Pub Date : 2021-05-01DOI: 10.1177/00694770211015580
J. Dill, T. Mcevoy
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Pub Date : 2021-04-01DOI: 10.1177/00694770211007805
J. Dill, T. Mcevoy
A 68-year-old woman developed a diffuse rash and a fever approximately 1 month after starting atorvastatin (20 mg nightly) following mitral valve replacement. Concurrent medications included digoxin (0.125 mg daily), furosemide (20 mg twice daily), potassium chloride (1 g twice daily), and warfarin (0.625 mg nightly). Laboratory findings included albumin (34.6 g/L), -glutamyl transpeptidase (45 units/L), glucose (13.24 mmol/L), creatine kinase MB subtype (18.0 units/L), creatine kinase (20 units/L), lactic dehydrogenase (398 units/L), sodium (135.9 mmol/L), leukocyte count (5.19 10/L), hemoglobin (98.0 g/L), platelet count (267 g/L), procalcitonin (0.130 ng/mL), and fibrinogen (4.35 g/L). Treatment included discontinuation of all drugs used prior to admission and administration of loratadine (10 mg daily), cetirizine (10 mg daily), vitamin C (100 mg 3 times daily), methylprednisolone (120 mg every 12 hours), intravenous omeprazole (40 mg every 12 hours), calamine, and ethacridine. A large number of blisters covering greater than 30% of the body appeared the next day, accompanied by fever. Additional treatment included administration of intravenous human immunoglobulin. The facial skin began to peel, and the trunk blisters ruptured. Mupirocin was applied topically. A new red patchy rash appeared on the lower extremities. On day 17, the face of the skin and trunk was mostly healed. After 60 days, the skin had regrown. HLA allele detection revealed the HLA-A*2:07, HLA-A*11:01, HLAB*15:02, HLA-B*40:01, HLA-C*3:04, and HLA-C*08:01 alleles. The authors concluded that this case described toxic epidermal necrolysis associated with atorvastatin. They proposed that the mutant HLA genotypes carried may have a correlation with Stevens-Johnson syndrome and toxic epidermal necrolysis. Atorvastatin [“Lipitor”] Lv M et al (J Zhang, Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Rd, Fuzhou 350001, China; e-mail: pollyzhang2006@126.com) Toxic epidermal necrolysis in a patient on atorvastatin expressing human leukocyte antigen alleles: a case report. Medicine (Baltimore) 100:e24391 (Jan) 2021
一名68岁女性在二尖瓣置换术后开始阿托伐他汀(每晚20毫克)约1个月后出现弥漫性皮疹和发烧。同时使用的药物包括地高辛(0.125 mg /天)、速尿(20 mg /天2次)、氯化钾(1 g /天2次)和华法林(0.625 mg /天)。实验室检查结果包括白蛋白(34.6 g/L)、-谷氨酰转肽酶(45单位/L)、葡萄糖(13.24 mmol/L)、肌酸激酶MB亚型(18.0单位/L)、肌酸激酶(20单位/L)、乳酸脱氢酶(398单位/L)、钠(135.9 mmol/L)、白细胞计数(5.1910/L)、血红蛋白(98.0 g/L)、血小板计数(267 g/L)、降钙素原(0.130 ng/mL)、纤维蛋白原(4.35 g/L)。治疗包括停用入院前使用的所有药物，并给予氯雷他定(每日10毫克)、西替利嗪(每日10毫克)、维生素C(100毫克，每日3次)、甲基强的松龙(每12小时120毫克)、静脉注射奥美拉唑(每12小时40毫克)、炉甘石和乙沙啶。第二天出现大量水泡，覆盖全身30%以上，并伴有发热。其他治疗包括静脉注射人免疫球蛋白。面部皮肤开始剥落，躯干的水泡破裂。局部应用莫匹罗星。下肢出现新的红色斑疹。第17天，面部皮肤和躯干基本愈合。60天后，皮肤再生了。HLA等位基因检测结果为HLA- a *2:07、HLA- a *11:01、HLAB*15:02、HLA- b *40:01、HLA- c *3:04、HLA- c *08:01等位基因。作者得出结论，该病例描述了与阿托伐他汀相关的中毒性表皮坏死松解。他们提出携带的突变HLA基因型可能与Stevens-Johnson综合征和中毒性表皮坏死松解有关。350001福州新泉路29号福建医科大学协和医院药剂科;表达人白细胞抗原等位基因的阿托伐他汀患者中毒性表皮坏死松解一例报告。医学(巴尔的摩)100:e24391 (Jan) 2021
