1/69. Intravenous injection of talc-containing drugs intended for oral use. A cause of pulmonary granulomatosis and pulmonary hypertension.Clinical and morphologic features are described in two patients known to have repeatedly injected intravenously talc-containing drugs intended for oral use. In one patient severe pulmonary hypertension developed; the talc granulomas in him were located predominantly within the pulmonary arteries. The second patient had normal pulmonary arterial pressures, and the talc granulomas in him were located predominantly in the pulmonary interstitium. Of 19 previously described patients with pulmonary talc granulomas, 12 had morphologic evidence of pulmonary hypertension (in three of severe degree); in each, talc granulomas were located predominantly within the pulmonary arteries. In those without signs of pulmonary hypertension, granulomas were located predominantly in the pulmonary interstitium. Why there are differences in the distribution of the talc granulomas is unclear. It is clear, however, as demonstrated by one of our patients, that severe pulmonary hypertension may be a consequence of intravenous injection of drugs intended for oral use.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/69. Bronchial mucormycosis with progressive air trapping.A previously healthy 70-year-old woman developed fever, cough, and exertional dyspnea. Her symptoms progressed over a 2-month period despite treatment by her primary care physician with 2 courses of oral antibiotics and the addition of prednisone. Hypoxemia and the finding of hyperglycemia with mild ketoacidosis led to hospital admission. Serial chest radiographs demonstrated diffuse heterogeneous pulmonary opacities and progressive air trapping in the right lower lobe. Fiberoptic bronchoscopy revealed a deep penetrating ulcer with exposed bronchial cartilage of the bronchus intermedius and dynamic airway obstruction with complete closure during expiration. biopsy of the ulcer revealed rhizopus arrhizus. Respiratory failure stabilized with the patient on conventional mechanical ventilation and receiving amphotericin b. Before surgery could be performed, pseudomonas aeruginosa pneumonia and septic shock developed, and the patient died.- - - - - - - - - - ranking = 0.2327235242165keywords = closure (Clic here for more details about this article) |
3/69. Bullous pemphigoid developing during systemic therapy with chloroquine.Bullous pemphigoid has been reported to be induced or precipitated by systemic therapy with several drugs, including penicillamine, captopril, frusemide and ampicillin. We report an African male patient with sarcoidosis who was prescribed chloroquine for progressive dyspnoea. After 3 months he developed generalized pruritus which evolved into a widespread bullous eruption with acral targetoid lesions resembling erythema multiforme. The histological and immunofluorescence findings were diagnostic of bullous pemphigoid. The atypical clinical features of this case resemble the phenotype that has been noted in previous reports of drug-induced bullous pemphigoid.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
4/69. Severe pulmonary toxicity in patients treated with a combination of docetaxel and gemcitabine for metastatic transitional cell carcinoma.BACKGROUND: Both gemcitabine and docetaxel have been associated with pulmonary toxicity when used as single agents. We report a study in which three of five cases developed pulmonary toxicity (which proved fatal in one case) when these drugs were used in combination to treat metastatic transitional cell cancer. patients AND methods: Three patients developed dyspnoea, in two cases associated with pulmonary infiltrates, whilst receiving the combination of gemcitabine and docetaxel in a phase I trial. The case notes of all five patients entered into this trial were studied. A literature review was undertaken to gain information on reported pulmonary toxicity with the deoxy-cytidine analogues and taxanes given alone or in combination with or without radiotherapy. RESULTS: Three patients developed delayed dyspnoea whilst receiving gemcitabine/docetaxel in combination. This settled with cessation of treatment in one patient, however in the remaining two cases significant hypoxia developed, associated radiologically with evidence of progressive pulmonary infiltrates. One of these patients developed respiratory failure after bronchoscopy and biopsy and died. His chest X-ray changes were consistent with adult respiratory distress syndrome. The transbronchial biopsy and post mortem lung histology in this patient showed diffuse alveolar damage. The remaining patient settled with high dose prednisolone but died subsequently of progressive metastatic disease. CONCLUSION: The combination of gemcitabine and docetaxel showed promising activity in this small study. The development of pulmonary symptoms in three cases with radiological lung infiltrates in two other cases was cause for concern. patients receiving this drug combination should be closely monitored for similar problems.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
