RESUMEN
Some chemotherapeutic agents can cause iatrogenic lymphoproliferative disorders. In analogy to what has been observed with other nucleoside analogues such as cladribine and fludarabine, we document the first case of an Epstein-Barr virus-positive, iatrogenic immunodeficiency-associated, lymphoproliferative disease, formally resembling polymorphic post-transplant lymphoproliferative disease in a patient treated with azacitidine (Vidaza) for chronic myelomonocytic leukaemia (CMML). A 78-year-old female patient was diagnosed with CMML in January 2012, and treatment with azacitidine was initiated, which lasted for five cycles from February until June 2012. The patient was hospitalized in June 2012 under the suspicion of pneumonia. Transformation of the CMML was suspected at that time too. During hospitalization, a generalized enlargement of the lymph nodes and the spleen was noticed. The patient rapidly deteriorated and finally died of respiratory insufficiency. At autopsy, an Epstein-Barr virus-associated lymphoproliferative disorder, resembling polymorphic post-transplant lymphoproliferative disease with involvement of the lymph nodes, the spleen and the lung and causing necrotizing pneumonia, was diagnosed. Diagnostic criteria for diffuse large B-cell lymphoma or infectious mononucleosis-like lymphoproliferative disease were not met. This is the first documented case of an azacitidine-associated lymphoproliferative disease, raising awareness for possible not yet known side effects of this drug, which should be kept in mind by oncologists and pathologists.
Asunto(s)
Antimetabolitos Antineoplásicos/efectos adversos , Azacitidina/efectos adversos , Infecciones por Virus de Epstein-Barr/complicaciones , Leucemia Mielomonocítica Crónica/tratamiento farmacológico , Trastornos Linfoproliferativos/etiología , Anciano , Antimetabolitos Antineoplásicos/uso terapéutico , Azacitidina/uso terapéutico , Transfusión de Componentes Sanguíneos , Médula Ósea/patología , Terapia Combinada , Progresión de la Enfermedad , Resultado Fatal , Femenino , Humanos , Enfermedad Iatrogénica , Leucemia Mielomonocítica Crónica/terapia , Pulmón/patología , Ganglios Linfáticos/patología , Trastornos Linfoproliferativos/inducido químicamente , Trastornos Linfoproliferativos/patología , Trastornos Linfoproliferativos/virología , Necrosis , Neumonía/etiología , Neumonía/patología , ARN Viral/análisis , Bazo/patología , Proteínas de la Matriz Viral/análisisRESUMEN
We report the case of an 83-year-old female patient who developed diclofenac-associated liver injury nine days after therapy had started. Diclofenac was used to treat back pain associated with an acute exacerbation of a chronic lumbovertebral symptoms reversed. We discuss the adverse reaction profile of diclofenac, particularly diclofenac-induced liver injury. We also discuss the epidemiology, clinical presentation and mechanisms of NSAID-induced liver injury, as well as risk factors and preventive measures.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Diclofenaco/efectos adversos , Espondilosis/tratamiento farmacológico , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/uso terapéutico , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Estudios Transversales , Diagnóstico Diferencial , Diclofenaco/uso terapéutico , Interacciones Farmacológicas , Quimioterapia Combinada , Femenino , Humanos , Pruebas de Función Hepática , Factores de Riesgo , SuizaRESUMEN
A 68-year-old female patient presented at the emergency room with episodes of epistaxis, dysphagia and malaise. The patient had acute prerenal renal failure, probably in association with previous infection of the airways and treatment with NSAID's. Laboratory values revealed greatly decreased leukocyte and platelet counts as well as anemia. The patient had a diagnosis of a seronegative arthritis since 9 months and, therefore, was treated with low dose methotrexate (MTX) 10 mg/week. After exclusion of other causes, myelosupression was considered to be associated with low-dose MTX. After stopping MTX and treatment with folic acid leucocyte and platelet counts returned to normal and stomatitis recovered as well within nine days. We discuss the pharmacology of low-dose MTX and in particular the risk factors and prophylaxis of its toxicity. Renal function needs special attention in patients treated with low-dose MTX.
