Idiosyncratic reaction to single 7.5 mg dose of methotrexate: Mishappening by chance

Abstract Periungual pyogenic granuloma-like lesions are not uncommon side effects of isotretinoin therapy, but these cases are relatively infrequently reported. Excessive granulation tissue appeared in two patients receiving oral isotretinoin therapy for severe acne. Once isotretinoin was discontinued, the outgrowths resolved spontaneously in both patients. It is probably an idiosyncratic reaction to isotretinoin which renders the skin more susceptible to extracellular matrix and blood vessel formation. Moreover, similar lesions may be observed particularly with newer targeted therapies, such as inhibitors of epidermal growth factor receptor (EGFR) and mitogen-activated protein kinase kinases (MEKs). EGFR inhibitors associated painful periungual inflammation (paronychia), which often arises from the nail wall during newer targeted therapies, has been classified in the third major group of dermatologic toxicity. Cutaneous toxicity may be interpreted as a stress response that affects epidermal homeostasis. In the cell, stress signals are transmitted to effectors which then produce an inflammatory response. In conclusion, paronychia and excessive granulation tissue in the nail folds are not uncommon side effects of oral retinoids. It is therefore particularly important for practicing dermatologists to be aware that the best management approach is drug discontinuation.

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Idiosyncratic reaction to nebulised ribavirin in an artifically ventilated neonate

Journal of Infection ◽

10.1016/s0163-4453(89)95162-1 ◽

1989 ◽

Vol 19 (1) ◽

pp. 85-87 ◽

Cited By ~ 1

Author(s):

M. Cosgrove ◽

H.R. Jenkins ◽

P.H. Rowlandson ◽

O.P. Gray

Keyword(s):

Idiosyncratic Reaction

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Idiosyncratic reaction after oxaliplatin infusion

Annals of Oncology ◽

10.1023/a:1008366223918 ◽

2001 ◽

Vol 12 (1) ◽

pp. 132-133 ◽

Cited By ~ 36

Author(s):

D. Santini ◽

G. Tonini ◽

A. Salerno ◽

B. Vincenzi ◽

G. Patti ◽

...

Keyword(s):

Idiosyncratic Reaction

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Temozolomide-induced aplastic anaemia and incidental low-grade B-cell non-Hodgkin lymphoma in a geriatric patient with glioblastoma multiforme

BMJ Case Reports ◽

10.1136/bcr-2018-228803 ◽

2019 ◽

Vol 12 (6) ◽

pp. e228803 ◽

Cited By ~ 1

Author(s):

Felipe Batalini ◽

Matthew R Kaufmann ◽

Gabriel Francisco Aleixo ◽

Reed Drews

Keyword(s):

Glioblastoma Multiforme ◽

B Cell ◽

Aplastic Anaemia ◽

Methylation Status ◽

Tumour Resection ◽

Low Grade ◽

Idiosyncratic Reaction ◽

Non Hodgkin Lymphoma ◽

Tumour Location ◽

Methylguanine Methyltransferase

Glioblastoma multiforme is an astrocyte-derived tumour representing the most aggressive primary brain malignancy. The median overall survival is 10–12 months, but it drops to 3–8.5 months for the cohort with more than 65 years old, which account to half of all patients. Initial management in this patient population aims to balance overall patient survival and quality of life with the inherent risks of treatment intervention, which include maximal safe tumour resection, radiation and temozolomide (TMZ) chemotherapy. This is accomplished through risk stratification as a function of patient age, functional status, comorbidities, tumour location and methylguanine methyltransferase promoter methylation status. We describe the care of a patient with prolonged febrile neutropaenia, with a rare but fatal complication from TMZ-induced idiosyncratic reaction, leading to aplastic anaemia and a provoking diagnosis of low-grade B-cell non-Hodgkin’s lymphoma.

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Angiographic features of drug-induced bilateral angle closure and transient myopia with Ciliochoroidal effusion

BMC Ophthalmology ◽

10.1186/s12886-019-1230-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Yong Koo Kang ◽

Byeong Jae Son ◽

Dong Ho Park ◽

Jae Pil Shin

Keyword(s):

Case Series ◽

Ultrasound Biomicroscopy ◽

Angle Closure ◽

Drug Induced ◽

Idiosyncratic Reaction ◽

Transient Myopia ◽

Extravascular Fluid ◽

Ciliochoroidal Effusion ◽

Myopic Shift ◽

Shallow Anterior Chamber

Abstract Background To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases. Methods This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM). Results Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from − 0.5 to − 17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels). Conclusions The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.

