Dapsone-Induced Methemoglobinemia

1998 ◽  
Vol 32 (5) ◽  
pp. 549-553 ◽  
Author(s):  
Kristina E Ward ◽  
Michelle W McCarthy
Keyword(s):  
Case Reports ◽  
Pneumocystis Carinii ◽  
Unknown Etiology ◽  
Case Summary ◽  
Aerosolized Pentamidine ◽  
Immunosuppressed Patients ◽  
Cadaveric Kidney ◽  
Unclear Etiology ◽  
Therapeutic Doses ◽  
Rule Out

OBJECTIVE: To report a case of methemoglobinemia in a patient receiving dapsone for prophylaxis of Pneumocystis carinii pneumonia (PCP). CASE SUMMARY: A 69-year-old white woman was hospitalized to rule out sepsis. Two years prior to this admission, the patient received an orthotopic liver transplant after which she required hemodialysis three times weekly. Because of intolerance to trimethoprim/ sulfamethoxazole and aerosolized pentamidine, she was prescribed dapsone therapy on hospital day 13, that was continued for 11 days. On hospital day 45 the patient received a cadaveric kidney transplant, and dialysis treatments were scheduled only as needed. One week after the transplant, dapsone therapy was resumed. Nine days into this course of dapsone, the patient developed dyspnea and oxygen desaturation of unknown etiology. The patient was evaluated for and diagnosed with methemoglobinemia. She received two doses of intravenous methylene blue and one dose of oral activated charcoal due to fluctuating methemoglobin concentrations. DISCUSSION: The elimination of dapsone is not completely understood. Several case reports of dapsone-induced methemoglobinemia are present in the literature. Most have occurred in patients who have accidentally or deliberately overdosed. Cases of methemoglobinemia in patients receiving therapeutic doses of dapsone are discussed. CONCLUSIONS: The growing numbers of immunosuppressed patients due to transplantation or HIV may result in increased dapsone use for the prevention of PCP. Clinicians should be aware of the adverse effects associated with dapsone therapy, and patients with dyspnea and hypoxemia of unclear etiology should be evaluated for methemoglobinemia.

scholarly journals Zolpidem for Insomnia: A Double-Edged Sword. A Systematic Literature Review on Zolpidem-Induced Complex Sleep Behaviors

2021 ◽  
pp. 025371762199237
Author(s):  
Niti Mittal ◽  
Rakesh Mittal ◽  
M. C. Gupta
Keyword(s):  
Adverse Reactions ◽  
Case Reports ◽  
Case Series ◽  
Eligibility Criteria ◽  
Study Objective ◽  
Spontaneous Reports ◽  
Cochrane Database ◽  
Sleep Behaviors ◽  
Therapeutic Doses ◽  
Favorable Side Effect Profile

Background: Being a nonbenzodiazepine, zolpidem is believed to have a favorable side-effect profile and is widely prescribed for insomnia. However, in the past few years, numerous neuropsychiatric adverse reactions, particularly complex sleep behaviors (CSBs), have been reported with zolpidem. Objective: To conduct a systematic review of zolpidem-associated CSBs. Data Sources: An electronic search was conducted using MEDLINE, Embase, PubMed, and Cochrane database of systematic reviews to extract relevant articles till July 2020. Study Eligibility Criteria: Any type of literature article (case report, case series, and observational or interventional study) reporting CSBs associated with zolpidem. Results: In this review, we present aggregate summarized data from 148 patients presenting with zolpidem-induced CSBs (79 patients from 23 case reports and 5 case series; 69 patients out of 1454 taking zolpidem [4.7%] from three observational clinical studies). Various types of CSBs associated with zolpidem were reported, most common being sleepwalking/somnambulism and sleep-related eating disorder. On causality assessment, around 88% of cases were found to have a probable association with zolpidem. Limitations: Extraction of data from observational studies and spontaneous reports, due to nonavailability of any randomized controlled trials relevant to the study objective. Conclusion and Implication of Key Findings: Zolpidem-induced CSBs, although not very common, may develop when the drug is used at therapeutic doses for insomnia. Doctors need to be alert to monitor such adverse effects of zolpidem and exercise caution while prescribing it.

scholarly journals Prevention of venous thromboembolism in hospitalized patients with chronic kidney disease

