Cabergoline
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Pleuropulmonary toxicity in an elderly patient: case report A 65-year-old ex-smoker developed pleuropulmonary toxicity during treatment with cabergoline for Parkinson’s disease. The man, who had been receiving cabergoline 4 mg/day for the last 3 years, levodopa/carbidopa, benserazide and entacapone, was referred with swollen ankles, dyspnoea and intolerance of a supine position for over 1 month. Physical examination revealed bilateral basal hypophonesis during respiratory auscultation and pitting oedema of the lower half of his legs. Laboratory investigations revealed the following: LDH 333, ESR 70 and CRP 1.3. Bilateral pleural effusion was revealed by chest x-ray. An echocardiogram showed an altered ventricular relaxation and a left ventricle ejection fraction of 60%. A diagnosis of heart failure was considered. The man received antidiuretics with only slight improvement in distal swelling. A pleural tap revealed lymphocyte exudate with a low ADA value. Pleural biopsy demonstrated isolated regions of reactive mesothelial proliferation and marked fibrosis. Bilateral pleural thickening and effusion involving the underlying parenchyma was revealed by chest CT. Respiratory function testing revealed the following: FEV1 2.18L (77%), FVC 2.88L (73%), FEV1/FVC 76%, RV 1.60L (76%), TLC 4.55L (73%), KCO 84% and DLCO 71%. Arterial blood gas analysis (room air) revealed a pH of 7.43, a PaO2 of 88.7mm Hg, a PaCO2 of 36.7mm Hg and a bicarbonate level of 25.3 mEq/L. He had an alveolo-arterial gradient of 14mm Hg and a COHb of 0.4%. Cabergoline was discontinued and he received prednisolone. During 2 years’ follow-up, his clinical condition improved. However, his mild left pleural thickening persisted. Pulmonary function tests revealed a relatively improved restrictive pattern. Author comment: "Using Karch and Lasagna’s classical criteria, we defined a relationship of "probable causality" between the drug and the adverse effects reported. . . Our case meets four of Karch and Lasagna’s five criteria." Belmonte Y, et al. Pleuropulmonary toxicity of another anti-Parkinson’s drug: Cabergoline. Open Respiratory Medicine Journal 3: 90-93, 5 Jun 2009. Available 803008497 from: URL: http://dx.doi.org/10.2174/1874306400903010090 - Spain
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Reactions 27 Mar 2010 No. 1294
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