Asunto(s)
Antirreumáticos/toxicidad , Artritis/tratamiento farmacológico , Gingivitis Ulcerosa Necrotizante/inducido químicamente , Metotrexato/toxicidad , Pancitopenia/inducido químicamente , Estomatitis/inducido químicamente , Adalimumab , Anciano , Antiinflamatorios/administración & dosificación , Antiinflamatorios/efectos adversos , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Antirreumáticos/administración & dosificación , Biopsia , Médula Ósea/efectos de los fármacos , Médula Ósea/patología , Diagnóstico Diferencial , Quimioterapia Combinada , Femenino , Humanos , Metotrexato/administración & dosificación , Pancitopenia/diagnóstico , Prednisona/administración & dosificación , Prednisona/efectos adversos , Estomatitis/diagnósticoRESUMEN
A 67-year old man was hospitalized due to an aorto-coronary bypass and cecal perforation. After administration of atorvastatin, amiodarone, and fluconazole, rhabdomyolysis developed with electrolyte disturbances (hyperphosphatemia, hyopcalcemia) and a massive increase in creatine kinase and myoglobin. In the clinical course, other complications manifested such as acute renal failure, critical illness myopathy, acute gout on the knee, and sternal infection with coagulase-negative staphylococci. After stopping the assumed causal agents and treating the complications, the patient could be transferred for rehabilitation after a more than two months hospital stay. We discuss the causes and symptoms of muscle diseases as well as the epidemiology, mechanisms, treatment, and prevention of drug-induced myopathies with a focus on statins.
Asunto(s)
Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Anticolesterolemiantes/efectos adversos , Antifúngicos/efectos adversos , Puente de Arteria Coronaria Off-Pump , Fluconazol/efectos adversos , Ácidos Heptanoicos/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Pirroles/efectos adversos , Rabdomiólisis/inducido químicamente , Anciano , Amiodarona/administración & dosificación , Amiodarona/farmacocinética , Antiarrítmicos/administración & dosificación , Antiarrítmicos/farmacocinética , Anticolesterolemiantes/administración & dosificación , Anticolesterolemiantes/farmacocinética , Antifúngicos/administración & dosificación , Antifúngicos/farmacocinética , Atorvastatina , Citocromo P-450 CYP3A , Inhibidores del Citocromo P-450 CYP3A , Relación Dosis-Respuesta a Droga , Interacciones Farmacológicas , Quimioterapia Combinada , Fluconazol/administración & dosificación , Fluconazol/farmacocinética , Ácidos Heptanoicos/administración & dosificación , Ácidos Heptanoicos/farmacocinética , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Tasa de Depuración Metabólica/efectos de los fármacos , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/diagnóstico , Pirroles/administración & dosificación , Pirroles/farmacocinética , Rabdomiólisis/sangre , Rabdomiólisis/diagnósticoAsunto(s)
Iloprost/farmacología , Trombocitopenia/inducido químicamente , Plaquetas/citología , Femenino , Prótesis Valvulares Cardíacas , Humanos , Inmunoglobulinas/química , Persona de Mediana Edad , Recuento de Plaquetas , Arteria Pulmonar/patología , Receptores de Epoprostenol/metabolismo , Síndromes de la Apnea del Sueño/terapia , Trombocitopenia/diagnósticoRESUMEN
We report the case of a 71-year-old male patient who presented at the emergency room with episodes of epistaxis and jaundice. The patient was on therapy with phenprocoumon, atorvastatin and perindopril. Findings on admission included prominent elevation of transaminases and bilirubin and a high INR due to impaired liver function and oral anticoagulation. After exclusion of other causes like viral or autoimmune hepatitis and after having obtained a liver biopsy, a diagnosis of drug induced liver damage (DILI) was made. Epidemiology, pathophysiology and clinical signs of DILI are discussed with a special focus on coumarines, statins and ACE-inhibitors.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/toxicidad , Anticoagulantes/toxicidad , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Ácidos Heptanoicos/toxicidad , Inhibidores de Hidroximetilglutaril-CoA Reductasas/toxicidad , Perindopril/toxicidad , Fenprocumón/efectos adversos , Pirroles/toxicidad , Vitamina K/antagonistas & inhibidores , Administración Oral , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Anticoagulantes/administración & dosificación , Atorvastatina , Biopsia , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Interacciones Farmacológicas , Quimioterapia Combinada , Hematuria/inducido químicamente , Hematuria/patología , Ácidos Heptanoicos/administración & dosificación , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hígado/efectos de los fármacos , Hígado/patología , Pruebas de Función Hepática , Masculino , Perindopril/administración & dosificación , Fenprocumón/administración & dosificación , Pirroles/administración & dosificaciónRESUMEN
We report on a patient with Pneumocystis jirovecii pneumonia who developed fever, rash, eosinophilia and hepatitis 10 days after initiation of a therapy with sulfamethoxazole and trimethoprim. A DRESS syndrome was diagnosed and the therapy was changed successfully to pyrimethamine and dapsone. We describe the clinical picture, causative drugs, pathogenesis, differential diagnoses and therapy of this life-threatening disease to acquaint the general practitioner with it.
