Indomethacin
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Encephalopathy, hemiparesis and aphasia A 79-year-old man developed encephalopathy, hemiparesis and aphasia during treatment with indomethacin for axial and peripheral spondyloarthritis [route not stated]. The man, with history of axial and peripheral spondyloarthritis initially received treatment with infliximab and methotrexate from 2004–2008, which was later discontinued due to prostate cancer. From 2008, he received ketoprofen as required for the pain. Three weeks prior to his current admission, his therapy was switched to extended-release indomethacin 75mg tablet twice daily (morning and evening). On 24 April 2019, he was admitted due to vomiting and rapidly worsening language disorder. Physical examination showed drowsiness, complete disappearance of fluency, severe aphasia, and altered reading and writing capability. A flaccid motor deficit of the right upper limb and right visuospatial hemineglect was also noted. His sensory analysis was limited to reactions adapted to painful stimuli. Various other examinations were found to be normal. A lumbar puncture was performed with clear fluid. Based on the findings and symptoms, he was diagnosed with encephalopathy and right sided hemiparesis. The man’s indomethacin therapy was discontinued on admission. During the course of admission, he developed isolated hyperthermia [aetiology unknown]. Therefore, tests for herpes were ordered. He received empirical treatment with acyclovir with pending results of the herpes PCR. After indomethacin discontinuation, his alertness and speech impairment regressed significantly in 72 hours with resumption of oral fluency and normal consciousness. The CSF culture remained sterile and herpes PCR results showed negative result; thus, acyclovir was also discontinued. Two weeks after the discontinuation of indomethacin, a complete normalisation of consciousness, motor deficit of the right upper limb and speech was noted. A neuropsychological assessment performed on 9 May 2019 confirmed the absence of disorientation in space and time, absence of instrumental abnormalities and executive function abnormalities. The adverse effects of indomethacin pointed an intrinsic causality of 3 (likely). Subsequently, he was discharged home without sequelae. Afanou D, et al. Indomethacin-induced hemiparesis and aphasia : Case report. Pratique Neurologique - FMC : Jan 2020. Available from: URL: http://doi.org/10.1016/ 803505116 j.praneu.2020.08.002 [French; summarised from a translation]
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Reactions 3 Oct 2020 No. 1824
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