scholarly journals Functional and anatomical characterization of a non-leaking bilateral cystoid macular edema induced by paclitaxel therapy for ovarian cancer: a case report

2019 ◽  
Author(s):  
Stephan Hoffmann ◽  
David Ganster ◽  
Patrick Sidoroff ◽  
Stefan Mennel
Keyword(s):  
Ovarian Cancer ◽  
Macular Edema ◽  
Side Effect ◽  
Cystoid Macular Edema ◽  
Vision Loss ◽  
Early Recognition ◽  
Fluorescence Angiography ◽  
Drug Induced ◽  
Rare Side Effect ◽  
Paclitaxel Treatment

Abstract Abstract: Background: Paclitaxel is a member of the taxane family used for cancer therapy. Ovarian cancer is treated with Paclitaxel in first- and in second- line therapy. Cystoid macular edema without fluorescein leakage is a rare side effect of Paclitaxel treatment. Case presentation: We report the case of a 59-year-old female with ovarian cancer treated with paclitaxel. The patient received 21 cycles of adjuvant chemotherapy and was presented with bilateral gradual vision loss due to macular edema after paclitaxel treatment. Optical coherence tomography revealed a bilateral cystoid macular edema. Fluorescence angiography demonstrated the unusual finding of non-leakage in the late phases of the angiogram. Microperimetric findings of both eyes confirmed the visual deficits. After cessation of the paclitaxel therapy, vision, OCT and microperimetric findings returned to normal. Also, color vision testing demonstrated no persistent defect after therapy cessation. Conclusion: Paclitaxel induced bilateral maculopathy is a rare side effect of chemotherapy. Cessation of the Paclitaxel drug therapy leads to complete functional and anatomical resolution of drug induced side effects. Vision, microperimetric defects, color perception as also anatomical defects detected by OCT change to normal after drug cessation. Taxane induced bilateral maculopathy is a rare disease which should be known by ophthalmologists as also oncologists. Paclitaxel therapy must be counseled to report any vision problems during the treatment period because early recognition of a rare non leaking CME can facilitate appropriate intervention to reverse visual compromise and minimize any potential long-term ophthalmologic sequelae.

scholarly journals Uncover the Underlying Mechanism of Drug-Induced Myopathy by Using Systems Biology Approaches

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Dong Li ◽  
Aixin Li ◽  
Hairui Zhou ◽  
Xi Wang ◽  
Peng Li ◽  
...  
Keyword(s):  
Signaling Pathway ◽  
Side Effect ◽  
Chemical Structure ◽  
Safety Evaluation ◽  
Underlying Mechanism ◽  
Mapk Signaling ◽  
Drug Induced ◽  
Drug List ◽  
Rare Side Effect

Drug-induced myopathy (DIM) is a rare side effect; however, the consequence could be fatal. There are few reports to systematically assess the underlying mechanism of DIM. In this study, we curated the comprehensive DIM drug list based on structured labeling products (SPLs) and carried out the analysis based on chemical structure space, drug protein interaction, side effect space, and transcriptomic profiling space. Some key features are enriched from each of analysis. Specifically, the similarity of DIM drugs is more significant than random chance, which shows that the chemical structure could distinguish the DIM-positive drugs from negatives. The cytochrome P450 (CYP) was identified to be shared by DIM drugs, which indicated the important role of metabolism in DIM. Three pathways including pathways in cancer, MAPK signaling pathway, and GnRH signaling pathway enriched based on transcriptomic analysis may explain the underlying mechanism of DIM. Although the DIM is the current focus of the study, the proposed approaches could be applied to other toxicity assessments and facilitate the safety evaluation.

Bevacizumab-induced dysphonia: A case report with brief review of literature

2019 ◽  
Vol 26 (4) ◽  
pp. 1032-1036
Author(s):  
So Yi Lam ◽  
Chung-Shien Lee ◽  
Sandhya Sharma ◽  
Kit Cheng
Keyword(s):  
Ovarian Cancer ◽  
Case Report ◽  
Side Effect ◽  
Case Reports ◽  
Palliative Therapy ◽  
Ovarian Adenocarcinoma ◽  
Voice Changes ◽  
Patient Reported ◽  
Rare Side Effect

