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Offending Drug (offending + drug)
Selected AbstractsManagement of gynaecomastia: an updateINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2007P. Gikas Summary Gynaecomastia, a benign enlargement of the male breast as a result of proliferation of the glandular component, is common, being present in 30,50% of healthy men. It may be an incidental finding, an acute unilateral or bilateral tender breast enlargement or a progressive painless enlargement of the male breast. A general medical history and careful physical examination, looking for features suggestive of breast cancer, often suffice for evaluation in patients without symptoms or those with incidentally discovered breast enlargement. If the gynaecomastia is of recent onset, a more detailed evaluation, including selected laboratory tests to search for an underlying cause is necessary. Treatment depends on the cause: an offending drug may need to be withdrawn or alternatively radiation, surgery and/or medical therapy may be necessary. The use of a combination of surgical excision and liposuction through a periareolar incision represents the surgical approach of choice. [source] Neuroimaging in Posterior Reversible Encephalopathy SyndromeJOURNAL OF NEUROIMAGING, Issue 2 2004C. Lamy ABSTRACT The terms posterior reversible leukoencephalopathy, reversibleposterior cerebral edema syndrome, and posterior reversibleencephalopathy syndrome(PRES) all refer to a clinicoradiologic entity characterized by headaches, confusion, visual disturbances, seizures, and posterior transient changes on neuroimaging. Clinical findings are not sufficiently specific to readily establish the diagnosis; in contrast, magnetic resonance imaging pattern is often characteristic and represents an essential component of the diagnosis of PRES. Typical lesions predominate in the posterior white matter, with some involvement of the overlying cortex; are hyperintense on T2-weighted images; and are usually hypointense or isointense on diffusion-weighted images, with an increase of the apparent diffusion coefficient, indicating vasogenic edema. The pathogenesis is incompletely understood, although it seems to be related to the breakthrough of autoregulation and endothelial dysfunction. Since its initial description, this syndrome has been subsequently described in an increasing number of medical conditions, including hypertensive encephalopathy, eclampsia, and the use of cytotoxic and immunosuppressive drugs. The diagnosis has important therapeutic and prognostic implications because the reversibility of the clinical and radiologic abnormalities is contingent on the prompt control of blood pressure and/or discontinuing the offending drug. On the contrary, when unrecognized, conversion to irreversible cytotoxic edema may occur. [source] Clinicopathlogical features and prognosis of drug rash with eosinophilia and systemic symptoms: a study of 30 cases in TaiwanJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 9 2008C-C Chiou Abstract Background, Drug rash with eosinophilia and systemic symptoms (DRESS), a group of non-blistering severe cutaneous adverse drug reactions (SCADRs), is characterized by skin rash and multiorgan involvement. Details of this reaction have not been reported in the literature so far. Aim, We investigate clinical and pathological features and prognosis of DRESS and hope this study will provide data concerning this disorder in Taiwan. Methods, From January 2001 to June 2006, a total of 30 patients, diagnosed with DRESS, were enrolled and evaluated for demographic characteristics, pathological findings, complications and outcome. Results, Patient ages ranged from 13 to 78, with an equal sex ratio. The most common offending drug was allopurinol followed by carbamazepine. Pathologic changes observed were lichenoid dermatitis, erythema multiforme, pseudolymphoma and vasculitis. Impairment of liver and renal functions and blood dyscrasia were frequent complications. Active infection or reactivation of HHV-6 was observed in 7 of 11 patients studied serologically. Two patients developed type 1 diabetes mellitus. The mortality rate was 10% (3 of 30). Conclusions, DRESS is a heterogeneous group of life-threatening conditions. The leading drug in DRESS in Taiwan is allopurinol. High eosinophil count and multiple underlying diseases are poor prognostic factors in patients with DRESS. [source] Symmetrical Drug-Related Intertriginous and Flexural Exanthem due to Oral RisperidonePEDIATRIC DERMATOLOGY, Issue 2 2009BENGU NISA AKAY M.D. The clinical findings were compatible with so-called symmetrical drug related intertriginous and flexural exanthema, also known as Baboon syndrome. Although epicutaneous patch testing with the offending drug was negative, drug rechallenge produced a recurrence of the skin findings. To the best of our knowledge, this is the first case of symmetrical drug related intertriginous and flexural exanthema reported due to risperidone. [source] Acute Hepatitis Associated with Treatment of Peyronie's Disease with Potassium Para-Aminobenzoate (Potaba)THE JOURNAL OF SEXUAL MEDICINE, Issue 12 2008Joey Roy ABSTRACT Introduction., Potassium para-aminobenzoate is an agent used in the treatment of sclerotic diseases including Peyronie's disease of the penis. It has been reported that this medication may have been responsible for cases of acute liver injury. Aim., To inform clinicians of the possibility of an adverse drug event associated with the oral intake of potassium para-aminobenzoate by reporting an additional case and compiling information from previous reports. Methods., The affected patient's medical records were