Drug-induced Liver Injury Caused by Ipragliflozin Administration with Causality Established by a Positive Lymphocyte Transformation Test (LTT) and the Roussel Uclaf Causality Assessment Method (RUCAM): A Case Report

ABSTRACT A 75-year old male patient had been regularly visiting our hospital for the management of his type 2 diabetes mellitus since he was diagnosed at age 64 years. When he developed hypoglycemic episodes with sulfonylurea, ipragliflozin (50 mg/day) was started to replace the sulfonylurea therapy. However, 49 days after starting ipragliflozin, his AST increased from 13 to 622 U/L, ALT increased from 9 to 266 U/L, ALP increased from 239 to 752 U/L, and γ-GTP increased from 19 to 176 U/L. ZTT was 3.5 U, TTT was 0.4 U, and total bilirubin was 0.7 mg/dL. IgM hepatitis A antibody, hepatitis B antigen, hepatitis C virus antibody, IgM CMV antibody, and IgM EB VCA antibody were negative, whereas a lymphocyte transformation test for ipragliflozin was positive. Abdominal CT scan showed mild fatty liver but no sign of nodular lesions. Following admission to our hospital, he received liver supportive therapy with the discontinuation of ipragliflozin therapy. He was discharged from the hospital 18 days later with AST and ALT levels reduced to 20 U/L and 13 U/L, respectively. Based on the clinical presentation of this patient, it is highly important to monitor liver function along with other possible clinical complications (e.g., dehydration, ketosis, and urinary tract infection) associated with SGLT2 inhibitor therapy.

Rivaroxaban: A novel anticoagulant.

For more than 50 years, warfarin has single-handedly ruled the world of anti-coagulation without any competition, whatsoever! The anticoagulant was made available in 1940 and since then no other anti-coagulant has ever been able to match it in the clinical arena. But it looks like that the advances in the field of anti-coagulation, for the first time, have seriously started to erode its base. This review takes a look at rivaroxaban, a direct factor Xa inhibitor and one of the most foremost competitors of warfarin.

Skin eruption and thrombocytopaenia in a woman with glaucoma: a case report / Erupción cutánea y trombocitopenia en una mujer con glaucoma: reporte de un caso

Antibiotic and non-antibiotic sulphonamides are often prescribed. Although chemical differences make cross-reactivity rare, reactions may be severe in patients allergic to sulphur. Adverse reactions are common with sulphonamides but low platelets and skin changes are rarely associated with eye-drops for glaucoma. A woman treated with dorzolamide and timolol presented with disseminated eruption. On admission, her physical examination was unremarkable except for the skin changes and severe thrombocytopaenia was detected. Skin biopsy showed hyperkeratosis, acanthosis, perivascular and periadnexal infiltrates with no vasculitis. After discontinuation of eye-drops, the eruption improved but low platelets persisted. Skin changes reappeared with use of dapsone which suggested sulphonamide cross-reactivity.

A menudo se prescriben sulfonamidas antibióticas y no-antibióticas. Aunque las diferencias químicas hacen que la reactividad cruzada sea algo raro, las reacciones pueden ser severas en los pacientes alérgicos al azufre. Las reacciones adversas son comunes con las sulfonamidas pero las plaquetas bajas y los cambios en la piel raramente se asocian con las gotas oculares para el glaucoma. A una mujer a quien se le hizo un tratamiento con dorzolamida y timolol, se le presentó una erupción diseminada. En el momento del ingreso, su examen físico fue común y corriente excepto por los cambios en la piel. Además se le detectó una trombocitopenia severa. La biopsia de la piel reveló hiperqueratosis, acanthosis, infiltrados perivasculares y periadnexales sin vasculitis. Tras descontinuar las gotas oculares, la erupción mejoró pero las plaquetas bajas persistieron. Los cambios de la piel reaparecieron con el uso de dapsona, lo que hizo pensar en una reactividad cruzada de la sulfonamida.

Bleeding gums: duloxetine may be the cause.

Duloxetine is a newly introduced drug. It is being prescribed for the management of diabetic neuropathic pain and major depressive disorder. The most frequently observed adverse events with duloxetine are nausea, dry mouth and somnolence, constipation, diarrhea, decreased appetite, weight loss, feeling of fatigue, dizziness, somnolence, hypohidrosis, decreased libido and erectile dysfunction. One of the patients being prescribed the drug developed bleeding gums on being started with the drug which resolved on stopping it. We hereby report this case.