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Neuroleptic Malignant Syndrome – A medical emergency in a psychiatric patient

Bangladesh Critical Care Journal ◽

10.3329/bccj.v6i2.38590 ◽

2018 ◽

Vol 6 (2) ◽

pp. 108-110

Author(s):

Rajib Ahsan Sumon ◽

Eshita Majumder

Keyword(s):

Neuroleptic Malignant Syndrome ◽

Complete Resolution ◽

Antipsychotic Drugs ◽

Medical Emergency ◽

Muscle Rigidity ◽

Atypical Antipsychotic Drug ◽

Presumptive Diagnosis ◽

Idiosyncratic Reaction ◽

High Fatality Rate ◽

Work Up

With an estimated incidence of 0.02 to 3.23%1, neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction to antipsychotic drugs; having a relatively high fatality rate of about 10%2. Here, we are reporting, a 38 years old female schizoaffective patient, presented with fever, muscle rigidity and altered sensorium who had started tablet risperidone(an atypical antipsychotic drug) 11 days prior to hospital admission. After initial sepsis work up and neuroimaging, infective causes and acute cerebrovascular incidents were ruled out and a presumptive diagnosis of NMS was made. Immediate discontinuation of suspected causative agent, along with the provision of supportive care leads to complete resolution of all the symptoms in our patient.Bangladesh Crit Care J September 2018; 6(2): 108-110

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Acute Liver and Renal Failure: A Rare Adverse Effect Exclusive to Intravenous form of Amiodarone

Case Reports in Critical Care ◽

10.1155/2016/5232804 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Robin Paudel ◽

Prerna Dogra ◽

Saurav Suman ◽

Saurav Acharya ◽

Jyoti Matta

Keyword(s):

Adverse Effect ◽

Renal Failure ◽

Drug Toxicity ◽

Unusual Case ◽

Renal Toxicity ◽

Wide Spectrum ◽

Polysorbate 80 ◽

Ventricular Tachyarrhythmias ◽

Case Review ◽

Idiosyncratic Reaction

Amiodarone is an antiarrhythmic drug which is highly effective against a wide spectrum of ventricular tachyarrhythmias making it irreplaceable in certain group of patients. We report an unusual case of acute liver and renal failure within 24 hours of initiation of intravenous (IV) amiodarone which resolved after stopping the medication. The mechanism of acute liver and renal toxicity is not clearly known but is believed to be secondary to amiodarone induced (relative) hypotension, idiosyncratic reaction to the drug, and toxicity of the vector that carries the medication, polysorbate-80. In this case review, we discuss the hyperacute drug toxicity caused by IV amiodarone being a distinctly different entity compared to the adverse effects shown by oral amiodarone and support the suggestion that oral amiodarone can be safely administered even in patients who manifest acute hepatitis with the IV form.

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Bilateral, Simultaneous, Acute Angle Closure Glaucoma in Pseudophakia Induced by Chlorthalidone

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/3713818 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Indra Durai ◽

Mrunali Mohan Dhavalikar ◽

Chandran Prem Anand ◽

Venkatraman Ganesh ◽

Ramaswami Krishnadas

Keyword(s):

Case Reports ◽

Crystalline Lens ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Systemic Hypertension ◽

Drug Induced ◽

Idiosyncratic Reaction ◽

Acute Angle Closure ◽

Acute Angle Closure Glaucoma

Purpose. To report two persons with acute, bilateral, and simultaneous angle closure glaucoma in pseudophakia secondary to uveal effusions induced by administration of chlorthalidone.Methods. Case reports.Results. Bilateral shallow anterior chambers and high intraocular pressure with decline in visual acuity were reported in two patients within days of intake of chlorthalidone for systemic hypertension. Gonioscopy confirmed appositional angle closure while choroidal detachment and ciliochoroidal detachment were revealed on ultrasonographic studies. Discontinuing chlorthalidone and institution of aqueous suppressants to reduce IOP and cycloplegics reversed angle closure and glaucoma.Conclusions. Reports of angle closure glaucoma in pseudophakic eyes induced by idiosyncratic reaction to chlorthalidone confirms that osmotic changes in the crystalline lens has no role in the pathogenesis of drug induced glaucoma and reaffirms that glaucoma is secondary to ciliochoroidal detachment and ciliary body rotation and edema.

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