Introduction Anti-angiogenic treatment in adjunct with chemotherapy is widely used for the treatment of various cancers. These agents inhibit vascular endothelial growth factor (VEGF) signaling thereby inhibiting tumor proliferation and invasion. Dysphonia, or voice changes, has been documented, but is an underreported side effect of anti-angiogenic agents. We report a case of intermittent dysphonia in a patient with metastatic, platinum-refractory ovarian cancer treated with bevacizumab. Case report A 48-year-old female with high grade mixed type ovarian adenocarcinoma and concurrent left sided breast cancer was transitioned to palliative therapy with gemcitabine-bevacizumab for her ovarian cancer. At a follow-up visit after three cycles of the new therapy, the patient complained of intermittent changes in her voice, describing periods of hoarseness or softness in her voice after the chemotherapy—sometimes to the point that her voice was inaudible. Management and outcome: A new pelvic thrombus was discovered upon assessment of the patient’s disease. Bevacizumab was held and she was referred to ear, nose, and throat evaluation for dysphonia. Laryngoscopic examination showed normal vocal cord, with normal movements and no lesion or necrosis. During subsequent follow-up, the patient reported improvement in her voice with no additional dysphonia. Discussion Vocal adverse effects of anti-VEGF agents have been documented in landmark trials and case reports; however, clinicians are often unaware of this rare side effect. Although VEGF-induced dysphonia may be rare and may not impede the patient’s quality of life in some cases, it is critical to acknowledge and not underestimate this adverse effect.

Ejaculatory Dysfunction Produced by Clozapine. Three Case Reports and Review of Pathophysiological Mechanisms

1993 ◽  
Vol 60 (4) ◽  
pp. 354-356
Author(s):  
Y. Talmon ◽  
M. Guy ◽  
S. Eisenkraft ◽  
N. Guy
Keyword(s):  
Drug Therapy ◽  
Side Effect ◽  
Case Reports ◽  
Retrograde Ejaculation ◽  
Anti Psychotic ◽  
Drug Induced ◽  
Pathophysiological Mechanisms ◽  
Rare Side Effect ◽  
Schizophrenic Patients ◽  
Ejaculatory Dysfunction

Three chronic paranoid schizophrenic patients were treated with clozapine, a new anti-psychotic agent. Retrograde ejaculation developed as a side-effect. Stopping the drug therapy or reducing the dosage caused the side-effect to disappear. Re-challenge caused the return of the side-effect. We discuss this rare side-effect to clozapine, and the pathophysiological mechanisms of ejaculation disturbances, with emphasis on those that are drug-induced.

Ophthalmic adverse effects of taxanes: The Mayo Clinic experience

2020 ◽  
pp. 112067212096904
Author(s):  
Blake H Fortes ◽  
Harris Liou ◽  
Lauren A Dalvin
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Macular Edema ◽  
Side Effect ◽  
Cystoid Macular Edema ◽  
Meibomian Gland ◽  
Nasolacrimal Duct ◽  
Common Side Effect ◽  
Canalicular Obstruction ◽  
Clinic Experience

Purpose: To investigate ophthalmic side effects of taxanes and compare side effect frequency, requirement for cessation of taxane therapy, visual acuity outcome, and concurrent systemic effects between paclitaxel and docetaxel. Methods: Patients taking taxanes at a single center from 1/1/2010 to 2/29/2020 were retrospectively reviewed for clinical characteristics, treatments, and concurrent systemic adverse effects. Results: Of 1918 patients, 22 (1.1%) experienced an ophthalmic side effect that came to the attention of an eye care provider. Mean age at presentation of the side effect was 62 years (median 66, range 23–82). The most common side effect was meibomian gland dysfunction in 5 (23%) patients, followed by cystoid macular edema in 4 (18%) patients and canalicular obstruction in 4 (18%) patients, followed by diplopia in 2 (9%) patients, and singular cases of lash alopecia, and blepharitis, among others. Lids/lashes as well as nasolacrimal duct adverse effects occurred more frequently with docetaxel therapy than with paclitaxel therapy. Follow-up was available in 10 (45%) patients, with mean duration of 5 months (median 4, range 0–12 months). Of these patients, the ophthalmic side effects were resolved or controlled without discontinuing therapy in 8 (80%) patients. Taxane cessation was required in one patient with docetaxel-related canalicular obstruction and one patient with paclitaxel-related cystoid macular edema. Conclusion: Ophthalmic taxane-related adverse events are rare with estimated frequency of ophthalmic side effects of about 1%. Nevertheless, it is important that ophthalmologists recognize the range of side effects for optimal management. Most ophthalmic events can be treated with targeted therapy without discontinuation of life-prolonging taxane therapy.

scholarly journals Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

2020 ◽  
Keyword(s):  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Cystoid Macular Edema ◽  
Vision Loss ◽  
Intravitreal Bevacizumab ◽  
Visual Outcome ◽  
Intravitreal Triamcinolone ◽  
Concurrent Treatment ◽  
Intravitreal Triamcinolone Acetonide ◽  
Anti Vegf

