Hypoglycemia associated with the use of gatifloxacin.

UNLABELLED: We present the histories, clinical findings, and hospital course of three patients who developed hypoglycemia after receiving gatifloxacin. Possible mechanisms for the hypoglycemia are outlined. CASE 1: A 89-year-old diabetic male receiving glyburide was given a single dose of gatifloxacin for bronchitis. Thirteen hours later, he was found to be unresponsive with a blood glucose level of 34 mg/dL. The hypoglycemia resolved within 24 hours of stopping gatifloxacin. CASE 2: A 80-year-old nondiabetic woman with end-stage renal disease and recent surgery was treated with gatifloxacin, cefepime, and metronidazole for pneumonia. Sixteen hours later, her serum glucose level was 61 mg/dL, and over the next 24 hours was as low as 39 mg/dL. The hypoglycemia resolved within 40 hours of stopping gatifloxacin. CASE 3: A 58-year-old diabetic man receiving glyburide was admitted for myocardial infarction and renal failure. Twelve hours after receiving gatifloxacin for pneumonia, his blood glucose level was 60 mg/dL and was as low as 42 mg/dL between 2 and 22.5 hours of a second dose of gatifloxacin. The hypoglycemia resolved within 24 hours of stopping gatifloxacin. CONCLUSIONS: Gatifloxacin use may precipitate hypoglycemia in diabetic patients receiving oral hypoglycemic agents and in nondiabetic patients with chronic renal failure. Discontinuation of gatifloxacin results in improvement in glucose homeostasis.

Severe hyperglycemia during gatifloxacin therapy in patients without diabetes.

OBJECTIVE: To present two cases of severe hyperglycemia in patients without diabetes who received gatifloxacin therapy. METHODS: We describe the histories, clinical findings, and hospital courses of two women in whom severe hyperglycemia developed after gatifloxacin therapy was initiated. Interacting factors that may result in severe hyperglycemia in patients without diabetes and the literature explaining the mechanism by which gatifloxacin can alter glucose metabolism are reviewed. RESULTS: Our first patient, a 46-year-old woman with end-stage renal disease, presented with a 3-day history of fever, abdominal pain, and hypotension. Admission laboratory data included a fasting plasma glucose level of 72 mg/dL and a glycosylated hemoglobin of 5.3%. She was treated with gatifloxacin for an infected ovarian cyst found on laparotomy. Her subsequent glucose values ranged from 400 to 500 mg/dL and remained high during gatifloxacin therapy. Antibiotic treatment was changed to ciprofloxacin. On outpatient follow-up, the patient's fasting plasma glucose levels had decreased to a range of 87 to 108 mg/dL. Our second patient, a 77-year-old woman with a history of chronic renal failure and congestive heart failure, was hospitalized because of dyspnea and hypotension. She was given gatifloxacin for a urinary tract infection. Her daily fasting plasma glucose value gradually increased from 100 mg/dL on admission to 694 mg/dL on the 6th hospital day. The patient required insulin therapy throughout her hospitalization, and she died on the 12th hospital day. CONCLUSION: Gatifloxacin therapy may precipitate severe hyperglycemia in patients without diabetes, especially in the elderly population, those with renal insufficiency, and those receiving multiple drugs known to alter glucose metabolism. Discontinuation of gatifloxacin treatment may result in improved glucose homeostasis.

Osteogenic sarcoma of the sella after radiation treatment of a pituitary adenoma.

OBJECTIVE: To report an uncommon case of osteogenic sarcoma of the sella turcica after radiation treatment of a pituitary adenoma. METHODS: We present the clinical history, physical findings, laboratory data, imaging studies, and pathologic findings in a patient found to have osteogenic sarcoma of the sella after radiation therapy for a nonfunctioning pituitary adenoma. RESULTS: Six years after transsphenoidal resection and postoperative fractionated radiation therapy for a nonfunctioning pituitary adenoma that extended to the cavernous sinus, a 45-year-old man presented with a sinus infection, diplopia, and ophthalmoplegia of the right eye. A computed tomographic scan of the head showed a mass in the sella with involvement of the optic chiasm and right cavernous sinus. Transsphenoidal resection and debulking of the tumor revealed an osteogenic sarcoma. The patient was discharged from the hospital with residual diplopia and ophthalmoplegia. He was treated with levothyroxine, testosterone, and hydrocortisone. Six weeks later, the patient was readmitted after he was found unresponsive, and computed tomographic scans disclosed a massive cerebrovascular accident. He died a few days later. CONCLUSION: Osteogenic sarcoma is a rare, late complication of radiation treatment of pituitary adenoma. Although radiotherapy remains an effective adjunctive treatment in patients with pituitary adenomas, particularly those with residual or recurrent tumor, potential complications must be acknowledged.