Ibuprofen
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Haemorrhagic oesophagitis: case report A 33-year-old man developed haemorrhagic oesophagitis during treatment with ibuprofen for subjective fevers. The man was admitted to the emergency department for multiple episodes of coffee-ground emesis associated with subjective fever and generalised abdominal pain. He had been ingesting over-the-counter ibuprofen tablets every 4–6h since last week for the subjective fevers [dose not stated]. His medical history was significant for shortness of breath as a child, which was relieved on lying down. His mother also observed bluish discoloration of finger nails, which were noted to be swollen. Additionally, central cyanosis, conjunctival congestion and clubbing of fingers and toes were observed. On admission, his vital signs revealed the following: HR 101 beats/minute, RR 22 breaths/minute and oxygen saturation of 93% on room air. On examination, he was found to be underdeveloped for his age and had clubbing of fingers and toes. Additionally, a loud, single second heart sound with a mid-systolic murmur was heard. Rectal examination showed positive results for occult faeces test. The man was prophylactically treated with pantoprazole infusion. Complete blood count was trended every 8h. Chest X-ray revealed cardiomegaly with characteristic boot-shaped heart with upturned apex and pulmonary oligaemia. A CT scan of the pelvis and abdomen revealed diffuse wall thickening of the distal oesophagus. Echocardiogram showed severe pulmonary stenosis causing right ventricular outflow tract obstruction, an over-riding aorta, right ventricular hypertrophy and ventricular septal defect, suggesting untreated tetralogy of Fallot (TOF). Due to the severe pulmonary stenosis, he developed pulmonary hypertension and high-grade diastolic heart failure. Based on these findings, haemorrhagic oesophagitis secondary to the ibuprofen therapy was considered. The haemorrhagic oesophagitis subsequently resulted in GI bleeding. His bleeding episodes were maintained with the pantoprazole infusion, which was subsequently switched to oral form. His haematocrit and Hb levels were found to be stable. Therefore, no blood transfusion was required. Eventually, he was discharged to follow-up with cardiology for surgical correction of TOF. Parthvi R. Ibuprofen-Associated Hemorrhagic Esophagitis in a Patient With Tetralogy of Fallot. American Journal of Therapeutics : 6 Aug 2020. Available from: URL: http:// 803500133 doi.org/10.1097/MJT.0000000000000902
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Reactions 5 Sep 2020 No. 1820
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