Can idiosyncratic drug reactions occur in quick succession? a case of cross sensitivity between levetiracetam and phenytoin

The occurrence of adverse drug reactions (ADRs) to more than one drug in quick succession can cause diagnostic dilemma to the doctor and increased burden of suffering to the patient. We present a single case report of a 23 year old female who developed rash and agranulocytosis in quick succession as ADRs to phenytoin and levetiracetam respectively. These antiepileptic drugs (AEDs) were prescribed as prophylaxis against post traumatic seizures (PTS). Hence a proper rationale for the prophylactic treatment of PTS and pharmacovigilance for early detection of adverse drug reactions is the need of the hour.

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Late Brachial Plexopathy due to Radiation-Induced Fibrosis. A single case report illustrating the importance of electrophysiology and MRI in differenzial diagnostics for delayed radiation-induced plexopathy

Klinische Neurophysiologie ◽

10.1055/s-0030-1250843 ◽

2010 ◽

Vol 41 (01) ◽

Author(s):

TN Witt ◽

UM Ganswindt ◽

A Staebler ◽

C Weiss

Keyword(s):

Case Report ◽

Single Case ◽

Brachial Plexopathy ◽

Single Case Report ◽

Radiation Induced

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A rare coexistence of acromegaly, myasthenia gravis, sicca syndrome, and elevated serum IgG4 levels: A single case report

Endocrine Abstracts ◽

10.1530/endoabs.70.aep708 ◽

2020 ◽

Author(s):

Wan-Chen Wu ◽

Huang Abel Po-Hao

Keyword(s):

Case Report ◽

Myasthenia Gravis ◽

Single Case ◽

Elevated Serum ◽

Sicca Syndrome ◽

Single Case Report ◽

Serum Igg4

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Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report

International Journal of Molecular Sciences ◽

10.3390/ijms22126480 ◽

2021 ◽

Vol 22 (12) ◽

pp. 6480

Author(s):

Céline K. Stäuble ◽

Markus L. Lampert ◽

Thorsten Mikoteit ◽

Martin Hatzinger ◽

Kurt E. Hersberger ◽

...

Keyword(s):

Cytochrome P450 ◽

Case Report ◽

Adverse Drug Reactions ◽

Active Metabolite ◽

Hepatic Metabolism ◽

Cytochrome P450 3A4 ◽

Drug Reactions ◽

Drug Induced ◽

Potential Impact ◽

Intermediate Metabolizer

We report two cases of patients who developed severe adverse drug reactions including persistent movement disorders, nausea, and vertigo during treatment with quetiapine at maximum daily doses ranging between 300 and 400 mg. The extensive hepatic metabolism of quetiapine is mainly attributed to cytochrome P450 3A4 (CYP3A4). However, there is recent evidence supporting the idea of CYP2D6 playing a role in the clearance of the quetiapine active metabolite norquetiapine. Interestingly, both patients we are reporting of are carriers of the CYP2D6*4 variant, predicting an intermediate metabolizer phenotype. Additionally, co-medication with a known CYP2D6 inhibitor and renal impairment might have further affected quetiapine pharmacokinetics. The herein reported cases could spark a discussion on the potential impact of a patient’s pharmacogenetic predisposition in the treatment with quetiapine. However, further studies are warranted to promote the adoption of pharmacogenetic testing for the prevention of drug-induced toxicities associated with quetiapine.

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Sequential bilateral Behçet’s neuroretinitis associated with prepapillary vitreous exudate: case report

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-020-00226-y ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Imen Ksiaa ◽

Safa Ben Aoun ◽

Sourour Zina ◽

Dhouha Nefzi ◽

Sana Khochtali ◽

...

Keyword(s):

Case Report ◽

Single Case ◽

Signal Loss ◽

Fiber Layer ◽

Swept Source ◽

Single Case Report ◽

Shadowing Effect ◽

Eye Involvement ◽

The Right ◽

Inflammatory Changes

Abstract Objective To describe a case of Behçet disease (BD) uveitis manifesting with sequential bilateral neuroretinitis associated with prepapillary inflammatory vitreous exudate (PIVE). Material and methods A single case report documented with multimodal imaging. Results A 37-year-old man developed neuroretinitis with associated PIVE in the left eye. He was diagnosed with ocular toxoplasmosis and treated accordingly based on positive serologic testing and negative work-up for other entities, including BD. The disease course was favorable, but 1 year later a similar neuroretinitis developed in the right eye. Extraocular features of BD became evident only at the time of the second eye involvement, and the patient received corticosteroid and immunosuppressive therapy. Swept source (SS) OCT showed at the acute phase in both eyes a typical “mushroom-shaped” prepapillary hyperreflectivity of the PIVE. SS OCT angiography (OCTA) demonstrated a corresponding prepapillary hypointense area due to shadowing effect, decreasing in size while scanning deeper layers. It also detected peripapillary retinal hypervascularity in both eyes and a sectoral area of flow signal loss in the first involved left eye. Visual acuity improved following the resolution of the PIVE and associated acute inflammatory changes in both eyes. The left eye showed residual optic disc pallor and retinal nerve fiber layer defects. Conclusion Sequential bilateral neuroretinitis associated with PIVE may occur before other clinical features of BD become evident. SS OCT and OCTA can provide useful information for the diagnosis and management of this rare, but typical, ocular manifestation of BD uveitis.

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