Ivermectin
- PDF / 152,070 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 45 Downloads / 189 Views
1 S
Various toxicities: case report A 13-year-old boy developed impaired consciousness, coma, ataxia, binocular diplopia, abdominal pain, vomiting, gait disorder, nausea, weakness in inferior limb, progressive drowsiness, dysarthria and hyperreflexia in inferior limb secondary to drug toxicity during prophylactic treatment with ivermectin for scabies infection. The boy received a single dose of oral ivermectin 0.23 mg/kg (12mg) for prophylaxis of scabies infection at 03:00pm. At 06:00pm, he developed a gait disorder with feeling of weakness in inferior limbs, nausea and abdominal pain. At 7:00pm, he was admitted to the pediatric emergency department with impaired consciousness and progressive drowsiness. Subsequent physical examination showed cardiac frequency at 90 bpm, arterial tension at 117/80, temperature at 37.2°C, blood oxygenation at 100% and glucose at 0.98 g/dL. He exhibited Glasgow coma score of 15, with a gait trouble, a dysarthria, a binocular diplopia and digestive symptoms including vomiting and abdominal pain, with a sensibility in left hypochondre. At that time, ivermectin plasma level was 74.4 ng/mL. Approximately after 6 hours of receiving ivermectin (i.e. at 09:30), his condition worsened with a consciousness disorder, Glasgow coma score 11 (coma), pyramidal symptoms with Babinski sign and hyperreflexia in inferior limbs. He was transferred to the ICU. During hospitalisaiton, he had normal paraclinical tests results and showed fluctuating Glasgow coma score between 11 and 13. At 8 hours post ivermectin administration, the plasma ivermectin was found to be 27.4 ng/mL. The boy received treatment with omeprazole for prevention of stress ulcer, ondansetron for nausea and an unspecified perfusion of polyionic solution. After 48 hours, he fully recovered and discharged from the ICU with only abdominal pain and few pyramidal signs in lower limbs. As other conditions were ruled out one the basis of cerebral TDM, cerebral MRI, electroencephalogram, metabolic analysis and lumbar puncture fluid analysis, he was diagnosed with ivermectin intoxication. Based on ABCB1 sequencing, he was identified as a compound heterozygote with two nonsense mutations. At day 4, abdominal pain and pyramidal signs in lower limbs were resolved. Baudou, et al. Serious Ivermectin Toxicity and Human ABCB1 Nonsense Mutations. New England Journal of Medicine 383: No. 8, 20 Aug 2020. Available from: URL: http:/ 803501470 /doi.org/10.1056/NEJMc1917344
0114-9954/20/1822-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 19 Sep 2020 No. 1822
Data Loading...