2013 ◽  
pp. 269-276
Author(s):  
Marcora Mandreoli ◽  
Antonio Santoro
Keyword(s):  
Renal Failure ◽  
Venous Thromboembolism ◽  
Renal Disease ◽  
Case Reports ◽  
Current Evidence ◽  
High Morbidity ◽  
Medical Patients ◽  
Medically Ill ◽  
Increased Risk ◽  
Therapeutic Doses

Despite the high morbidity and mortality associated with venous thromboembolism in hospitalized medical patients with a number of risk factors, and large evidence that prophylaxis is effective, prophylaxis rates remain elusive in medically ill patients. Furthermore, in patients with renal failure, prophylaxis often is omitted or sub-optimal, due to fear of provoking hemorrhage. Patients with end-stage renal disease often have platelet deficits. Low molecular weight heparin (LMWH) therapy may also be difficult to manage in these cases because LMWH clearance is largely dependent on the kidneys. Administration of LMWH to patients with some degree of renal failure may lead to bioaccumulation of anti-Xa activity with an increased risk of bleeding. In recent years, LMWH has largely replaced unfractionated heparin (UFH) for the treatment and prophylaxis of thromboembolic disease. LMWHs have been shown to be superior to UFH in the prevention of venous thromboembolism. They are also easier to administer and do not require laboratory monitoring. However, several case reports and a metaanalysis indicate that the use of LMWHs at therapeutic doses in patients with advanced renal failure can be associated with major bleeding with serious adverse effects. In this paper, we review recent evidence supporting the safety of LMWHs at prophylactic doses in patients with mild or moderate renal disease. Current evidence suggests that bioaccumulation of enoxaparin (the most widely used LMWH) can occur when the drug is used at standard therapeutic doses in patients with severely impaired renal function. This risk can be reduced by empiric dose reduction or monitoring of anti-Xa heparin levels.

scholarly journals Patient with Metastatic Process in the Skeleton of Unknown Etiology

2019 ◽  
pp. 135-142
Author(s):  
Majerníková M ◽  
Sedláček J ◽  
Monhart Z
Keyword(s):  
Multiple Myeloma ◽  
Primary Tumor ◽  
Case Reports ◽  
Unknown Etiology ◽  
Primary Process ◽  
Kidney Tumor ◽  
Complex Treatment ◽  
Benign Process ◽  
Metastatic Process

Bearing bone involvement is a possible sign of generalization variety of cancers. In many cases the process of bearing skeletal diagnosed at the time when the primary tumor is not obvious. The task of the physician is quickly to determine whether it is a benign process or not, and diagnosis of the primary process by which then determine the further progress of therapy. The search for causative bearing shell process, alternatively the primary tumor, is often common practice in the hands of internist. Departments of Clinical Oncology do not have to have sufficient capacity for complex treatment all of newly discovered deposits skeleton whose nature does not have to be always initially clear. Therefore, in the opinion of the authors in these cases, the role of internist as a significant diagnosis very important In our article, we introduce six case reports of patients who were bearing the ambiguous process of investigation of the skeleton in our department in 2014. In accordance with the literature data were represented kidney tumor, multiple myeloma, chondrosarcoma, and in one case the origo malignant process was not found.

scholarly journals PAX2 Mutation-Related Renal Hypodysplasia: Review of the Literature and Three Case Reports

2022 ◽  
Vol 9 ◽  
Author(s):  
Yu-Ming Chang ◽  
Chih-Chia Chen ◽  
Ni-Chung Lee ◽  
Junne-Ming Sung ◽  
Yen-Yin Chou ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Case Reports ◽  
Genetic Disorder ◽  
Unknown Etiology ◽  
Related Disorder ◽  
Multiple Systems ◽  
Genetic Sequencing ◽  
Renal Hypodysplasia

Paired box 2 (PAX2)-related disorder is an autosomal dominant genetic disorder associated with kidney and eye abnormalities and can result in end stage renal disease (ESRD). Despite reported low prevalence of PAX2 mutations, the prevalence of PAX2 related disorders may have been underestimated in past studies. With improved genetic sequencing techniques, more genetic abnormalities are being detected than ever before. Here, we report three patients from two families with PAX2 mutations identified within 1 year. Two patients were adults with chronic kidney disease and were followed for decades without correct diagnoses, including one with ESRD who had even undergone kidney transplant. The third patient was a neonate in whom PAX2-related disorder manifested as oligohydramnios, coloboma, and renal failure that progressed to ESRD within 1 year after birth. The phenotypes of PAX2 gene mutation were shown to be highly variable, even within the same family. Early detection promoted genetic counseling and guided clinical management. The appropriate time point for genetic study is an important issue. Clinicians must be more alert for PAX2 mutation when facing patients with congenital kidney and urinary tract anomalies, chronic kidney disease of unknown etiology, involvement of multiple systems, and/or a family history of renal disease.