Asunto(s)
Erupciones por Medicamentos/diagnóstico , Hipersensibilidad a las Drogas/diagnóstico , Eosinofilia/etiología , Exantema/etiología , Fiebre de Origen Desconocido/etiología , Pruebas de Función Hepática , Infecciones Oportunistas/tratamiento farmacológico , Pneumocystis carinii , Neumonía por Pneumocystis/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales de Origen Murino , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Humanos , Linfoma de Células T/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/inducido químicamente , Neumonía por Pneumocystis/inducido químicamente , Prednisona/administración & dosificación , Prednisona/efectos adversos , Rituximab , Vincristina/administración & dosificación , Vincristina/efectos adversosRESUMEN
We report a patient with personality disorder and depression who developed a reversible macular rash 10 days after starting lamotrigine (LTG). We discuss the safety profile of LTG, risk factors for adverse reactions of the skin, the management of risk reduction of LTG - induced skin reactions and the possibility of a controlled reexpostion of patients with benign LTG - associated rash.
Asunto(s)
Anticonvulsivantes/efectos adversos , Trastorno Depresivo/tratamiento farmacológico , Trastornos Disruptivos, del Control de Impulso y de la Conducta/tratamiento farmacológico , Triazinas/efectos adversos , Adulto , Ansiolíticos/efectos adversos , Ansiolíticos/uso terapéutico , Anticonvulsivantes/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada , Femenino , Humanos , Lamotrigina , Lorazepam/efectos adversos , Lorazepam/uso terapéutico , Triazinas/uso terapéuticoRESUMEN
We report on a 76 year old woman who fainted on her way to the restroom during the night. At the emergency department, a prolonged QT-interval was noticed in addition to sinusbradycardia and marginal hypokalemia. The QT-interval normalized promptly after citalopram was discontinued. Taking into account the clinical picture and the ascertained orthostatic dysregulation, a diagnosis of orthostatic syncope was made. Because of the lengthened QT-interval, drug-induced torsade de pointes ventricular arrhythmia was considered as a differential diagnosis. We describe that citalopram was most probably the cause for the prolonged QT-interval. In our article we discuss the pathophysiology of drug-induced long QT syndrome (LQTS), the most important drugs involved, and finally the prophylaxis and treatment of a TdP ventricular arrhythmia.
