Tolvaptan
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Tolvaptan Fever: case report
A 68-year-old woman developed fever during treatment with tolvaptan for suspected syndrome of inappropriate antidiuretic hormone secretion (SIADH). The woman, who was hospitalised to Shanghai General Hospital due to urgent, frequent and painful urination and a 1-week history of gait and grip perturbation and limb weakness, was diagnosed with urinary tract infection caused by Extended-spectrum beta-lactamase (ESBL)-positive Escherichia coli. Drug susceptibility test results indicated sensitivity to imipenem. Her medical history included hypertension and surgery for a right kidney cancer. She had been receiving amlodipine as a treatment of hypertension. She was also found to have hyponatraemia and hypochloraemia post-admission. Intravenous and oral sodium supplementation was administered. However, she responded poorly to the treatment. Both adrenal-pituitary and thyroid functions were found to be normal. Intracranial tumour-induced hyponatremia and hypochloremia were excluded following a cranial and pituitary MRI. No abnormalities were noted in the color Doppler ultrasound and chest CT imaging. A suspicion of SIADH was made after consultation with the endocrinology department. As a result, she started receiving oral tolvaptan 15 mg/day. She developed a high fever of 39–40°C one day after taking tolvaptan. The fever persisted for 2 days. Her general conditions deteriorated sharply, and she developed symptoms of anorexia and palpitations. The woman’s tolvaptan therapy was immediately discontinued. Twenty-four hours following the discontinuation of tolvaptan, her body temperature returned to roughly 38°C. A blood routine and hyperthermia culture showed negative results. A follow-up urine routine and midstream urine culture also yielded negative results. A rheumatoid immunoassay ruled out an autoimmune diseaseinduced fever. Negative T.SPOT results ruled out tuberculosis-induced fever. Her body temperature normalised 72h following the discontinuation of tolvaptan, and her general condition markedly improved. After 5 days of discontinuation of tolvaptan, the woman was again re-started on oral tolvaptan 15 mg/day by her family members. The next day, she developed fever (body temperature roughly 38.5°C). Her body temperature returned to normal post discontinuation of tolvaptan. Therefore, tolvaptan-induced drug fever was considered. Yan Y, et al. One case report of drug fever induced by tolvaptan. Pharmaceutical Care and Research 15: 188 and 192, No. 3, Jun 2015 [Chinese; summarised from a translation]
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Reactions 25 Jan 2020 No. 1788
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