scholarly journals ‘Failure’ of laser prophylaxis in an eye with stickler syndrome

2021 ◽  
Vol 11 (4) ◽  
pp. 110-111
Author(s):  
Michael P Blair
Keyword(s):  
Vision Loss ◽  
Clinical Course ◽  
Case Reports ◽  
Visual Outcome ◽  
Stickler Syndrome ◽  
Connective Tissue Disorders ◽  
Macular Function ◽  
Giant Retinal Tear ◽  
Case Summary

Background: Stickler syndrome is one of the most common inherited connective tissue disorders and is an important cause of pediatric vision loss due to a high risk of retinal detachment in these patients. Methods: Case report. Case summary: This case reports describes the clinical course of a 10 year old boy with Sticklers Syndrome who underwent bilateral peripheral laser prophylaxis. During routine follow up, he was found to have an asymptomatic giant retinal tear (GRT) with limited sub-retinal fluid expansion due to prior prophylactic laser. He underwent surgery with vitrectomy and scleral buckle with vision remaining at 20/25 at 6 month follow up. Conclusion: Although the utility of laser prophylaxis in Stickler patients is debated, this case demonstrates that after laser prophylaxis, even if GRT develops, expansion can be limited. Laser prophylaxis along with frequent examinations, can prevent development of PVR and complex detachments and preserve macular function with excellent visual outcome.

scholarly journals The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax

2020 ◽  
Author(s):  
Nadeem Jimidar ◽  
Patrick Lauwers ◽  
Emmanuela Govaerts ◽  
Marc Claeys
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Case Reports ◽  
Gunshot Wounds ◽  
Computed Tomography Scan ◽  
Imaging Studies ◽  
Left Chest ◽  
Case Summary ◽  
Tomography Scan

Abstract Background Hamman’s sign is a rare phenomenon. Louis Hamman described this pathognomonic clicking chest noise in association with pneumomediastinum in 1937. This typical noise can also be present in left-sided pneumothorax. Clinical cases already mention this pericardial knock in 1918 in gunshot wounds of the left chest and in 1928 in cases of spontaneous left-sided pneumothorax. However, the sound itself has only rarely been recorded. Case summary We describe a case of a young man with no significant medical history who was referred to the hospital with chest pain and audible clicks, documented with his smartphone. Imaging studies including chest radiograph and computed tomography scan revealed a left-sided pneumothorax. The patient underwent semi-urgent insertion of a thorax drain. His clinical outcome was excellent. Discussion In recent years only a few case reports describe Hamman’s sign, as it is rare and happens only transiently. This case report includes the audible clicks recorded by the patient with his smartphone. We stress the importance of thoracic clicking sounds as key symptom in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse.

scholarly journals In Vitro Pharmacodynamic Parameters of Sordarin Derivatives in Comparison with Those of Marketed Compounds against Pneumocystis carinii Isolated from Rats

2000 ◽  
Vol 44 (5) ◽  
pp. 1284-1290 ◽  
Author(s):  
Pablo Aviles ◽  
El-Moukhtar Aliouat ◽  
Antonio Martinez ◽  
Eduardo Dei-Cas ◽  
Esperanza Herreros ◽  
...  
Keyword(s):  
Pneumocystis Carinii ◽  
Maximum Effect ◽  
Drug Concentrations ◽  
Number Of Microorganisms ◽  
Immunosuppressed Patients ◽  
The Hill ◽  
Drug Free ◽  
Good Agreement

