Chronic Anticholinergic Toxicity Discovered in a Pharmacogenomics, Polypharmacy Patient

2021 ◽  
Vol 36 (6) ◽  
pp. 304-310
Author(s):  
Michael J. Schuh ◽  
Sheena Crosby
Keyword(s):  
Infectious Disease ◽  
Fever Of Unknown Origin ◽  
Interprofessional Collaboration ◽  
Diagnostic Testing ◽  
Unknown Origin ◽  
Cutaneous Vasodilation ◽  
Testing And Evaluation

OBJECTIVE: To report a case of chronic anticholinergic toxicity in a referred, pharmacogenomics (PGx), polypharmacy patient. SUMMARY: The patient is a 67-year-old male who was referred to the polypharmacy service for a PGx consult. This patient has had episodic fever of unknown origin, general cutaneous vasodilation, tremors, jerks, and brain fogginess which have been unexplained. He has seen specialists from infectious disease, rheumatology, endocrinology, and neurology with no contributory condition causing these symptoms, so he was referred for PGx testing and evaluation by the polypharmacy pharmacist. CONCLUSION: This case demonstrates the importance of pharmacist-patient consultations and how a PGx consult may expose polypharmacy medicationrelated problems of greater significance than the PGx indication for the consult. In addition, the case demonstrates positive interprofessional collaboration between pharmacists and physicians to more effectively solve complex medication-related problems that may not be easily diagnosed through objective lab or diagnostic testing.

scholarly journals HMGB1, anti-HMGB1 antibodies, and ratio of HMGB1/anti-HMGB1 antibodies as diagnosis indicator in fever of unknown origin

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mingkun Chen ◽  
Li Zhu ◽  
Miao Xue ◽  
Rongrong Zhu ◽  
Liling Jing ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Autoimmune Disease ◽  
Serum Concentration ◽  
Malignant Tumor ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Healthy Control Group ◽  
Control Group ◽  
Elisa Kit ◽  
Healthy Control

AbstractTo evaluate the feasibility of serum HMGB1, anti-HMGB1 antibodies, and HMGB1/anti-HMGB1 ratio as a diagnosis indicator of initial clinical classification in patients with fever of unknown origin (FUO). Ninety-four patients with classical FUO and ninety healthy controls were enrolled in this study. The subjects’ clinical data and serum were collected. The serum concentration of HMGB1 was detected by a commercial HMGB1 ELISA kit, while the serum concentration of anti-HMGB1 antibodies were detected by an in-house built anti-HMGB1 antibodies ELISA kit and further confirmed by immunoblotting. According to the hospital diagnosis on discharge, ninety-four FUO patients were divided into four groups, Infectious disease subgroup, autoimmune disease subgroup, malignant tumor subgroup, and undetermined subgroup. The concentrations of HMGB1 in the infectious disease subgroup and autoimmune disease subgroup were higher than those in the malignant tumor subgroup, undetermined subgroup, and healthy control group. The concentration of anti-HMGB1 antibodies in autoimmune disease subtype group was higher than those in other subgroups as well as healthy control group. According to the distribution of HMGB1 and anti-HMGB1 in scatter plots of the patients with FUO, we found that the ratio of serum HMGB1/anti-HMGB1 is an ideal clinical indicator for differential diagnosis of different subtypes of FUO. The best cut-off was 0.75, and the sensitivity, specificity, and AUC were 66.67%, 87.32%, and 0.8, respectively. Correlation analysis showed that serum concentration of HMGB1 was moderately correlated with CRP in infectious diseases subgroup, and the serum concentration of anti-HMGB1 antibodies was strongly correlated with erythrocyte sedimentation rate in autoimmune disease subgroup. Our study had showed that serum HMGB1/anti-HMGB1 antibodies ratio can help clinicians identify FUO subtypes, thereby avoiding many unnecessary examinations and tests, and improving the effectiveness of clinical diagnosis and treatment of FUO.

scholarly journals Diagnostic Use of Serum Ferritin Levels to Differentiate Infectious and Noninfectious Diseases in Patients with Fever of Unknown Origin

2013 ◽  
Vol 34 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Seong Eun Kim ◽  
Uh Jin Kim ◽  
Mi Ok Jang ◽  
Seung Ji Kang ◽  
Hee Chang Jang ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Serum Ferritin ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Unknown Origin ◽  
University Hospital ◽  
Disease Group ◽  
Hematologic Disease ◽  
Hematologic Diseases

INTRODUCTION: In this study, we determined whether serum ferritin levels could be used to differentiate between fever of unknown origin (FUO) caused by infectious and noninfectious diseases.METHODS: FUO patients were hospitalized at Chonnam National University Hospital between January, 2005 and December, 2011. According to the final diagnoses, five causes were identified, including infectious diseases, hematologic diseases, noninfectious inflammatory diseases, miscellaneous and undiagnosed.RESULTS: Of the 77 patients, 11 were caused by infectious diseases, 13 by hematologic diseases, 20 by noninfectious inflammatory diseases, 8 by miscellaneous diseases, and 25 were undiagnosed. The median serum ferritin levels in infectious diseases was lower than those in hematologic diseases and (median (interquartile range) of 282.4 (149.0–951.8) ng/mL for the infectious disease group, 1818.2 (485.4–4789.5) ng/mL for the hematologic disease group, and 563.7 (399.6–1927.2) ng/mL for the noninfectious inflammatory disease group,p= 0.048, Kruskal–Wallis test). By comparison using the Mann–Whitney test, statistically significant differences were found only between the infectious disease and hematologic disease groups (p= 0.049) and between the infectious disease and groups (p= 0.04).CONCLUSION: An optimal cutoff value of serum ferritin levels to predict FUO caused by a noninfectious disease (hematologic diseases, noninfectious inflammatory diseases) was established as 561 ng/mL.

