Bevacizumab-Induced Oral Mucositis in Background of Cutaneous Plaque-Type Psoriasis

2012 ◽  
Vol 46 (11) ◽  
pp. e32-e32 ◽  
Author(s):  
Andra M Popa ◽  
Kelly Valla ◽  
Latha Radhakrishnan ◽  
Sandra Cuellar ◽  
J Lee Villano
Keyword(s):  
Oral Mucositis ◽  
Mucosal Damage ◽  
Glioneuronal Tumor ◽  
Probability Scale ◽  
Imaging Studies ◽  
Continuous Therapy ◽  
Psoriatic Disease ◽  
Plaque Type ◽  
Case Summary ◽  
History Of

OBJECTIVE: To report the serial development of oral mucositis following infusion of bevacizumab in a young woman with a malignant brain tumor and history of cutaneous psoriasis. CASE SUMMARY: A 29-year-old woman with a history of active cutaneous psoriasis and a malignant glioneuronal tumor was treated with bevacizumab for 2.5 years. With each infusion of bevacizumab, she developed oral mucositis within 36 hours. She received temozolomide as part of concurrent therapy with radiation and as maintenance therapy; it was discontinued after continuous therapy for 1.5 years. Bevacizumab 10 mg/kg was added after 7 cycles of maintenance temozolomide, as the tumor had minimal response and evidence of increased perfusion with angiogenesis on imaging studies. All medication, including temozolomide, was evaluated and eventually discontinued, with the exception of bevacizumab, which remained the drug suspected of causing the mucositis. DISCUSSION: Oral mucositis is a frequent adverse effect of cytotoxic chemotherapy, but has not been reported with bevacizumab. The Naranjo probability scale indicated a probable adverse drug reaction. This likely indicates that bevacizumab is one of many drugs known to induce exacerbation of psoriatic disease. We speculate that oral mucositis developed as bevacizumab-induced generation of proinflammatory cytokines within the vascular endothelium, leading to mucosal damage and ulceration. In addition, interruption of reparative angiogenic pathways with bevacizumab likely contributed to the severity of mucositis. CONCLUSIONS: Clinicians should be aware that bevacizumab can potentially exacerbate psoriatic disease.

Statin-Associated Bilateral Foot Myopathy

2019 ◽  
Vol 33 (6) ◽  
pp. 899-902 ◽  
Author(s):  
Mary Caitlin Baggett ◽  
Diane Nykamp
Keyword(s):  
Cardiovascular Risk ◽  
Lipid Lowering ◽  
Common Side Effect ◽  
Probability Scale ◽  
Case Summary ◽  
History Of ◽  
Muscle Groups ◽  
Artery Disease ◽  
Alternative Lipid ◽  
Statin Use

Objective: To report a case of statin-induced bilateral foot myopathy that resulted from 2 different statins. Case Summary: A 44-year-old Caucasian male with a history of ventricular fibrillation cardiac arrest, hyperlipidemia, and coronary artery disease experienced bilateral foot pain, weakness, and soreness while taking atorvastatin 20 mg daily. The pain subsided within weeks of discontinuing atorvastatin but returned years later after the initiation of rosuvastatin. The Naranjo probability scale indicates that this is a definite association between bilateral foot myopathy and statin use. Discussion: There is an association with statin use and lowering cardiovascular risk in patients with dyslipidemia and cardiovascular disease. However, statin metabolites can accumulate in the myocytes of muscle groups to cause a common side effect of myopathy. Statin myopathy typically occurs in large, bilateral, or proximal muscle groups, such as the thighs, back, calves, or buttocks. This patient was unusual in that his muscle symptoms only occurred in his feet and was severe enough to affect his ambulation. Conclusion: Stain-associated muscle symptoms have been reported to lessen medication adherence. There is also a risk with muscle symptoms that the patient could develop rhabdomyolysis, a rare but serious condition. Recognizing statin-associated muscle symptoms even in uncommon locations is important, so that alternative lipid-lowering strategies can be implemented to lower cardiovascular risk.

Fulminant Hepatic Failure Associated with Propylthiouracil

2003 ◽  
Vol 37 (2) ◽  
pp. 224-228 ◽  
Author(s):  
Jorge K Ruiz ◽  
Giorgio V Rossi ◽  
Humberto A Vallejos ◽  
Rosemarie W Brenet ◽  
Isabel B Lopez ◽  
...  
Keyword(s):  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Adverse Reactions ◽  
Medical Sciences ◽  
Probability Scale ◽  
Histologic Study ◽  
Case Summary ◽  
Severe Liver Dysfunction ◽  
History Of ◽  
Therapeutic Measures

