Hydrochlorothiazide
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Various toxicities: case report A 71-year-old woman developed pruritus, shortness of breath, diaphoresis, elevated serum procalcitonin and wheezing in bilateral lung with poor air entry during treatment with hydrochlorothiazide for elevated blood pressure. The woman, who had a history of chronic kidney disease stage 3, hypertension, type II diabetes mellitus, was diagnosed to have non-obstructive coronary artery disease and admitted following presentation to a hospital in the USA. After 3 days, she started receiving hydrochlorothiazide [route and dosage not stated]. Shortly thereafter, she developed shortness of breath and pruritus, and she became diaphoretic. Physical examination of the lungs and cardiovascular was significant for wheezing in the bilateral lung fields with poor air entry. Procalcitonin level, which was negative on admission, was noted to be elevated (88 ng/mL) at 3 hours following the onset of symptoms, and the tryptase level was 45 ng/mL. The woman started receiving prednisone, epinephrine and unspecified broad-spectrum antibacterials and antihistamines. She was moved to the ICU. The procalcitonin level after 9 hours was found to be 329 ng/mL. Previously, she had an allergy to sulfa-drugs with similar reactions. She was observed to have improved on the second day. Laboratory data and diagnostic imaging were unremarkable for infections, and the antibacterials were stopped subsequently. She had developed pruritus, shortness of breath, diaphoresis, elevated serum procalcitonin and wheezing in bilateral lung fields secondary to sulfa-containing hydrochlorothiazide [time to reactions onsets not stated]. Al hillan A, et al. Elevated serum procalcitonin in the setting of allergic reaction :-A marker of anaphylaxis. American Journal of Respiratory and Critical Care Medicine 199: 803446155 (plus poster) abstr. A6120, No. 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6120 [abstract]
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Reactions 18 Jan 2020 No. 1787
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