{"title":"Reporting on Adverse Clinical Events","authors":"J. Dill, T. Mcevoy","doi":"10.1177/00694770211007805","DOIUrl":"https://doi.org/10.1177/00694770211007805","url":null,"abstract":"A 68-year-old woman developed a diffuse rash and a fever approximately 1 month after starting atorvastatin (20 mg nightly) following mitral valve replacement. Concurrent medications included digoxin (0.125 mg daily), furosemide (20 mg twice daily), potassium chloride (1 g twice daily), and warfarin (0.625 mg nightly). Laboratory findings included albumin (34.6 g/L), -glutamyl transpeptidase (45 units/L), glucose (13.24 mmol/L), creatine kinase MB subtype (18.0 units/L), creatine kinase (20 units/L), lactic dehydrogenase (398 units/L), sodium (135.9 mmol/L), leukocyte count (5.19 10/L), hemoglobin (98.0 g/L), platelet count (267 g/L), procalcitonin (0.130 ng/mL), and fibrinogen (4.35 g/L). Treatment included discontinuation of all drugs used prior to admission and administration of loratadine (10 mg daily), cetirizine (10 mg daily), vitamin C (100 mg 3 times daily), methylprednisolone (120 mg every 12 hours), intravenous omeprazole (40 mg every 12 hours), calamine, and ethacridine. A large number of blisters covering greater than 30% of the body appeared the next day, accompanied by fever. Additional treatment included administration of intravenous human immunoglobulin. The facial skin began to peel, and the trunk blisters ruptured. Mupirocin was applied topically. A new red patchy rash appeared on the lower extremities. On day 17, the face of the skin and trunk was mostly healed. After 60 days, the skin had regrown. HLA allele detection revealed the HLA-A*2:07, HLA-A*11:01, HLAB*15:02, HLA-B*40:01, HLA-C*3:04, and HLA-C*08:01 alleles. The authors concluded that this case described toxic epidermal necrolysis associated with atorvastatin. They proposed that the mutant HLA genotypes carried may have a correlation with Stevens-Johnson syndrome and toxic epidermal necrolysis. Atorvastatin [“Lipitor”] Lv M et al (J Zhang, Department of Pharmacy, Fujian Medical University Union Hospital, #29 Xinquan Rd, Fuzhou 350001, China; e-mail: pollyzhang2006@126.com) Toxic epidermal necrolysis in a patient on atorvastatin expressing human leukocyte antigen alleles: a case report. Medicine (Baltimore) 100:e24391 (Jan) 2021","PeriodicalId":102871,"journal":{"name":"Clin-Alert®","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123317450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-01DOI: 10.1177/00694770211001108
J. Dill, T. Mcevoy
{"title":"Reporting on Adverse Clinical Events","authors":"J. Dill, T. Mcevoy","doi":"10.1177/00694770211001108","DOIUrl":"https://doi.org/10.1177/00694770211001108","url":null,"abstract":"","PeriodicalId":102871,"journal":{"name":"Clin-Alert®","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126208227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1177/0069477020986522
J. Dill, T. Mcevoy
An 80-year-old Caucasian male patient developed worsening confusion, irritability, delusions, persecution, and slurred speech approximately 3 weeks after starting melatonin (1 mg daily). Concurrent medications included enalapril, atenolol, chlortalidone, gliclazide, esomeprazole, atorvastatin, dutasteride, and silodosin. No other herbal-type medications were ingested. On admission, abnormal laboratory tests included a decreased serum sodium level (110 mEq/L). Other laboratory levels were in normal. Hematological and urinary screenings for infectious etiologies were negative. Based on these results, both melatonin and chlortalidone were discontinued. Treatment was initiated with hypertonic saline (3%), haloperidol, and sodium valproate. Symptoms gradually resolved over several days and was associated with normalization of serum sodium levels. By the fourth day serum sodium levels were within normal levels. At a 2-month follow-up assessment, chlorthalidone was reinitiated with no further events noted; serum sodium and other electrolytes were within normal limits. Rechallenge with