OBJECTIVE: To report 2 fatal cases of fulminant hepatic failure associated with propylthiouracil treatment against hyperthyroidism. CASE SUMMARY: Two women, 30 and 32 years old with no previous liver disease, were treated with propylthiouracil against Graves' disease. Both patients developed jaundice after a 4- and 5-month treatment period, respectively. The disease was similar to viral hepatitis, with a progressive course to severe liver dysfunction and death, along with multisystem organ failure despite extensive therapeutic measures. One of the patients was pregnant and subsequently miscarried. Neither patient had a history of alcoholism, drug abuse, blood transfusion, or exposure to hepatitis A, B, or C. Extrahepatic obstruction was ruled out with an abdominal ultrasonogram. Serologic studies and immunologic tests were negative. A submassive necrosis was shown in a postmortem histologic study. DISCUSSION: Naranjo probability scale criteria applied to both cases confirm the adverse reactions as probable. These cases fit the requirements of drug hepatotoxicity proposed by Hanson and the Council of the International Organization of Medical Sciences. Eight deaths associated to propylthiouracil were found in our review of the medical literature up to December 2000. CONCLUSIONS: Despite the widespread use of propylthiouracil, fulminant hepatitis with death is exceptionally rare; these 2 cases could be added to the fatal outcomes published to date.

scholarly journals Association of Streptococcus with Plaque Type of Psoriasis

2015 ◽  
Vol 5 (2) ◽  
pp. 99-103
Author(s):  
Mohammad Akram Hossain ◽  
Lubna Khondker
Keyword(s):  
Streptococcus Pyogenes ◽  
Plaque Psoriasis ◽  
Skin Diseases ◽  
Chronic Plaque Psoriasis ◽  
Psoriatic Disease ◽  
Plaque Type ◽  
History Of ◽  
The Difference ◽  
Guttate Psoriasis ◽  
Medical University

Background: Guttate psoriasis has a well-known association with streptococcal throat infections, but the effects of these infections in patients with chronic plaque type of psoriasis remains to be evaluated. In Bangladesh several studies were done on psoriasis but no data about association between streptococcal throat infection and plaque type psoriasis are available so far. Considering the co-morbidities of psoriasis patients, it might be justifiable to find out the events that provoke the initiation or exacerbation of psoriatic disease process.Objective: To observe the association of streptococcus with plaque type of psoriasis.Materials and Methods: This observational study was conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Forty seven patients clinically and histopathologically diagnosed as having plaque psoriasis were selected as cases and patients with skin diseases other than psoriasis were selected as controls.Results: In this study majority of subjects (55%) were diagnosed as chronic plaque psoriasis. Among the subjects with guttate flare of chronic plaque psoriasis 64.2% gave a positive history of sore throat. ASO titer was raised (>200 IU/mL) in 28 (59.5%) patients of chronic plaque psoriasis and 7 (17.9%) patients of non-psoriatic respondents. The difference between two groups was significant (p<0.05). Streptococcus pyogenes was found in 12 (25.5%) in chronic plaque psoriasis patients versus in 4 (10.2%) in controls (p>0.05).Conclusion: This study shows that streptococcal throat infections are associated with plaque psoriasis and early treatment of throat infections may be beneficial for plaque type of psoriasis patients.J Enam Med Col 2015; 5(2): 99-103

Probable Amlodipine-Induced Angioedema

2009 ◽  
Vol 43 (4) ◽  
pp. 772-776 ◽  
Author(s):  
Jessica Southward ◽  
Elizabeth Irvine ◽  
Marina Rabinovich
Keyword(s):  
Autoimmune Disease ◽  
Hemorrhagic Stroke ◽  
Past History ◽  
Case Reports ◽  
Channel Blockers ◽  
Probability Scale ◽  
Careful Evaluation ◽  
Thyroid Autoimmune Disease ◽  
Case Summary ◽  
History Of

Objective: To report a case of angioedema likely associated with amlodipine administration in a patient with a right thalamic hemorrhagic stroke. Case Summary: A 50-year-old female experienced angioedema during hospitalization for s right thalamic hemorrhagic stroke. She had no past history of angioedema and all of her medications were assessed for risk of angioedema. After careful evaluation, case reports linking calcium channel blockers (CCBs) and angioedema led to further examination of amlodipine as a cause. Amlodipine therapy had been initiated 24 hours prior to the development of angioedema, which then resolved 72 hours after discontinuation of the drug. In total, the patient experienced oropharyngeal swelling for 10 days. Discussion: In determining a cause for the patient's angioedema we eliminated genetic, allergic, physically induced, thyroid autoimmune disease-associated, and medication-induced causes. Three case reports describing 7 patients have linked the CCBs verapamil, diltiazem, and nifedipine with angioedema. The onset and resolution of symptoms in our patient were very similar to those seen in other case reports. Application of the Naranjo probability scale found a probable link between amlodipine and angioedema. Conclusions: Although few reports of CCB-induced angioedema exisi, to our knowledge, this is the first reported case to suggest a link between angioedema and amlodipine therapy. Clinicians should consider amlodipine as a potential cause of angioedema.

