Drug-induced Liver Injury Following Prolonged use of Nitrofurantoin.

Nitrofurantoin is the antibiotic of choice for treatment and prophylaxis of recurrent episodes of lower urinary tract infections. Although adverse effects such as anorexia, vomiting, and pulmonary hypersensitivity are commonly reported with nitrofurantoin use, studies have demonstrated that rarely nitrofurantoin can also induce diverse forms of liver injury, spanning from mild hepatitis to severe and potentially fatal fulminant liver failure. These occur especially in elderly females with preexisting liver or renal impairment. Here, we present a case of a 62-year-old female in good health who exhibited symptoms of fatigue, abdominal pain, and dark-colored urine. Through investigation, she was diagnosed with a case of drug-induced liver injury associated with the prolonged use of nitrofurantoin.

RésuméLa nitrofurantoïne est l'antibiotique de choix pour le traitement de la prophylaxie d'épisodes récurrents d'infections des voies urinaires intérieures. Bien que des effets indésirables tels que l'anorexie, des vomissements et une hypersensibilité pulmonaire soient fréquemments rapportés lors de l'utilisation de la nitrofuratoïne, des études ont demontré que dans de rares cas, la nitrofurantoïne peut également induire diverses formes de lésions hépatiques, allant d'une hépatite légère à une incapacité hépatique fulminante grave et potentiellement mortelle. Celle-ci surviennent particulièrement chez des femmes âgées ayant une insuffisance hépatique ou rénale préexistante.Nous présentons ici l'étude d'une femme de 62 ans en bonne santé qui manifestait des symptômes de fatigue, de douleurs abdominales et d'urine de couleur foncée. À travers une enquête, on lui a diagnostiquée un cas de lésion hépatique d'origine médicamenteuse associée à l'utilisation prolongée de la nitrofurantoïne.

Immunogenicity of Covishield vaccine in patients with autoimmune rheumatic diseases.

Introduction: The Coronavirus disease 2019 (COVID-19) pandemic has been the biggest threat to humankind during the last 3 years. It has caused the loss of more than 6.9 million precious lives across the world. The only method by which the massacre could be stopped was by mass vaccination or mass immunization. The patients suffering from autoimmune rheumatic disorders (AIRDs) and treated with immunosuppressants were the high-priority candidates for vaccination. However, the data regarding the efficacy of COVID-19 vaccines in this group of patients are very less. Hence, this study was planned to study the immunogenicity of Covishield in patients with AIRDs attending the rheumatology OPD at DMCH, Ludhiana. Materials and Methods: It was a prospective cohort study and was planned by the Department of Biochemistry and Department of Clinical Immunology and Rheumatology at Dayanand Medical College and Hospital, Ludhiana. Fifty patients with AIRDs attending the DMCH rheumatology OPD and 52 age and sex-matched healthy controls who had received two doses of Covishield vaccine were included in this study. Patients having any other immunosuppressive conditions like uncontrolled diabetes, hepatitis, malignancy or HIV were excluded. Patients who had suffered from previous laboratory-confirmed COVID-19 infection (by RT-PCR) were also excluded. Blood samples were collected following all aseptic precautions from patients and controls on the 28th day after administration of a second dose of Covishield vaccine and total antibodies to the severe acute respiratory syndrome coronavirus 2 spike (S) protein receptor binding domain was measured using Elecsys Anti-SARS-CoV-2 S kit from Roche. Results: It was observed that no significant difference was there in antibody titre between cases and controls (6213 ± 4418 vs. 8331 ± 7979, P = 0.1022). It was also observed that no statistically significant difference in antibody titre in cases without prednisolone and those taking treatment with prednisolone was found (P = 0.7058). A similar observation was found in terms of methotrexate also (P = 0.457). No significant difference in antibody titres was there when compared with controls (for prednisolone, P = 0.169, for methotrexate, P = 0.078). We found that only the patients receiving mycophenolate mofetil showed a statistically significant decrease in antibody titre in comparison to healthy controls (P = 0.03). Our study showed no statistically significant difference in antibody titres between patients suffering from different AIRDs. Conclusion: Our study supplements the fact that patients with AIRDs in India can receive Covishield as the primary vaccine against COVID-19 without concerns regarding decreased immunogenicity or increased adverse effects.

Higher Levels of Creatine Kinase MB (CK-MB) Than Total Creatine Kinase (CK): A Biochemistry Reporting Error or an Indicator of Other Pathologies?

The creatine kinase (CK) enzyme and its isoenzymes hold significant diagnostic value, appearing in distinct patterns across various tissues. The most common method for creatine kinase MB (CK-MB) estimation is based on immunoinhibition. However, this method can report falsely elevated CK-MB levels in various scenarios. Persistently elevated CK-MB levels or discrepancies between measured values and the patient's clinical condition warrant further investigation, such as total CK isoenzyme electrophoresis. This report presents a case where a patient was diagnosed with acute myocardial infarction and treated according to established guidelines. However, the presence of abdominal pain, in addition to persistently elevated CK-MB after the resolution of cardiac symptoms and a higher CK-MB to total CK ratio, suggested alternative pathologies. Thorough laboratory investigations, including quantitative CK isoenzyme electrophoresis and contrast-enhanced computed tomography (CECT) of the abdomen, followed by emergency operative intervention, led to a secondary diagnosis of acute small bowel infarction.