melatonin was not performed. The patient was advised to not restart melatonin therapy. Based on the results of this case report, the author concluded that this patient experienced syndrome of inappropriate antidiuretic hormone related to melatonin therapy based on the temporal relationship between the administration of the product and the onset of symptoms. Melatonin [Melatonin] Famularo G (G Famularo, San Camillo Hospital, Rome, Italy) Syndrome of inappropriate antidiuretic hormone secretion in a patient treated with melatonin. Ann Pharmacother 55:131-132 (Jan) 2021
一位80岁的白人男性患者在开始使用褪黑素(每日1mg)约3周后出现了日益恶化的精神错乱、易怒、妄想、迫害和言语不清。同时使用的药物包括依那普利、阿替洛尔、氯他酮、格列齐特、埃索美拉唑、阿托伐他汀、杜他雄胺和西洛多辛。没有摄入其他草药类药物。入院时，实验室检查异常包括血清钠水平下降(110 mEq/L)。其他实验室水平正常。血液学和泌尿学感染病因筛查均为阴性。基于这些结果，褪黑激素和氯他酮都被停用。治疗开始时使用高渗盐水(3%)、氟哌啶醇和丙戊酸钠。几天后症状逐渐消退，血清钠水平恢复正常。到第四天，血清钠水平在正常范围内。在2个月的随访评估中，氯噻酮重新开始使用，没有发现进一步的事件;血清钠及其他电解质在正常范围内。未进行褪黑素再挑战。建议患者不要重新开始褪黑素治疗。根据本病例报告的结果，作者根据服用产品与症状发作的时间关系得出结论，该患者经历了与褪黑激素治疗相关的抗利尿激素不适当综合征。褪黑素[褪黑素]Famularo G (G Famularo，圣卡米洛医院，罗马，意大利)患者接受褪黑素治疗后抗利尿激素分泌不当的综合征。Ann Pharmacother 55:31 -132 (Jan) 2021
{"title":"Reporting on Adverse Clinical Events","authors":"J. Dill, T. Mcevoy","doi":"10.1177/0069477020986522","DOIUrl":"https://doi.org/10.1177/0069477020986522","url":null,"abstract":"An 80-year-old Caucasian male patient developed worsening confusion, irritability, delusions, persecution, and slurred speech approximately 3 weeks after starting melatonin (1 mg daily). Concurrent medications included enalapril, atenolol, chlortalidone, gliclazide, esomeprazole, atorvastatin, dutasteride, and silodosin. No other herbal-type medications were ingested. On admission, abnormal laboratory tests included a decreased serum sodium level (110 mEq/L). Other laboratory levels were in normal. Hematological and urinary screenings for infectious etiologies were negative. Based on these results, both melatonin and chlortalidone were discontinued. Treatment was initiated with hypertonic saline (3%), haloperidol, and sodium valproate. Symptoms gradually resolved over several days and was associated with normalization of serum sodium levels. By the fourth day serum sodium levels were within normal levels. At a 2-month follow-up assessment, chlorthalidone was reinitiated with no further events noted; serum sodium and other electrolytes were within normal limits. Rechallenge with melatonin was not performed. The patient was advised to not restart melatonin therapy. Based on the results of this case report, the author concluded that this patient experienced syndrome of inappropriate antidiuretic hormone related to melatonin therapy based on the temporal relationship between the administration of the product and the onset of symptoms. Melatonin [Melatonin] Famularo G (G Famularo, San Camillo Hospital, Rome, Italy) Syndrome of inappropriate antidiuretic hormone secretion in a patient treated with melatonin. Ann Pharmacother 55:131-132 (Jan) 2021","PeriodicalId":102871,"journal":{"name":"Clin-Alert®","volume":"03 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127334881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-01DOI: 10.1177/0069477020948852
J. Dill, T. Mcevoy
{"title":"Reporting on Adverse Clinical Events","authors":"J. Dill, T. Mcevoy","doi":"10.1177/0069477020948852","DOIUrl":"https://doi.org/10.1177/0069477020948852","url":null,"abstract":"","PeriodicalId":102871,"journal":{"name":"Clin-Alert®","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116139971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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