diligently reviewed; all available and relevant information pertaining to this adverse event is reported. Similar case reports were analyzed and compared, and relevant information was compiled in this report. Results., The patient enjoyed a full biochemical recovery from his hepatitis 4 months after discontinuation of potassium para-aminobenzoate. Conclusion., To date, the oral use of potassium para-aminobenzoate has been reported to be linked to acute liver injury in six individuals. Appropriate management of this adverse drug event is the immediate discontinuation of the offending drug and general patient support measures. Roy J, and Carrier S. Acute hepatitis associated with treatment of Peyronie's disease with potassium para-aminobenzoate (Potaba). J Sex Med **;**:**,**. [source] Belatacept as Maintenance Immunosuppression for Postrenal Transplant de novo Drug-Induced Thrombotic MicroangiopathyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009N. Ashman De novo posttransplant thrombotic microangiopathy (TMA) is a complication of solid organ transplantation, which remains difficult to treat. In many cases, immunosuppressants and particularly calcineurin inhibitors, trigger TMA. Although withdrawing the offending drug may lead to resolution of TMA, graft and patient outcomes are poor. Specific treatments, including plasma exchange, have not gained widespread acceptance in those with fulminant disease and new approaches to the condition are urgently needed. We report a case of posttransplant de novo TMA presenting serially in association with ciclosporin, tacrolimus and sirolimus in a young recipient of a living donor kidney transplant. We describe a patient treated with belatacept, a novel CTLA4 Ig fusion protein, as ongoing maintenance immunosuppression to allow avoidance of conventional agents once associated with TMA. We report excellent early graft outcome, with no adverse events using this strategy. We suggest that belatacept may have a role in this traditionally difficult-to-treat group of patients. [source] Reversible encephalopathy following 5-fluorouracil-based chemotherapy in patients with dihydropyrimidine dehyrogenase deficiencyASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2009Dong Wook KIM 5-fluorouracil (5-FU) is one of the most frequently used chemotherapy agents for the treatment of a number of solid cancers. We report two patients with advanced gastric cancer who developed acute encephalopathy after receiving chemotherapy composed of 5-FU and oxaliplatin. One patient presented with altered consciousness and the other with generalized tonic clonic seizure. 5-FU-induced encephalopathy was suspected by clinical, radiological and electroencephalographic findings, and both patients had reduced expression of dihyropyrimidine dehydrogenase, the rate-limiting enzyme responsible for the catabolism of 5-FU. The neurological symptoms improved spontaneously, and did not recur in the following cycle of chemotherapy with the administration of a reduced dose of 5-FU. We suggest that the early recognition of this adverse event can reverse 5-FU-induced neurological symptoms and a dose reduction of the offending drug can prevent the recurrence of 5-FU induced encephalopathy. [source] Proton pump inhibitor-induced acute interstitial nephritisBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 6 2007Linda Härmark What is already known about this subject ,,In several case reports the use of omeprazole has been associated with interstitial nephritis. ,,Recently there have been reports linking other proton pump inhibitors (PPIs) with interstitial nephritis. What this study adds ,,We present supplementary cases received by the Netherlands Pharmacovigilance Centre Lareb, concerning interstitial nephritis in users of PPIs including omeprazole, pantoprazole and rabeprazole. ,,In this case series seven patients are presented. In six cases they recovered spontaneously after cessation of the PPI, in one case the patient recovered after treatment with a corticosteroid. ,,Further support for this association comes from the worldwide adverse drug reaction database of the World Health Organization. ,,This report shows that interstitial nephritis can occur with all PPIs. Health professionals should be aware of this potential serious adverse drug reaction. Aim To investigate the association between the use of proton pump inhibitors (PPIs) and acute interstitial nephritis (AIN). Methods The Netherlands Pharmacovigilance Centre Lareb received seven case reports of AIN induced by various PPIs. In five of the reports it was mentioned that the diagnosis was confirmed by a renal biopsy. Results The time to onset varied between hours to 4 months. In all cases but one the patient spontaneously recovered after withdrawal of the offending agent. In one case the patient received treatment with prednisolone and recovered. In one patient a rechallenge was done 9 days after the initial event. Within 12 h of re-exposure the patient developed symptoms of AIN. Conclusions The mechanism of drug-induced AIN is unknown, but an immunological mechanism is suspected. Our reports show no relation between dosage, latency, time to recovery, age or gender, supporting the hypothesis that the aetiology of AIN is immunological. Lareb has received reports of AIN with the use of omeprazole, pantoprazole and rabeprazole. This shows that AIN is a complication associated with the whole group of PPIs and not only omeprazole. It is important for health professionals to be aware of this adverse drug reaction, because an accurate and timely diagnosis and withdrawal of the offending drug can prevent potentially life-threatening renal failure. [source] | ||||||||||