Multiple drugs
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Various toxicities: 3 case reports In a case report, 3 women aged 58–87 years were described, who developed Mycobacterium avium complex (MAC) infection, diarrhea, liver toxicity, Mycobacterium chelonae infection, confusion, Mycobacterium marseillense infection or rebound effect in the form of myositis flare during treatment with azathioprine, prednisone, methotrexate, erythromycin, rifabutin, clarithromycin or amitriptyline. Additionally, in one of these 3 women, the concomitant use of clarithromycin and amitriptyline resulted in confusion [durations of treatments to reactions onsets not stated; not all dosages routes and outcomes stated]. Case 1: A 66-year-old woman had dermatomyositis in remission since February 2018. She had leftcalf necrotic ulcer since December 2017, a small ulcerative plaque in the proximal third of her left arm and a lump in the proximal third of her left elbow. She also had mechanical pain in her left scapula. She received immunosuppressant drug therapy with azathioprine 100mg per day, prednisone 5mg per day and oral methotrexate 20mg weekly. She received hydroxychloroquine concomitantly. Her elbow lump resulted in an abscess, which was drained and sent for culture, the acid fast smear revealed 4 bacilli per field and PCR confirmed that she was positive for Mycobacterium avium complex (MAC) infection. A bone scan revealed an abscess posterior to the left scapula and a right lateral malleolus osteomyelitis. Treatment with azathioprine and methotrexate was held. She then received treatment with erythromycin and developed diarrhoea. She exhibited liver toxicity while being treated with rifabutin. Her treatment was switched to ethambutol, moxifloxacin and azithromycin. At follow-up 6 months, improvement in her condition was reported. Case 2: A 87-year-old woman had longstanding systemic lupus erythematosus (SLE) in remission since February 2018. She had an ongoing dactylitis since March 2017, which progressed to a finger-wrist extensor tenosynovitis in October 2017. She received immunosuppressant drug therapy with prednisone 5mg per day as needed. Based on her functional impairment of the hand, she received 40mg of triamcinolone intra-articular injections and lidocaine solution for tenosynovitis in early January 2018 and February 2018. A synovial fluid sample was collected and sent for analysis and culture. Ten days later, the acid fast smear results revealed 2 bacilli per field and the culture was positive for Mycobacterium chelonae infection. Treatment with prednisone was held. She then received treatment with imipenem, clarithromycin and amitriptyline. She developed confusion following drug interaction between clarithromycin and amitriptyline. At follow-up 6 months, improvement in her condition was reported. Case 3: A 58-year-old woman had longstanding overlap of limited cutaneous systemic sclerosis and dermatomyositis with interstitial lung disease. She was admitted because of a Clostridium difficile colitis, after receiving 2 courses of antibiotics for an episode of sinusitis in Nove
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