ABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Intravenous sodium stibogluconate (SbV) is the mainstay of treatment for mucocutaneous leishmaniasis. Incidence of this disease is increasing in the UK, partly because of returning military personnel. SbV has a side effect profile that requires treatment interruption in up to 28% of patients. Side effects can be unpleasant and - in the case of QTc prolongation - dangerous. CASE SUMMARY: A volunteer medical worker returning from Guatemala was diagnosed with mucocutaneous leishmaniasis. Because of previous renal problems, NSAIDs were contraindicated. Severe side effects of myalgia and arthralgia would have necessitated a treatment interruption, but a trial of prednisolone gave excellent symptomatic relief. The patient's QTc, amylase and C-reactive protein also fell following initiation of steroid treatment. The SbV treatment course was completed successfully. WHAT IS NEW AND CONCLUSION: This is the first reported case of the dangerous and disabling side effects of SbV being treated very effectively with glucocorticoids. Of note is the normalization of the apparently sodium stibogluconate-induced prolongation of the QTc interval. Further investigation into this potential beneficial effect is warranted.
Subject(s)
Antimony Sodium Gluconate/adverse effects , Antiprotozoal Agents/adverse effects , Glucocorticoids/therapeutic use , Prednisolone/therapeutic use , Adult , Antimony Sodium Gluconate/therapeutic use , Antiprotozoal Agents/therapeutic use , Arthralgia/chemically induced , Arthralgia/drug therapy , Guatemala , Humans , Leishmaniasis, Mucocutaneous/drug therapy , Long QT Syndrome/chemically induced , Long QT Syndrome/drug therapy , MaleSubject(s)
Blood Gas Analysis/instrumentation , Cognition , Bias , Equipment Failure , Female , Humans , Hydrogen-Ion Concentration , JudgmentABSTRACT
We present a series of cases of phenytoin toxicity where the diagnosis was initially missed. These patients all suffered unnecessary morbidity or investigations. The side-effects and unusual pharmacokinetics of phenytoin are discussed, as well as the array of potential drug interactions. We remind clinicians that phenytoin toxicity can easily mimic a cerebellar lesion or alcohol intoxication, and suggest that in accordance with National Institute for Clinical Excellence (NICE) guidelines phenytoin should no longer be used as a first-line treatment for epilepsy.
Subject(s)
Anticonvulsants/adverse effects , Cerebellar Diseases/chemically induced , Phenytoin/adverse effects , Aged , Anticonvulsants/blood , Anticonvulsants/pharmacokinetics , Cerebellar Diseases/diagnosis , Epilepsy/drug therapy , Humans , Male , Middle Aged , Phenytoin/blood , Phenytoin/pharmacokineticsSubject(s)
Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Myasthenia Gravis/complications , Myasthenia Gravis/diagnosis , Aged, 80 and over , Cholinesterase Inhibitors/therapeutic use , Deglutition Disorders/drug therapy , Diagnosis, Differential , Female , Glucocorticoids/therapeutic use , Humans , Myasthenia Gravis/drug therapy , Prednisolone/therapeutic use , Pyridostigmine Bromide/therapeutic useSubject(s)
Muscle Weakness/chemically induced , Muscle Weakness/diagnosis , Asthenia/chemically induced , Asthenia/diagnosis , Asthenia/etiology , Colchicine/adverse effects , Diagnosis, Differential , Graft Rejection/complications , Graft Rejection/diagnosis , Graft Rejection/drug therapy , Humans , Kidney Transplantation/adverse effects , Male , Middle Aged , Muscle Weakness/etiologyABSTRACT
We present a case of chronic inflammatory demyelinating polyneuropathy occurring subsequent to influenza vaccination in a 74-year-old gentleman with no previous neurological history.