Diltiazem
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Diltiazem First report of acute pharyngeal inflammatory mass: case report
An 85-year-old woman developed acute pharyngeal inflammatory mass during treatment with diltiazem for atrial fibrillation. The woman, who had a history of atrial fibrillation, chronic obstructive pulmonary disease, heart failure with reduced ejection fraction and tobacco abuse, presented to the emergency department. She had sore throat associated with neck-swelling and difficulty swallowing. Her symptoms started approximately 18 hours prior following ingestion of diltiazem [dosage not stated] extended-release tablets. She reported to have felt like the tablet got stuck upon swallowing. Shortly thereafter, she developed progressive pain and swelling on the right side of her neck. At presentation, she was oxygenating 100% on room air. Her examination was significant for mild stridor. A mild to moderate swelling with mild tenderness to palpitation on the right side of the neck was noted. Anteroposterior neck X-ray revealed some mild tracheal deviation at the left of the anteroposterior view. A softtissue neck CT scan with IV contrast showed a heterogeneous mass-like peripherally enhancing lesion (18mm) within the right preepiglottic fat. The mass caused airway asymmetry and narrowing leading to airway obstruction. Based on these image findings, a sub-acute or chronic process was suspected. The woman was hospitalised and treated with dexamethasone under several hours of observation; however, no subjective or clinical worsening was noted. Treatment with amoxicillin/clavulanic acid for any potential infectious aetiology and hydrocodone for pain control with close out-patient follow-up was decided for her. At an outpatient follow-up 2 days later, her symptoms had completely resolved, and she felt well. Subsequent video laryngoscopy indicated absence of any abnormalities, and the mass like lesion had resolved. Based on these findings and subsequent improvement within two days, the process was considered as acute. The diagnosis of an acute pharyngeal inflammatory mass secondary to tissue-adherence of diltiazem extended release tablet was confirmed [duration of treatment to reaction onset not stated]. Manning W, et al. Acute Airway Inflammation Caused By Incomplete Ingestion of Extended-Release Diltiazem: A Case Report. Journal of Emergency Medicine 58: e247-e249, No. 6, Jun 2020. Available from: URL: http://doi.org/10.1016/j.jemermed.2020.03.015
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of acute pharyngeal inflammatory mass associated with diltiazem. The WHO ADR database contained 3 reports of acute pharyngeal inflammatory mass associated with diltiazem.
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Reactions 12 Sep 2020 No. 1821
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