American journal of therapeutics
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Review Case Reports
Neuroleptic Malignant Syndrome Associated With Metoclopramide Use in a Boy: Case Report and Review of the Literature.
Neuroleptic malignant syndrome (NMS), an idiosyncratic reaction comprising muscular rigidity, altered level of consciousness, and autonomic dysfunction, is a rare but serious medical condition. It is most commonly precipitated by major tranquilizers such as butyrophenones, phenothiazines, and thioxanthines. Metoclopramide, a chlorbenzamide derivative with antidopaminergic properties, is widely used to treat nausea and emesis. ⋯ He subsequently recovered fully and was discharged home with pediatric follow-up. This case represents the first description of NMS in association with metoclopramide in a healthy boy. It demonstrates the importance of considering this diagnosis early in the course of disease in patients with muscular rigidity, altered level of consciousness and autonomic dysfunction, and the need to rapidly respond to the physiological aberrations.
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Review Case Reports
Systemic Intravenous Lidocaine for the Treatment of Complex Regional Pain Syndrome: A Case Report and Literature Review.
Complex regional pain syndrome (CRPS) was described in 1864 by Mitchell et al as a condition characterized by many unique symptoms. Although symptoms may differ from patient to patient, the most common complaints are painful swelling in upper or lower extremities or changes in the skin. CRPS has been given many different names since it was first mentioned in the literature in 1851. ⋯ Intravenous lidocaine is used to block the sodium channels in neuronal membranes, thus stopping initiation and conduction of impulses associated with neuropathic and inflammatory pain. The use of regional intravenous lidocaine (by applying a tourniquet on the affected extremity) has been well-documented in the literature with a successful decrease in pain symptoms. A unique case of the use of systemic intravenous lidocaine will be presented.
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Infliximab is one of the TNF-α inhibitors, a class of medications that made a revolution in treatment of rheumatic diseases especially rheumatoid arthritis. The activation of tuberculosis and atypical mycobacterial infections has been described in the setting of TNF-α inhibitor therapy, but septic arthritis relating to this treatment has not yet been reported in previous literature. We describe a 50-year-old woman with dermatomyositis who developed Mycobacterium Avium Complex septic arthritis, while being treated with infliximab for active skin disease. This case highlights an important complication related to therapy with TNF-α inhibitors.
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Case Reports
Unusual Bleeding Due to Riociguat Use in a Patient With Chronic Thromboembolic Pulmonary Hypertension.
Riociguat is a new drug prescribed to patients with pulmonary hypertension that reduces the pressure in pulmonary artery by vasodilation. This drug like many other drugs has several side effects, some of which can be serious such as bleeding. Riociguat causes vaginal bleeding by increasing endometrial thickness and blood flow to the endometrium, therefore, should be used with care especially for patients who have history of dysfunctional uterine bleeding. In this case report, we present a 27-year-old female patient with chronic thromboembolic pulmonary hypertension and dysfunctional uterine bleeding presented with severe vaginal bleeding under riociguat treatment.
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Sevoflurane is associated with a relatively high incidence of emergence agitation (EA) in children. Prophylactic treatment, including midazolam, dexmedetomidine, ketamine, fentanyl and propofol, has been used to prevent EA. However, the question of which prophylactic treatment should be preferred to decrease the incidence of EA is still unclear. ⋯ One interesting finding of this network meta-analysis is that dexmedetomidine might be the best choice to prevent EA. However, there is weak evidence that dexmedetomidine is better than ketamine for the prevention of sevoflurane-related EA in children. As a result, more studies are needed to compare dexmedetomidine with ketamine.