Verrucous Psoriasis Successfully Treated with Ixekizumab: A Case Report with Review Literature

2020 ◽  
Vol 103 (9) ◽  
pp. 948-951
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Case Report ◽  
Rare Variant ◽  
Psoriasis Vulgaris ◽  
Review Literature ◽  
Antituberculous Therapy ◽  
Plaque Type ◽  
History Of

Verrucous psoriasis is a rare variant of plaque-type psoriasis with only about 35 cases reported. The authors reported a man with a history of psoriasis vulgaris for seven years, presented with progressive verrucous hyperkeratotic plaques on both legs for three years. His earlier investigations favored the diagnosis of tuberculosis verrucosa cutis. After completing the antituberculous therapy, the lesions persisted. The later investigations favored a rare subtype of psoriasis named verrucous psoriasis. Keywords: Verrucous psoriasis, Tuberculosis verrucosa cutis, Mycobacterium tuberculosis, Ixekixumab

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

scholarly journals Locked twins—remote from term: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Abraham Fessehaye ◽  
Ferid A. Abubeker ◽  
Mekdes Daba
Keyword(s):  
Gestational Age ◽  
Twin Pregnancy ◽  
Caesarian Section ◽  
Obstetric Complication ◽  
Second Stage ◽  
Case Summary ◽  
History Of ◽  
Twin Pregnancies ◽  
Abdominal Delivery ◽  
First Stage Of Labor

Abstract Background Locked twins is a rare and hazardous obstetric complication, which occurs in approximately 1:100 twin pregnancies. One of the known etiologic factors for locked twins is size of the twins. We report a case of chin-to-chin locked twins that occurred at gestational age of 30 weeks pus 6 days. Case summary A 27 years-old primigravida Oromo mother presented with a history of pushing down pain and passage of liquor of 6 hours duration at gestational age of 30 weeks plus 6 days. With a diagnosis of twin pregnancy (first twin non-vertex), abdominal delivery was decided in latent first stage of labor but mother refused caesarian delivery and she was allowed to labor with the hope of achieving a vaginal delivery. In second stage, interlocking twin was encountered and a low vertical cesarean section was done to effect delivery of twins without the need to decapitate the first twin. Conclusion Locked twin is a rare obstetric complication. Whenever it is encountered, successful delivery can be achieved without the need to have decapitation of the first twin during caesarian section.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors

2021 ◽  
pp. 000348942110254
Author(s):  
Eric J. Formeister ◽  
Ricky Chae ◽  
Emily Wong ◽  
Whitney Chiao ◽  
Lauren Pasquesi ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Treatment Options ◽  
Depression And Anxiety ◽  
Imaging Studies ◽  
Comorbid Depression ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Chronic Dizziness ◽  
Associated Symptoms ◽  
History Of

Objectives: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. Methods: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). Results: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière’s disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo- R2 = 0.15; P < .001). Conclusions: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.

Rare case of metastatic adenocarcinoma to the maxillary sinus

2021 ◽  
Vol 14 (9) ◽  
pp. e244485
Author(s):  
Apurwa Prasad ◽  
Taha Alrifai ◽  
Sumathi Vijaya Rangan ◽  
Jessica Garcia
Keyword(s):  
Metastatic Disease ◽  
Colorectal Adenocarcinoma ◽  
Metastatic Adenocarcinoma ◽  
Imaging Studies ◽  
Timely Manner ◽  
Posterior Aspect ◽  
Delay In Diagnosis ◽  
Immune Histochemistry ◽  
History Of ◽  
Intestinal Type Adenocarcinoma

Colorectal carcinoma metastases to the head and neck are exceedingly rare. Patients may present with vague symptoms that may lead to a delay in diagnosis. We report the case of a 51-year-old man with a known history of stage IIIB colorectal adenocarcinoma who presented with right-sided molar tooth bleeding and right-sided palate swelling that led to difficulty speaking, eating and weight-loss of 15 pounds. Imaging studies revealed a 3.1×4.8×3 cm mass that was centred around the posterior aspect of the maxilla. Pathology revealed moderately differentiated intestinal type adenocarcinoma of colonic subtype, immune histochemistry was positive for CDX2, CK20 and MUC2, thus confirming metastatic disease to the maxilla. The patient is undergoing chemoradiation therapy for palliation of his symptoms. Clinicians should be aware of this potentional site of metastatic disease and suspect the diagnosis in a timely manner to avoid delays in making a diagnosis.

A case of nodular episcleritis mimicking a solitary giant episcleral mass

2021 ◽  
pp. 112067212110528
Author(s):  
Lan Zhou ◽  
Juanjuan Wang ◽  
Guihua Xu ◽  
Dingding Wang ◽  
Xiaoyi Wang ◽  
...  
Keyword(s):  
Topical Steroid ◽  
Inflammatory Cells ◽  
Systemic Hypertension ◽  
Eye Drops ◽  
Definite Diagnosis ◽  
Imaging Studies ◽  
Immunohistochemical Examination ◽  
History Of ◽  
Inflammatory Drugs

Purpose To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. Case report A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Conclusion Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.

Sign in / Sign up

Export Citation Format

Share Document