sweet’s Syndrome: A Case Report and Review of the Literature

2008 ◽  
Vol 22 (3) ◽  
pp. 296-298 ◽  
Author(s):  
Massud Ali ◽  
Donald R Duerksen
Keyword(s):  
Ulcerative Colitis ◽  
Immunosuppressive Therapy ◽  
Neutrophilic Dermatosis ◽  
Sweet’S Syndrome ◽  
Review Of The Literature ◽  
Neutrophilic Infiltration ◽  
Drug Induced ◽  
Sweet's Syndrome ◽  
History Of ◽  
Inflammatory Bowel

A 47-year-old man with a history of ulcerative colitis on prednisone and azathioprine was admitted to the hospital with a four-day history of fever, skin rash, arthralgias and leukocytosis. A skin biopsy demonstrated neutrophilic infiltration of the dermis that was consistent with Sweet’s syndrome. He improved after several days with an increase in his prednisone and azathioprine. Sweet’s syndrome is a rare cutaneous manifestation of inflammatory bowel disease, with approximately 40 cases reported in the literature. In a previously reported case of a patient with ulcerative colitis-associated Sweet’s syndrome who was on azathioprine at the time of the skin eruption, the azathioprine was stopped, raising the possibility of drug-induced Sweet’s syndrome. In the present case, the azathioprine was actually increased with complete resolution of the skin manifestations. This would support the theory that immunosuppressive therapy is the mainstay of therapy for this condition. In conclusion, Sweet’s syndrome is a neutrophilic dermatosis that is rarely associated with ulcerative colitis. It may occur while on immunosuppressive therapy and responds to an intensification of immunosuppression.

scholarly journals Identification of Mycobacterium genavense natural infection in a domestic ferret

2018 ◽  
Vol 31 (1) ◽  
pp. 133-136 ◽  
Author(s):  
Bérengère Dequéant ◽  
Quentin Pascal ◽  
Héloïse Bilbault ◽  
Elie Dagher ◽  
Maria-Laura Boschiroli ◽  
...  
Keyword(s):  
Natural Infection ◽  
Abdominal Ultrasound ◽  
Needle Aspiration ◽  
Mesenteric Lymph Nodes ◽  
Mustela Putorius ◽  
Tissue Samples ◽  
Acid Fast Bacilli ◽  
Mycobacterium Genavense ◽  
History Of ◽  
Progressive Weight Loss

A 6-y-old neutered male ferret ( Mustela putorius furo) was presented because of a 1-mo history of progressive weight loss, chronic cough, and hair loss. On clinical examination, the animal was coughing, slightly depressed, moderately hypothermic, and had bilateral epiphora. Thoracic radiography was suggestive of severe multinodular interstitial pneumonia. Abdominal ultrasound examination revealed hepatosplenomegaly and mesenteric and pancreaticoduodenal lymphadenopathy. Fine-needle aspiration of the pancreaticoduodenal lymph node, followed by routine Romanowsky and Ziehl–Neelsen stains, revealed numerous macrophages containing myriad acid-fast bacilli, leading to identification of mycobacteriosis. Autopsy and histologic examination confirmed the presence of disseminated, poorly defined, acid-fast, bacilli-rich granulomas in the pancreaticoduodenal and mesenteric lymph nodes, intestines, and lungs. Destaining of May-Grünwald/Giemsa–stained slides with alcohol, and then restaining with Ziehl–Neelsen, revealed acid-fast rods and avoided repeat tissue sampling without affecting the Ziehl–Neelsen stain quality and cytologic features. Tissue samples were submitted for a PCR assay targeting the heat shock protein gene ( hsp65) and revealed 100% homology with Mycobacterium genavense. We emphasize the use of special stains and PCR for identification of this potential zoonotic agent.

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