Background: Cystoid macular edema (CME), a common complication of branch retinal vein occlusion (BRVO), is associated with a significant vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is the gold standard of treatment, while grid macular photocoagulation has also been used as an adjuvant in patients with CME secondary to BRVO. More recent efforts were successful by the use of intravitreal triamcinolone acetonide. We proposed a concurrent use of intravitreal triamcinolone acetonide and intravitreal bevacizumab in the treatment of CME secondary to BRVO. Case presentation: We described an 82-year-old female with a BRVO in the right eye who developed associated CME. Repeated injections of intravitreal bevacizumab and modified grid macular laser treatment were ineffective. A concurrent treatment with intravitreal bevacizumab and triamcinolone acetonide resulted in complete and dramatic resolution of CME with a favorable visual outcome. Optical Coherence Tomography (OCT) demonstrated a significant decrease in central subfield thickness (CST) from 764μm to 253μm, without any post-procedure complications or recurrence of macular edema with complete recovery of visual acuity at 6-month follow-up. Conclusion: Early concurrent treatment with intravitreal anti-VEGF therapy (e.g. intravitreal bevacizumab) and intravitreal triamcinolone acetonide is likely to be more effective than intravitreal anti-VEGF agents alone or grid macular photocoagulation in the management of CME associated with BRVO.

scholarly journals Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

2020 ◽  
Vol 9 (3) ◽  
pp. 159-163
Author(s):  
Kakarla V. Chalam ◽  
Suzie Gasparian ◽  
Moises Enghelberg
Keyword(s):  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Cystoid Macular Edema ◽  
Vision Loss ◽  
Intravitreal Bevacizumab ◽  
Visual Outcome ◽  
Intravitreal Triamcinolone ◽  
Concurrent Treatment ◽  
Intravitreal Triamcinolone Acetonide ◽  
Anti Vegf

Background: Cystoid macular edema (CME), a common complication of branch retinal vein occlusion (BRVO), is associated with a significant vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is the gold standard of treatment, while grid macular photocoagulation has also been used as an adjuvant in patients with CME secondary to BRVO. More recent efforts were successful by the use of intravitreal triamcinolone acetonide. We proposed a concurrent use of intravitreal triamcinolone acetonide and intravitreal bevacizumab in the treatment of CME secondary to BRVO. Case presentation: We described an 82-year-old female with a BRVO in the right eye who developed associated CME. Repeated injections of intravitreal bevacizumab and modified grid macular laser treatment were ineffective. A concurrent treatment with intravitreal bevacizumab and triamcinolone acetonide resulted in complete and dramatic resolution of CME with a favorable visual outcome. Optical Coherence Tomography (OCT) demonstrated a significant decrease in central subfield thickness (CST) from 764μm to 253μm, without any post-procedure complications or recurrence of macular edema with complete recovery of visual acuity at 6-month follow-up. Conclusion: Early concurrent treatment with intravitreal anti-VEGF therapy (e.g. intravitreal bevacizumab) and intravitreal triamcinolone acetonide is likely to be more effective than intravitreal anti-VEGF agents alone or grid macular photocoagulation in the management of CME associated with BRVO.

scholarly journals Drug-induced Angioedema: A Rare Side Effect of Mirabegron

2019 ◽  
Vol 2019 ◽  
Author(s):  
Harley Davis ◽  
◽  
Troy Wallace, MD ◽  
Christine Gilkerson, MD ◽  
Elizabeth Saunders, MD ◽  
...  
Keyword(s):  
Side Effect ◽  
Drug Induced ◽  
Rare Side Effect

Citalopram-Associated Alopecia: A Case Report and Brief Literature Review

2019 ◽  
Vol 14 (2) ◽  
pp. 167-170 ◽  
Author(s):  
Joshua Hekmatjah ◽  
Kinza Tareen ◽  
Ruqiya Shama Tareen
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Side Effect ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Early Recognition ◽  
Side Effect Profile ◽  
First Line ◽  
Drug Induced ◽  
Bizarre Behavior

Background: Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line treatments for various psychiatric disorders. SSRIs offer an improved side effect profile compared to older treatments, which improves patients’ adherence and quality of life. Case Report:Here we discuss a case of an uncommon, but a distressing side effect of citalopram. A 76-year old woman was referred to the psychiatry clinic for bizarre behavior. The patient was diagnosed with behavioral variant frontotemporal dementia and was started on citalopram 20 mg and aripiprazole 5 mg daily. At 3.5 months the patient complained of diffuse hair thinning on her scalp. Citalopram was considered the offending agent and was discontinued. Within a few months, the patient regained most of her hair. Although drug-induced alopecia is common among other SSRIs, it is relatively rare with citalopram. Results and Conclusion:Early recognition, withdrawal of offending agent, and reassurance to the patient that hair loss is reversible can help alleviate patient distress and avoid relapse.

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