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Pulmonary-arterial-hypertension, nausea and diarrhoea: case report A 70-year-old woman developed nausea and diarrhoea during treatment with hydroxycarbamide; later, she developed pulmonary arterial hypertension during treatment with anagrelide for polycythaemia vera [routes and dosages not stated]. The woman with polycythaemia vera, started receiving treatment with hydroxycarbamide. However, she developed hydroxycarbamide related severe adverse effects manifesting as diarrhoea and nausea [duration of treatment to reaction onset not stated]. Therefore, the woman’s treatment was changed to anagrelide, with subsequent improvement in diarrhoea and nausea. However, a week after the anagrelide therapy initiation, she developed chest discomfort. The symptoms gradually progressed to shortness of breath and systemic oedema over a month, and her condition deteriorated to WHO functional class-III. Consequently, she was hospitalised due to systemic oedema and severe dyspnoea (1 month after anagrelide therapy start, current presentation). Examinations showed her serum brain natriuretic peptide (BNP) level increased at 847 pg/mL. Chest radiography demonstrated dilatation of the pulmonary artery and cardiomegaly with a cardiothoracic ratio of 65.5%. Transthoracic echocardiography showed right atrial and ventricular dilatation with severe tricuspid regurgitation, an elevated trans-tricuspid pressure gradient of 45mm Hg and compression of the left ventricle (D-shaped left ventricle). The left ventricle ejection fraction was noted as normal. McConnell sign was noted during right ventricular wall motion. Based on the examinations, a diagnosis of pulmonary arterial hypertension secondary to the anagrelide therapy was considered. Hence, her anagrelide therapy was stopped. Within 20 days of therapy discontinuation, the symptoms related to pulmonary arterial hypertension resolved completely with decrease in BNP level (40.53 pg/mL). Thereafter, she again started receiving hydroxycarbamide for polycythaemia vera. Sumimoto K, et al. "Anagrelide-induced pulmonary arterial hypertension": a rare case of drug-induced pulmonary arterial hypertension. Pulmonary Circulation 9: 1-3, No. 4, 803448821 2019. Available from: URL: http://doi.org/10.1177/2045894019896682

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Reactions 25 Jan 2020 No. 1788