5/69. etoposide-induced pulmonary toxicity.After treatment with etoposide, two patients with lung cancer developed interstitial infiltrates and respiratory failure. Of the two, one patient responded rapidly to steroid therapy and developed recurrent symptoms on re-challenge with etoposide. Both patients had histopathologic findings consistent with drug-induced pulmonary toxicity. etoposide-induced lung disease needs to be considered in patients who develop subacute dyspnea and interstitial infiltrates during treatment with this agent.- - - - - - - - - - ranking = 0.16666666666667keywords = drug (Clic here for more details about this article) |
6/69. Platypnoea-orthodeoxia syndrome.PLATYPNOEA: orthodeoxia is a rare syndrome of postural hypoxaemia accompanied by breathlessness. The predominant symptom, dyspnoea induced by upright posture, can be debilitating and difficult to discern without thorough evaluation of the patient's pattern of dyspnoea. The precise cause of the syndrome is unclear but patients develop right to left intracardiac shunting in the presence of normal right sided cardiac pressures. Initially, patients should have confirmation of orthostatic desaturation by erect and supine pulse oximetry. However, definitive diagnosis of an orthostatic intracardiac shunt is most readily established by echocardiography. The use of echocontrast with postural manoeuvres may facilitate the diagnosis. The treatment of choice is surgical closure of the intracardiac (usually interatrial) communication, which may result in dramatic symptomatic and haemodynamic improvement. Three cases (a 27 year old man and two women aged 63 and 72 years) are described that exemplify the presentation of this syndrome, and reflect the varied management strategies and outcomes of this condition.- - - - - - - - - - ranking = 0.2327235242165keywords = closure (Clic here for more details about this article) |
7/69. nitrofurantoin-induced lung disease: two cases demonstrating resolution of apparently irreversible CT abnormalities.A reticular pattern on high resolution CT (HRCT) invariably represents significant lung pathology and is the dominant feature of irreversible fibrosis. We present two cases of nitrofurantoin-induced pulmonary toxicity in which the initial HRCT showed a widespread reticular pattern and associated distortion of the lung parenchyma, thought to represent established fibrosis. Follow-up HRCT scans after withdrawal of the drug showed resolution of this supposedly irreversible pattern.- - - - - - - - - - ranking = 0.16666666666667keywords = drug (Clic here for more details about this article) |
8/69. Closure of patent foramen ovale in patients with orthodeoxia-platypnea using the amplatzer devices.We present a series of four patients with orthodeoxia-platypnea who underwent successful transcatheter closure of their patent foramen ovale using the Amplatzer devices (Amplatzer septal occluder/Amplatzer PFO occluder). The average saturation increased from 81% to 96% with complete resolution of symptoms. The Amplatzer devices are safe and effective treatment options for patients with orthodeoxia-platypnea.- - - - - - - - - - ranking = 0.2327235242165keywords = closure (Clic here for more details about this article) |
9/69. pergolide-induced dyspnea, bilateral pleural effusion and peripheral edema.A patient with severe Parkinson's disease presented with increasing dyspnea, bilateral pleural effusion and peripheral edema that were refractory to diuretic therapy and were first misdiagnosed as signs of right-sided heart failure. pergolide was the only culprit for this devastating condition and on its discontinuation all signs of fluid retention resolved. In this report, drug reactions to ergots and dopamine agonists are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = drug (Clic here for more details about this article) |
10/69. Laryngeal sarcoidosis: treatment with the antileprosy drug clofazimine.sarcoidosis is a chronic systemic granulomatous disease that occasionally affects the larynx. When the larynx is affected, the symptoms are frequently mild, but severe airway obstruction can occur. Although systemic corticosteroids are helpful, patients may become refractory to further drug administration. The current methods of treatment are here summarized, and the patient literature is reviewed. We also report a case of a young patient suffering from laryngeal sarcoidosis successfully treated by the antileprosy agent clofazimine and propose it as an alternative treatment of laryngeal sarcoidosis in patients refractory to corticosteroids.- - - - - - - - - - ranking = 0.83333333333333keywords = drug (Clic here for more details about this article) |
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