Paliperidone induced neutropenia in first episode psychosis: a case report

Background Neutropenia, a decrease in total number of neutrophils below 1500/mm3 and particularly severe neutropenia, defined as neutrophils less than 500/mm3, is a potential adverse effect of antipsychotic medications that can lead to increased risk of infections and death. However, much of the attention on the potential adverse effect is centered exclusively on clozapine, which remains the only antipsychotic medication in the United States requiring standardized monitoring of blood work. We demonstrate here that paliperidone can also cause neutropenia and therefore clinicians should be aware of this possibility especially during initiation of treatment. Case presentation The following report presents the case of a 23-year-old African American male with first episode psychosis who developed neutropenia after initiation of paliperidone. Neutropenia resolved after discontinuation of paliperidone and initiation of an alternative antipsychotic, haloperidol. Conclusions This case report demonstrates an example of paliperidone induced neutropenia which resolved with a switch to haloperidol. We conclude that when initiating paliperidone, clinicians should be more aware of the risk of neutropenia. Moreover, neutropenia may be a more common and overlooked issue in patients on antipsychotic medications other than clozapine and increased awareness of comparative risk across antipsychotics could help direct treatment.

Efficacy of antiviral therapy in patients with post-hepatitis C liver cirrhosis: is hyperuricaemia a potential adverse effect?

Hepatitis C virus (HCV) related liver cirrhosis is considered a major health problem; sofosbuvir (SOF)/ledipasvir (LDV) and SOF/daclatsvir (DACLA) are very promising direct antiviral agents (DAAS) especially in treating HCV genotype 4 which is the main genotype in Egypt. Uric acid elevation was reported in many systemic diseases and might be elevated during direct antiviral therapy. The aim is to evaluate efficacy and safety of SOF/LDV and SOF/DACLA plus ribavirin in treating HCV related child A liver cirrhosis and assess hyperuricaemia as a potential adverse effect to this regimen.MethodsThis prospective observatinal study included 128 HCV naive child A cirrhotic patients divided into two groups (77 patients were treated with SOF 400 mg, DACLA 60 mg and ribavirin 600 mg and 51 patients were treated with SOF 400 mg, LDV 90 mg and ribavirin 600 mg) for 12 weeks, during the treatment complete blood count, creatinine, bilirubin, alanine transaminase, aspartate transaminase and serum uric acid were monitored, HCV RNA quantitative PCR at 12 weeks after the end of treatment was done.ResultsResponse to treatment in SOF/LDV (sof/led) group is about (98%), response to treatment in SOF/DACLA (sof/dacla) group is about (96%). Hyperuricaemia was noticed in 17.6% of patients received sof/led and in 15.5% of those received sof/dacla.ConclusionSOF+LDV and SOF+DACLA plus ribavirin regimens are highly effective in treating chronic HCV patients with compensated liver cirrhosis. Hyperuricaemia is considered a potential adverse effect to DAAS containing ribavirin and may lead to serious side effects such as renal impairment.

A Case of Grover’s Disease Secondary to Brodalumab Therapy for Psoriasis

Background: Grover’s disease has been associated with a number of medications including sulfadoxine-pyrimethamine, recombinant interleukin (IL)-4, ipilimumab, and BRAF inhibitors. To our knowledge, Grover’s disease has not been reported in association with interleukin-17 inhibitors. Case Description: A 47-year-old female with plaque psoriasis developed Grover’s disease 3 months following initiation of brodalumab. Discontinuation of brodalumab and initiation of certolizumab pegol and methotrexate led to resolution of her rash. Conclusion: This case highlights Grover’s disease as a potential adverse effect of brodalumab therapy. In patients who develop Grover’s disease with brodalumab, modification of therapy may be considered due to the bothersome nature of the rash.

Alopecia After Switch to Tenofovir Alafenamide in 6 African American Women

No cases of tenofovir alafenamide (TAF)–induced alopecia have been reported in the literature. We describe 6 cases of hair loss in African American female patients after switching to TAF and aim to raise awareness about this potential adverse effect of TAF, which could predominate in certain patient populations.