2021 Volume 23 Issue 5 Published: 28 May 2021
  

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  • Pay attention to the new antineoplastic agent-related posterior reversible encephalopathy syndrome
    Ye Hong, Li Junjie, Wu liyong
    2021, 23(5): 225-227. https://doi.org/10.3760/cma.j.cn114015-20210414-00459
    Abstract ( ) PDF ( )
    With the widespread use of various new antineoplastic agents in clinic, there are more and more reports of posterior reversible encephalopathy syndrome associated with new antineoplastic agents. The pathogenesis of new antineoplastic agent-related PRES is mainly related to endothelial dysfunction. The clinical manifestations of new antineoplastic agent-related PRES are lack of specificity, including headache, confusion, visual loss, visual field defect, seizure, and focal neurological deficit, etc. Imaging examinations in some patients show reversible bilateral subcortical angiogenic oedema, which is regarded as typical imaging findings. At present, unified diagnostic criteria of PRES have not been formulated. The core of the treatment is dose reduction or drug withdrawal, and other symptomatic treatments such as blood pressure control and anti-epileptic treatment are also necessary. The prognosis is good in most patients if timely treatment is given.
  • Annual report of National Monitoring Network for Clinical Safe Medication (2020)
    Zhang Qingxia, Wang Yawei, Li Xiaoling, Wang Yuqin, Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs, et al
    2021, 23(5): 228-234. https://doi.org/10.3760/cma.j.cn114015-20210506-00532
    Abstract ( ) PDF ( )
    In 2020, a total of 15-849 cases of medication error (ME) from 255-hospitals in 24 provincial administrative regions were collected in the National Monitoring Network for Clinical Safe Medication. The number of hospitals reporting ME increased by 8.97% compared with that in 2019 (234-hospitals), and the number of reported ME cases increased by 5.27% compared with that in 2018 (15-056 cases). In 15-849 cases of ME reports, 54 (0.34%) were classified as grade A, 12-297 (77.59%) as grade B, 3-010 (18.99%) as grade C, 358 (2.26%) as grade D, 72 (0.45%) as grade E, 52 (0.33%) as grade F, 0 as grade G, 5 (0.03%) as grade H, and 1 (0.01%) as grade I. Among the 15-795 patients with ME of grade B to I, 9-347 (59.18%) were male and 6-448 (40.82%) were female, aged from 1 day to 101 years; 1-714 (10.85%) were children (<18 years old), 8-355 (52.90%) were middle aged patients (≥18 to <60 years old), and 5-726 (36.25%) were elderly patients (≥60 years old). Among the 130 patients with serious ME (grade E-I) that caused injury, 77 (59.23%) were male and 53 (40.77%) were female, aged from 4 months and 14 days to 94 years; 16(12.31%) were children, 46（35.38%） were middle aged patients, 68(52.31%) were elderly patients. Among the 9 patients with serious ME caused by mistaken use of drugs, 7 were children, accounting for 43.75% (7/16) of all children with serious ME. The 54 grade A MEs did not involve person who triggered the MEs and place where MEs occurred. Among the 15-795 grade B-I MEs, 10-748 (68.05%) were triggered by physicians, 3-797 (24.04%) by pharmacists, 578 (3.66%) by nurses, 329 (2.08%) by patients and their family members, and 343 (2.17%) by other persons; the proportion of MEs triggered by patients and their family members increased year by year for 3 consecutive years (1.06% and 2.04% in 2018 and 2019, respectively), and 49.23% (64/130) of severe ME were triggered by patients and their family members; 6-830 (43.24%) occurred in clinics, 3-808 (24.11%) in hospital wards, 3-776 (23.91%) in pharmacies, 985 (6.24%) in pharmacy intravenous admixture services, 220 (1.39%) in the nurse stations, 161 (1.02%) in patients′ houses, 2 (0.01%) in the community health service stations, and 13 (0.08%) in other places; the proportion of MEs occurred in clinics and patients′ houses increased year by year for 3 consecutive years (37.32% and 0.41% in 2018, 37.74% and 0.89% in 2019, respectively). The top 3 contents of MEs were wrong drug class, wrong usage, and wrong quantity. The top 3 persons who discovered the MEs were pharmacists, physicians, and nurses. The top 3 factors causing MEs were lack of related pharmacologic knowledge, tiredness, and insufficient training of medical workers.