ABSTRACT Pneumocystis carinii pneumonia remains one of the most serious complications of immunosuppressed patients. In this study, the in vitro pharmacodynamic parameters of four sordarin derivatives (GM 191519, GM 237354, GM 193663, and GM 219771) have been evaluated by a new quantitative approach and compared with the commercially available drugs pentamidine, atovaquone, and trimethoprim-sulfamethoxazole (TMP-SMX). In vitro activities and in vivo therapeutic efficacies of sordarin derivatives against P. carinii were also evaluated. In vitro activity was determined by the broth microdilution technique, comparing the total number of microorganisms in treated and drug-free cultures by using Giemsa staining. The in vitro maximum effect (E max), the drug concentrations to reach 50% of E max(EC50), and the slope of the dose-response curve were then estimated by the Hill equation (E max sigmoid model). Sordarin derivatives were the most potent agents againstP. carinii, with EC50s of 0.00025, 0.0007, 0.0043, and 0.025 μg/ml for GM 191519, GM 237354, GM 193663, and GM 219771, respectively. The EC50s of pentamidine, atovaquone, and TMP-SMX were 0.025, 0.16, and 26.7/133.5 μg/ml, respectively. The results obtained with this approach showed GM 237354 and GM 191519 to be approximately 35- and 100-fold more active in vitro than pentamidine, the most active marketed compound. All sordarin derivatives tested were at least 5,000-fold more active in vitro than TMP-SMX. The three sordarin derivatives tested in vivo—GM 191519, GM 237354, and GM 219771—showed a marked therapeutic efficacy, defined as reduction of cyst forms per gram of lung. GM 191519 was the most potent (daily dose reducing 50% of the P. carinii burden in the lungs [ED50], 0.05 mg/kg/day) followed by GM 237354 and GM 219771 (ED50s, 0.30 and 0.49 mg/kg/day, respectively). Good agreement between in vitro parameters and in vivo outcome was obtained when P. carinii pneumonia in rats was treated with sordarin derivatives.

Hemorrhagic complications of а novel coronavirus infection: actual clinical problem.

2021 ◽  
Author(s):  
И.Б. Симарова ◽  
С.Н. Переходов ◽  
А.Ю. Буланов
Keyword(s):  
Case Reports ◽  
Clinical Problem ◽  
Clear Understanding ◽  
The Novel ◽  
Hemorrhagic Events ◽  
Thrombotic Complications ◽  
Predictive Role ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
Therapeutic Doses

Гиперкоагуляционный характер коагулопатии, ассоциированной с новой коронавирусной инфекцией COVID-19, и высокий риск связанных с этим тромботических осложнений — хорошо известный факт на сегодняшний день. Тем не менее в литературе имеются описания и геморрагических событий у больных COVID. В обзоре приведен анализ публикаций, описывающих кровотечения при коронавирусной инфекции; общая частота их в среднем составляет 4–8%. Превалируют желудочно-кишечные кровотечения, существенную часть составляют межмышечные гематомы и кровоизлияния в кожу и слизистые. Показана предиктивная роль применения антикоагулянтов в терапевтических дозах и гипофибриногенемии. Отмечено отсутствие четкого понимания патофизиологических механизмов. Hypercoagulable character of coagulopathy associated with the novel coronavirus infection COVID-19, and the high risk of associated thrombotic complications is a well-known fact. However, there are also case reports of hemorrhagic events in COVID patients in the literature. The review summarizes the publications describing bleedings in coronavirus infection; their overall frequency is on average 4–8%. Gastrointestinal bleeding are prevalent, intermuscular hematomas and hemorrhages in the skin and mucous membranes are frequent. The predictive role of anticoagulants use in therapeutic doses and hypofibrinogenemia is shown. The absence of clear understanding of the pathophysiological mechanisms is noted.

Nosedrops and S.I.D.S

PEDIATRICS ◽  
1991 ◽  
Vol 88 (2) ◽  
pp. 419-419
Author(s):  
GERALD B. HICKSON
Keyword(s):  
Side Effect ◽  
Case Reports ◽  
Common Side Effect ◽  
Wide Spread ◽  
Over The Counter ◽  
Ability To Act ◽  
Life Threatening ◽  
Therapeutic Doses

In Reply.— The purpose of our paper was to examine the question of safety concerning over-the-counter (OTC) release of promethazine.1 Our stated opinion, that the drug is not appropriate for OTC release, was based on more than a suggested relationship with SIDS, but also on the drug's common side effect of sedation, ability to act as a cerebral stimulant even in therapeutic doses inducing hallucinations, convulsions and encephalopathy in some children, case reports concerning promethazine use and apparent life-threatening events, the potential for families to misuse this drug due to its sedative and antiemetic properties, and most importantly, FDA standards of safety for OTC medications which require "a low potential for harm which may result from abuse under conditions of wide spread availability."2

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