Posaconazole
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Acute pancreatitis during off-label use: case report A 10-year-old girl developed acute pancreatitis during off-label treatment with posaconazole for chronic granulomatous disease (CGD). The girl with a 3 years history of CGD was admitted to the hospital in Iran following nausea, vomiting, loss of appetite, epigastric pain and fever for 4 days. The epigastric pain was prominent and continuous in the periumbilical region. The pain got aggravated after the meals or when she was in supine position. In addition to CGD, she had a significant history of pulmonary tuberculosis followed by pulmonary aspergillosis that continued for a long period. The Abdominal examination revealed generalised tenderness. She also had a history of splenomegaly. Her vital signs included BP of 90/70mm Hg, HR of 58 beats per minute, RR of 25 breaths per minute and temperature of 38°C. She was previously admitted with the diagnosis of pulmonary aspergillosis one month ago. She had been receiving interferon-γ [Gamma-interferon], cotrimoxazole [trimethoprim-sulphomethoxazole], pantoprazole, ferrous sulfate and folic acid for 3 years. At the last admission, she had been prescribed with posaconazole syrup 5cc for every 8 hours. During review of drug-drug interaction, only interaction between pantoprazole and posaconazole was identified. The abdominal sonography shown enlargement of liver and inflation of the pancreas head was which indicated pancreatitis. Additionally, splenomegaly with prominent bile duct due to her CGD disease was detected. On performing a spiral CT-Scan, enlargement of pancreas was found along with splenomegaly accompanied by moderate abdominal-fluid accumulation. Her laboratory data at the time of admission was as follows: WBC 6800/mm3, haemoglobin 11.6 g/dL, AST 25 u/L, ALT 10 u/L, ESR 34 mm/h, amylase 1170 u/L , calcium 10.1 mg/dL , phosphorous 4.3 mg/dL, creatinine 0.6 mg/dL, ALP 570 u/L, BUN 14 mg/dL and blood glucose level 93 mg/dL. Posaconazole induced acute pancreatitis was confirmed. On the basis of Naranjo Adverse Drug Reactions Probability Scale, the causal relationship between posaconazole and pancreatitis was assessed as ’probable’. All the medications were discontinued, and the girl started receiving itraconazole and paracetamol [acetaminophen]. Two weeks later, she recovered. Her laboratory data normalised. All of her previous medications, except posaconazole, were resumed. Subsequently, she underwent transplantation, and she recovered. Tariverdi M, et al. Posaconazole-induced acute pancreatitis: A rare side effect in a child with chronic granulomatous disease. Archives of Pediatric Infectious Diseases 8: 1-4, 803504758 No. 4, Jan 2020. Available from: URL: http://doi.org/10.5812/pedinfect.99487
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Reactions 3 Oct 2020 No. 1824
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