scholarly journals Focused Diagnostic Approach to A Patient with Fever of Unknown Origin (FUO): A Review

2013 ◽  
Vol 3 (1) ◽  
pp. 27-34
Author(s):  
Jamal Uddin Ahmed ◽  
Muhammad Abdur Rahim ◽  
Md. Delwar Hossain ◽  
AKM Shaheen Ahmed ◽  
AKM Musa ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Fever Of Unknown Origin ◽  
Diagnostic Testing ◽  
Unknown Origin ◽  
Specific Pattern ◽  
Diagnostic Approach ◽  
Atypical Presentation ◽  
Main Difficulty ◽  
Diagnostic Challenge ◽  
Therapeutic Trials

Fever of unknown origin (FUO) is a diagnostic challenge for clinicians. Disorders presenting as fever of unknown origin are varied and extensive. Clinicians often find themselves hopeless with a patient with FUO and try to catch a straw by doing every conceivable test and run therapeutic trials in order to diagnose all of the myriad causes of FUO that are in fact part of the differential diagnosis of FUO in general. The main difficulty with diagnostic testing in patients with FUO is that it is unfocused. All disorders have a specific pattern of organ involvement. In a patient with FUO, there are almost always one or more clues from the history, physical examination, or nonspecific laboratory tests that suggest a particular diagnosis or at least limit diagnostic possibilities. It is worthy to remember that fever of unknown origin is more often caused by an atypical presentation of a common entity than by a rare disorder. Thus a focused diagnostic approach can minimize the miseries of both the clinician & the patient. Birdem Med J 2013; 3(1): 27-34 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17124

scholarly journals From autoimmune hepatitis to Q fever

2015 ◽  
Vol 10 (1) ◽  
pp. 58
Author(s):  
Davide Tizzani ◽  
Silvia Totaro ◽  
Valentina Laura Crudo ◽  
Andrea Viola ◽  
Vittorio Gallo ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Liver Biopsy ◽  
Autoimmune Hepatitis ◽  
Medical History ◽  
Coxiella Burnetii ◽  
Fever Of Unknown Origin ◽  
Clinical Presentation ◽  
Q Fever ◽  
Unknown Origin ◽  
Granulomatous Hepatitis

Q fever is an infectious disease caused by <em>Coxiella burnetii.</em> Its clinical presentation is often nonspecific and the serological diagnosis difficult to make, especially in the absence of specific and suspected medical history. This article presents a case of fever of unknown origin (FUO), interpreted as an autoimmune hepatitis, later proven by the liver biopsy to be a granulomatous hepatitis caused by <em>C. burnetii</em>. The approach to FUO, the features of granulomatous hepatitis and Q fever are presented and discussed.

scholarly journals Acute Liver Failure and Fever of Unknown Origin

2021 ◽  
Author(s):  
Terry A Marryshow ◽  
Daniel P McQuillen ◽  
Kenneth M Wener ◽  
J Morgan Freiman
Keyword(s):  
Infectious Disease ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Immune Reconstitution ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
History Taking ◽  
Immune Reconstitution Syndrome ◽  
Disseminated Histoplasmosis ◽  
Infectious Disease Service

Abstract We describe a case of acute liver failure in a woman in whom a diagnosis was initially unable to be established. The patient rapidly deteriorated, requiring admission to the intensive care unit and was placed under consideration for liver transplantation. On consultation with the infectious disease service, thorough history taking was performed which uncovered salient epidemiologic information pointing toward the eventual diagnosis of disseminated histoplasmosis. We discuss aspects of diagnosis and management, including the management of immune reconstitution syndrome which complicated treatment.

Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

2001 ◽  
Vol 40 (03) ◽  
pp. 59-70 ◽  
Author(s):  
W. Becker ◽  
J. Meiler
Keyword(s):  
Nuclear Medicine ◽  
Fever Of Unknown Origin ◽  
Tumor Imaging ◽  
White Blood Cells ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Recurrent Fever ◽  
Nuclear Medicine Imaging

SummaryFever of unknown origin (FUO) in immunocompetent and non neutropenic patients is defined as recurrent fever of 38,3° C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. The underlying diseases of FUO are numerous and infection accounts for only 20-40% of them. The majority of FUO-patients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of all cases. In this respect FOU in its classical definition is clearly separated from postoperative and neutropenic fever where inflammation and infection are more common. Although methods that use in-vitro or in-vivo labeled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO-patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs are more suited in evaluation of the focus in occult sepsis. Ga-67 citrate is the only commercially available gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-up of FUO. The number of Ga-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled WBCs. F-l 8-2’-deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by similar mechanisms. First results of FDG imaging demonstrated, that FDG may be superior to other nuclear medicine imaging modalities which may be explained by the preferable tracer kinetics of the small F-l 8-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conventional gamma camera.

Sign in / Sign up

Export Citation Format

Share Document