ABSTRACT
Desmopressin is a synthetic vasopressin analog that increases the plasma levels of coagulation factor VIII, von Willebrand factor, and tissue plasminogen activator. This hemostatic agent, which can be administered either parenterally or intranasally, has been approved for use in the prevention and treatment of hemorrhagic events during surgery in patients with hemophilia A, in cases of prolonged idiopathic bleeding, and for complications associated with platelet antiaggregant therapy. This case report describes cardiac toxicity associated with desmopressin administered according to the recommended indications: a 55-year-old woman diagnosed with Wegener's granulomatosis (WG) was treated with desmopressin to improve hemostasis and shorten bleeding time before a planned renal biopsy. She developed cardiac arrest within 60 minutes of the desmopressin injection. Cardiopulmonary resuscitation began immediately and was successful, although the patient subsequently died of WG-associated complications. Desmopressin administration thus appears, in some cases, to be associated with a high risk of thrombotic events, possibly by stimulating the rapid release of endothelial factors such as an abnormal multimeric form of von Willebrand factor, which might cause platelet aggregation. Clinicians should be aware of the possible occurrence of this little-known but potentially serious cardiac event associated with desmopressin administration and be prepared to initiate cardiopulmonary resuscitation immediately if needed.
Subject(s)
Deamino Arginine Vasopressin/adverse effects , Granulomatosis with Polyangiitis/complications , Heart Arrest/chemically induced , Hemostatics/adverse effects , Myocardial Infarction/etiology , Biopolymers , Biopsy , Bleeding Time , Deamino Arginine Vasopressin/therapeutic use , Disease Progression , Endothelium, Vascular/drug effects , Endothelium, Vascular/metabolism , Fatal Outcome , Female , Granulomatosis with Polyangiitis/blood , Granulomatosis with Polyangiitis/drug therapy , Hemorrhage/prevention & control , Hemostatics/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Kidney/pathology , Middle Aged , Myocardial Infarction/drug therapy , Thromboembolism/etiology , Thrombolytic Therapy , von Willebrand Factor/chemistry , von Willebrand Factor/metabolismABSTRACT
In patients with visual hallucinations, diagnostic strategy is unclearly codified. In patients known to have giant cell arteritis, the main diagnostic assumption is disease relapse. Indeed, this should lead to rapid corticosteroid therapy. However, the Charles Bonnet syndrome, that is a poorly known etiology of visual hallucinations usually observed in elderly people, should be part of the differential diagnosis. We report a 87-year-old woman, with a 2-year history of giant cell arteritis who was admitted with an acute onset of visual hallucinations and who met all the criteria for Charles Bonnet syndrome.