Asunto(s)
Antidepresivos de Segunda Generación/efectos adversos , Antipsicóticos/efectos adversos , Benzodiazepinas/efectos adversos , Citalopram/efectos adversos , Trastorno Depresivo/tratamiento farmacológico , Síndrome de QT Prolongado/inducido químicamente , Esquizofrenia Paranoide/tratamiento farmacológico , Anciano , Antidepresivos de Segunda Generación/uso terapéutico , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Citalopram/uso terapéutico , Diagnóstico Diferencial , Interacciones Farmacológicas , Quimioterapia Combinada , Electrocardiografía/efectos de los fármacos , Femenino , Humanos , Síndrome de QT Prolongado/diagnóstico , Olanzapina , Síncope Vasovagal/diagnósticoAsunto(s)
Lesión Renal Aguda/inducido químicamente , Anemia Hemolítica Autoinmune/inducido químicamente , Antituberculosos/efectos adversos , Nefritis Intersticial/inducido químicamente , Rifampin/efectos adversos , Tuberculosis Pulmonar/tratamiento farmacológico , Lesión Renal Aguda/diagnóstico , Anemia Hemolítica Autoinmune/diagnóstico , Antituberculosos/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Nefritis Intersticial/diagnóstico , Rifampin/uso terapéuticoRESUMEN
We report the case of a 38-year-old patient with a rupture of the right Achilles tendon after physical exercise. A few days before he had been treated with ciprofloxacine 500mg bid for chlamydial urethritis. We discuss know risk factors for Achilles tendon ruptures and the possible contribution of ciprofloxacin and fluorquinolones in this case.
Asunto(s)
Tendón Calcáneo/efectos de los fármacos , Antibacterianos/efectos adversos , Traumatismos en Atletas/inducido químicamente , Fluoroquinolonas/efectos adversos , Fútbol/lesiones , Traumatismos de los Tendones/inducido químicamente , Tendón Calcáneo/lesiones , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Infecciones por Chlamydia/tratamiento farmacológico , Ciprofloxacina/efectos adversos , Ciprofloxacina/uso terapéutico , Femenino , Fluoroquinolonas/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Ofloxacino/efectos adversos , Ofloxacino/uso terapéutico , Factores de Riesgo , Rotura Espontánea , Suiza , Uretritis/tratamiento farmacológicoRESUMEN
After months of successful analgesic therapy with oxcarbazepine, a 52-year old woman with trigeminal neuralgia suddenly experienced episodes of heavy trigeminal attacks regularly in the evening at about the same time. Asked about changes in daily life or eating habits, she reported the ingestion of healing earth daily in the morning. After stopping the ingestion of healing earth, analgesic control of trigeminal neuralgia was restored without any changes of the initial pharmacotherapy. In daily practice, interactions which significantly influence the absorption of drugs are often overlooked. The documentation of these interactions in drug interaction databases, in the prescribing information, and in the literature is sparse though clinically relevant. Separating the ingestion of interacting substances by a time interval may not sufficiently avoid the interaction in every case. Particular caution is warranted when slow-release cation containing drugs or substances with entero-hepatic circulation are used.
Asunto(s)
Anticonvulsivantes/efectos adversos , Carbamazepina/análogos & derivados , Naturopatía/efectos adversos , Neuralgia del Trigémino/tratamiento farmacológico , Anticonvulsivantes/farmacocinética , Anticonvulsivantes/uso terapéutico , Carbamazepina/efectos adversos , Carbamazepina/farmacocinética , Carbamazepina/uso terapéutico , Relación Dosis-Respuesta a Droga , Interacciones Farmacológicas , Femenino , Humanos , Absorción Intestinal/efectos de los fármacos , Cuidados a Largo Plazo , Persona de Mediana Edad , Oxcarbazepina , Neuralgia del Trigémino/sangre , Neuralgia del Trigémino/etiología , Lesiones por Latigazo Cervical/complicacionesRESUMEN
In an 81-year-old patient with a history of long-standing stable chronic renal failure a diagnosis of multiple myeloma was made. After an initial chemotherapy, a therapy with intravenous pamidronate, 90 mg monthly, was initiated. After four years of well tolerated therapy, pamidronate was stopped and zoledronate, 4 mg intravenously every four weeks, was started. After approximately one year, an elevated plasma creatinine was noted for the'first time, progressing to end stage renal failure within the next months. At admission, besides end-stage renal failure, severe asymptomatic hypocalcemia was noted. Renal biopsy findings included severe tubulointerstitial damage compatible with drug-induced tubular injury. Prerenal and postrenal failure could be excluded as well as myeloma kidney. The diagnosis of zoledronate-associated end-stage renal failure was made and treatment with hemodialysis was started. Hypocalcemia was treated with calcium and vitamin D3 supplements. After two years of follow up, the patient still required hemodialysis.
Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Hipocalcemia/inducido químicamente , Imidazoles/efectos adversos , Fallo Renal Crónico/inducido químicamente , Lesión Renal Aguda/inducido químicamente , Factores de Edad , Anciano , Anciano de 80 o más Años , Biopsia , Conservadores de la Densidad Ósea/administración & dosificación , Calcio/uso terapéutico , Creatinina/sangre , Difosfonatos/administración & dosificación , Difosfonatos/uso terapéutico , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Imidazoles/administración & dosificación , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/patología , Fallo Renal Crónico/terapia , Túbulos Renales/efectos de los fármacos , Túbulos Renales/patología , Persona de Mediana Edad , Mieloma Múltiple/complicaciones , Pamidronato , Diálisis Renal , Factores de Riesgo , Suiza , Factores de Tiempo , Vitamina D/uso terapéutico , Ácido ZoledrónicoRESUMEN
We report the case of an 18-year-old woman with arthralgia and swelling of distal joints at hands and feet, photosensitive reaction, butterfly rash, fatigue, tachypnea and unspecific cardiac pain three months after beginning a treatment with minocycline for acne. Recurrence of symptoms at a higher intensity occurred within hours of reexposition with minocycline. The antinuclear antibody test was positive. After withdrawal of minocycline, the symptoms improved and minocycline-induced lupus was diagnosed. In the Swissmedic and WHO adverse drug reaction databases 267 other cases of possible minocycline-induced lupus were identified. Typical clinical and laboratory features are arthralgia, arthritis, myalgia, increased transaminases and/or jaundice, unspecific symptoms like fatigue and fever, skin disorders and positive antinuclear antibodies.
Asunto(s)
Antibacterianos/efectos adversos , Lupus Eritematoso Sistémico/inducido químicamente , Minociclina/efectos adversos , Acné Vulgar/tratamiento farmacológico , Adolescente , Antibacterianos/administración & dosificación , Anticuerpos Antinucleares/sangre , Diagnóstico Diferencial , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , Minociclina/administración & dosificación , Factores de TiempoRESUMEN
AIM: To asses the prevalence of potentially critical drug-drug interactions (DDIs) in outpatients treated with a statin. PATIENTS/METHODS: Data of patients (e.g. age, sex, comorbidities, individual statin, number of drugs, number of diagnoses) were collected from 242 Swiss practitioners. The medication was screened electronically for potentially critical DDIs. RESULTS: We included 2742 statin-treated patients (mean age 65.1 +/- 11.2 [SD] years, 3.2 +/- 1.6 diagnoses, 4.9 +/- 2.4 drugs prescribed) from the German (53.3%), French (36%) or Italian speaking (10.7%) part of Switzerland. Of those, 401 (14.6%) had a total of 591 potentially severe DDIs; 190 patients (6.9%) had potential statin DDIs, 288 (10.5%) potential non-statin DDIs, mainly due to pharmacodynamic mechanisms. The prevalence of potential DDIs was similar between regions, except for a trend for a higher prevalence of drug-statin interactions in the French-speaking part. The number of drugs per patient and a diagnosis of arrhythmia or heart failure were identified as risk factors for DDIs. CONCLUSIONS: Drug combinations with potentially severe DDIs are common in patients treated with statins due to pharmacotherapy of their co-morbidities. Special attention in this specific population should be drawn on patients with polypharmacy and those with drug treatments for arrhythmia or heart failure.
Asunto(s)
Atención Ambulatoria , Interacciones Farmacológicas , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Sistemas de Registro de Reacción Adversa a Medicamentos , Anciano , Comorbilidad , Bases de Datos Factuales , Quimioterapia Combinada , Europa (Continente) , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
We report on a 34-year-old refugee from the Balkans presenting with a generalized papular rash during induction chemotherapy for acute myeloblastic leukaemia (AML M4eo). This rash appeared on day 5 of the chemotherapy and was diagnosed as disseminated scabies. It was successfully treated with a combination of oral ivermectin and topical lindane. Scabies disappeared completely despite ongoing neutropenia and other severe infectious complications. Disseminated scabies should be included in the differential diagnosis of rash in severely immunosuppressed patients coming from poor housing conditions.