Open Access Case Study

Resolution of Tremor Fluoxetine-induced in an Elderly Patient

Patrícia C. Mastroianni, Fernanda M. Oliveira, Fabiana R. Varallo

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2015/13473

Aim: To report a possible case of tremor fluoxetine-induced treated as Parkinson’s disease in an elderly female patient noncompliant with the pharmacotherapy, with uncontrolled hypertension and using fluoxetine to treat depression.
Presentation of Case: Patient complained of sleepiness in the morning, agitation, anxiety, insomnia and mental confusion. Her greatest concern was about bilateral hand tremors which, in her view became, worse after biperiden was prescribed. Therefore, she stopped taking it. The initial medication was: omeprazole, losartan, biperiden, fluoxetine, atenolol + chlorthalidone, acetylsalicylic acid, atorvastatin and diazepam. Pharmacotherapeutic follow up was performed in order to check the necessity, safety and effectiveness of treatment.
Discussion: During the analysis of pharmacotherapy, the patient showed uncontrolled blood pressure and had difficulty complying with the treatment. Thus, in view of the complaints expressed by the patient, our first hypothesis was a possible serotonin syndrome related to fluoxetine use. We proposed a change in the fluoxetine regime and discontinuation of biperiden. As tremors persisted, we suggested the replacement of fluoxetine by sertraline, since a possible tremor fluoxetine-induced could explain the complaint. This approach solved the drug-related problem identified.
Conclusion: Tremors reported by the patient was identified as an iatrogenic event related to fluoxetine, which was solved by management of serotonin-reuptake inhibitors.

Open Access Case Study

The Diagnostic Challenges in ACTH Dependent Cushing’s Disease

Enedina T Cuatecontzi Xochitiotzi, Mariana Quintanar Martínez, Tomás Herrera Arzola, René E Lizola Crespo, Roopa Mehta

International Journal of Medical and Pharmaceutical Case Reports, Page 6-11
DOI: 10.9734/IJMPCR/2015/14571

Objective: To discuss the difficulties in the diagnostic workup and management of ACTH dependent Cushing’s syndrome.
Methods: We report the case of a patient with ACTH dependent Cushing’s syndrome, in whom the identification of the source of ACTH production was a challenge.
Results: A 26-year-old man presented with a weight gain of 20kg, hypertension (250/160 mmHg), hypokalemia, purple stretch marks and severe proximal muscle weakness 6 months of evolution. He also had 4 episodes of pneumonia requiring hospitalization. ACTH-dependent hypercortisolism (cortisol 32ng/dl, ACTH 135pg/ml) was diagnosed. The severe clinical presentation suggested the possibility of ectopic ACTH production. The dexamethasone suppression test (DST) showed no inhibition of cortisol. Whole body octreotide scintigraphy and gallium-68 PET-CT did not show any evidence of ectopic tumor. A pituitary MRI was reported as normal. Bilateral inferior petrosal sinus sampling was carried out and was essential in establishing a diagnosis of Cushing’s disease. In a second MRI, a pituitary microadenoma on the left side was identified. The patient underwent transsphenoidal resection. Postoperatively, hypercortisolism persisted, and since the patients clinical condition deteriorated further, bilateral adrenalectomy was successfully performed, providing a definitive cure for the life threatening hypercortisolism.
Conclusion: The diagnosis and management of ACTH dependent Cushing´s syndrome remains a challenge. The results of dexamethasone suppression tests should be evaluated in the context of the patient. These tests have a high negative predictive value; however in the context of critical illness (pneumonia) may alter the hypothalamic-pituitary-adrenal axis response. This case confirms the need for a bilateral IPS sampling in order to establish diagnosis.

Open Access Case Study

Presence of Endocarditis on the Patch in the Left Ventricular Outflow Tract Successful Treated with Daptomycin

Quirino Ciampi, Chiara Manicardi, Bruno Villari

International Journal of Medical and Pharmaceutical Case Reports, Page 12-14
DOI: 10.9734/IJMPCR/2015/14166

We present a rare case of endocartitis on the patch in the left ventricular outflow, in a 42 year-old man patient that had undergone surgical correction of tetralogy of Fallot and definitive closure with Dacron patch of a ventricular septal defect and, after 21 years, aortic valve replacement with mechanical valve, for the presence of severe aortic regurgitation, Blood cultures demonstrated the presence of methicillin-resistant Staphylococcus aureus and transesophageal echocardiography demonstrated on the LV face of the previous Dacron patch the presence of pathological vegetation, with complete resolution after Daptomycin.

Open Access Case Study

Unusual Cause of Rhabdomyolysis Causing Acute Renal Failure: Achillea millefolium and Rheum palmatum Plants

Tamer Sakaci, Yener Koc, Taner Basturk, Ayse Sinangil, Elbis Ahbap, Ekrem Kara, Mustafa Sevinc, Cuneyt Akgol, Tuncay Sahutoglu, Zuhal Atan Ucar, Arzu Ozdemir Kayalar, Feyza Bayraktar Caglayan, Abdulkadir Ünsal

International Journal of Medical and Pharmaceutical Case Reports, Page 15-19
DOI: 10.9734/IJMPCR/2015/14620

Introduction: Rhabdomyolysis is a frequent disorder resulting from many different causes which may be apparent from the history, e.g. trauma, heavy exercise, intoxications. It contains both clinical and biochemical components. Acute kidney injury is probably the most significant and the most feared complication of rhabdomyolysis. Even though cases with rhabdomyolysis due to herbal medicine or extracts are reported; rhabdomyolysis because of consumption of plant itself is quite rare.
Case Presentations: Acute kidney injury in two otherwise healthy patients secondary to rhabdomyolysis is presented. Etiologic agents were determined as ingestion of plants named as “Yarrow” (Achillea millefolium) and “Turkish Rhubarb” (Rheum palmatum) growing especially in rural Southeastern Anatolia region of Turkey after all other possible causes of rhabdomylosis was ruled out. Hemodialysis was performed to both patients temporarily. Kidney damage was recovered eventually.
Conclusion: Herbal medicine and/or plants usage should be addressed in patients with rhabdomyolysis and acute kidney injury after all known etiologic reasons are ruled out.

Open Access Case Study

Restoration of Maxillary Anterior Teeth with Immediate Implant Placement into Extraction Sites: A Case Report with One Year Follow-Up

Mohammed M. Albadani, Elfatih I. Elamin, Manawar Ahmad, Mohammed M. Al Moaleem

International Journal of Medical and Pharmaceutical Case Reports, Page 20-26
DOI: 10.9734/IJMPCR/2015/13128

The demand for optimal esthetics has increased with the advent of the implant dentistry. It answers many questions concerning esthetics, like replacement of hopeless teeth in esthetic zone of maxillary arch. Now a days immediate restoration of a single tooth loss by implant supported prosthesis is highly predictable treatment.
This clinical report describes a protocol of an immediate tooth extraction, followed by placement of provisional denture in the prepared socket of maxillary central incisors. Surgical and restorative techniques are prescribed in the text. A review program of 3, 6, and 12 months was followed.