• PDF / 175,920 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 7 Downloads / 150 Views

DOWNLOAD

REPORT

---

1 S

Various toxicities: 2 case reports In a case series, a woman in her 30s and a 41-year-old man were described [not allexact ages stated], of whom the woman developed paradoxical inflammatory reactions, diabetes, cataracts, osteoporotic fractures and recurrent urinary tract infections during treatment with prednisolone for tuberculosis-associated immune reconstitution inflammatory syndrome, and the man developed paradoxical inflammatory reactions and unstable brain tuberculomata during treatment with dexamethasone for tuberculomata. Subsequently, they received off label treatment with anakinra for paradoxical inflammatory reactions [durations of treatments to reactions onsets not stated; not all routes and outcomes stated]. Case 1: A woman in her 30s developed paradoxical inflammatory reactions, diabetes, cataracts, osteoporotic fractures and recurrent urinary tract infections during treatment with prednisolone for tuberculosis-associated immune reconstitution inflammatory syndrome. Subsequently, she received off label treatment with anakinra for paradoxical inflammatory reactions. The woman presented in 2009 due to fever, myalgia, weight loss and night sweats at age of 33 years. She had lymphadenopathy and subsequently she was diagnosed with HIV infection. Her further investigation showed positive results for Mycobacterium tuberculosis, suggestive of disseminated tuberculosis. Hence, she was treated with unspecified anti-tubercular therapy with good response. After 2 weeks of anti-tubercular therapy, she started receiving antiretroviral therapy with tenofovir, efavirenz and emtricitabine. Thereafter, she developed fever with abdominal pain, vomiting and nausea and subsequently diagnosed with tuberculosis-associated immune reconstitution inflammatory syndrome along with large cervical and iliopsoas cold abscesses that required multiple aspirations. Due to protracted tuberculosis-associated immune reconstitution inflammatory syndrome, she started receiving prednisolone 60 mg/day. However, it was noted that she could not tolerate a prednisolone dose of less than 20mg/day as she had relapse of fever, abdominal pain, malaise and lymphadenopathy on each attempt to wean prednisolone over the following 3 years. She received 2 courses of anti-tubercular therapy. She also developed multiple prednisolone-related adverse effects including cataracts, diabetes, osteoporotic fractures and recurrent urinary tract infections. Her immune reconstitution inflammatory syndrome was additionally treated with montelukast; however, only limited response was obtained. She developed nephrotic syndrome two and a half years after the initial presentation. Low serum albumin, proteinuria and peripheral oedema with preserved renal function were noted. Subsequently, she underwent a renal biopsy that revealed mesangial and vascular amyloid deposition on sirius red staining, dichroic birefringence under polarised light and 10nm mesangial fibrils and she was diagnosed with amyloid A (AA) amyloidosis. Her investigation showed a tenfold increase in