  • Literature case analysis of tacrolimus-associated posterior reversible encephalopathy syndrome in patients after kidney transplantation
    Lu Jiejiu, Huang Guangming, Lyu Chunle, Liu Taotao
    2021, 23(5): 235-240. https://doi.org/10.3760/cma.j.cn114015-20201009-01019
    Abstract ( ) PDF ( )
    Objective To explore the clinical features of tacrolimus-associated posterior rever- sible encephalopathy syndrome (PRES) in patients after kidney transplantation.　Methods Relevant databases at home and abroad were searched as of August 2020, and case reports of tacrolimus-associated PRES after kidney transplantation were collected. Clinical information including patient′s basic characteristics, tacrolimus application (such as route of administration, dose, blood concentration, drug combination regimen, etc.), and the occurrence time, clinical manifestation, imaging characteristics, intervention measures, and outcomes of PRES were extracted and analyzed by descriptive statistical method.　Results A total of 16 patients were enrolled in the study, including 7 males and 9 females, aged from 7 to 54 years with a median age of 26 years. Of them, 6 patients were <18 years old and 10 patients were ≥18 years old. Among the 16 patients, 8 received intravenous administration and 8 oral administration. Thirteen patients had records of drug combination regimen and 1, 2, and 3 immunosuppressants were combined in 3, 8, and 2 patients, respectively. PRES occurred from 3 days to 3 months after renal transplantation and 10 patients (62.5%) occurred within 1 month after operation. Eleven of 13 patients who underwent tacrolimus plasma concentrations testing did not exceed the upper limit of the treatment window when PRES occurred. The main symptoms of PRES included convulsions/seizures-like seizures (in 11 patients), visual abnormalities (in 7 patients), persistent headache (in 6 patients), and coma or disturbance of consciousness (in 6 patients). CT and/or magnetic resonance imaging were performed in all 16 patients. Imaging features of cerebral edema or vasogenic cerebral edema were found in 15 patients and the lesions located mainly in occipital lobe (13 patients), parietal lobe (12 patients), and the frontal lobe (8 patients). After discontinuation or reduction of the tacrolimus dose and/or giving symptomatic and supportive treatments for 2-44 days (the median time of 9 days), symptoms subsided in all 16 patients and imaging examination showed cerebral edema, vasogenic cerebral edema, and other lesions subsided in 15 patients.　Conclusions Tacrolimus-associated PRES mostly occurred within 3 months after renal transplantation, which was not related to the route of administration or blood concentration of tacrolimus. The clinical manifestations of tacrolimus-associated PRES were similar to those caused by other factors. After discontinuation of tacrolimus, reduction of drug dose and/or administration of symptomatic treatment, most of the symptoms disappeared quickly and the imaging changes returned to normal.
  • Effect of evolocumab on risk of early intracerebral hemorrhage in patients with acute anterior circulation ischemic cerebral infarction
    Zhao Na, Zhang Ting, Yang Yun, Liao Haibin, Li Xun, Yu Miao, Liu Ran, Yue Wei
    2021, 23(5): 241-246. https://doi.org/10.3760/cma.j.cn114015-20210225-10218
    Abstract ( ) PDF ( )
    Objective To explore the effect of evolocumab on the risk of early intracranial hemor- rhage in patients with acute anterior circulation ischemic cerebral infarction.　Methods The medical records of patients with acute anterior circulation ischemic cerebral infarction who were admitted to Tianjin Huanhu Hospital within 48-hours of onset from January 2019 to September 2020 were collected and analyzed retrospectively. On the day of admission, all patients were given statin lipid-lowering therapy and the patients with fasting low density lipoprotein cholesterol (LDL-c) >3.37-mmol/L received combination therapy with statin and evolocumab. The patients who used statins alone were enrolled in the statins group and those with combined application of evolocumab were enrolled in the combination group. The situation of blood lipid level up to standard (LDL-c <1.70-mmol/L) and the occurrence of intracranial hemorrhage in the second week after admission were compared between the 2 groups. The patients were divided into bleeding group and non-bleeding group according to the occurrence of intracranial hemorrhage. The basic information, combined diseases, etiological classification of cerebral infarction, lipid-lowering program, National Institute of Health Stroke Scale (NIHSS) score on admission, blood pressure, blood lipid level, and blood lipid level in the second week of lipid-lowering treatment between the 2 groups were compared. The factors with P<0.05 were enrolled in the multivariate logistic regression analysis, odds ratio (OR) and its 95% confidence interval (CI) were calculated, and the risk factors of intracranial hemorrhage were analyzed.　Results A total of 437 patients were enrolled in the analysis, including 358 (81.9%) in the statins group and 79 (18.1%) in the combination group. The differences in basic information, combined diseases, etiological classification of cerebral infarction, lipid-lowering program, NIHSS score on admission, blood pressure, and other clinical features between the 2 groups were not statistically significant (all P>0.05). The baseline levels of total cholesterol (TC), triglyceride (TG), LDL-c, and high-density lipoprotein cholesterol (HDL-c) in the statins group were lower than those in the combination group (TC: P<0.001, TG: P<0.001, LDL-c: P=0.004, HDL-c: P=0.024). At the 2nd week of lipid-lowering treatment, the levels of LDL-c and TC in the statins group and the combination group were lower than those before treatment, but the differences of LDL-c and TC levels before and after treatment in the statins group were significantly lower than those in the combination group ［LDL-c: (0.66±0.91) mmol/L vs. (2.58±0.38) mmol/L, P<0.001; TC: (0.37±0.18) mmol/L vs. (1.94±0.44) mmol/L, P<0.001］. The rate of lipid level up to standard in the combination group was significantly higher than that in the statins group ［87.3% (69/79) vs. 9.7% (37/358), P<0.001］. The incidences of intracranial hemorrhage were 12.0% (43/358) in the statins group and 13.9% (11/79) in the combination group within 2 weeks after admission respectively. Multivariate logistic regression analysis showed that complication with atrial fibrillation (OR=3.054, 95%CI: 1.402-6.651, P=0.005), higher NIHSS score on admission (OR=3.431, 95%CI: 1.554-7.573, P=0.001), and etiological classificantion as cardiac embolism (OR=1.544, 95%CI: 1.047- 2.278, P=0.028) were independent risk factors for early intracranial hemorrhage. Conclusions The combination of statins and elouzumab has better lipid-lowering effect in patients with acute anterior circulation cerebral infarction. No correlation is found between evolocumab and early intracranial hemorrhage.
  • Literature analysis of dropped head syndrome induced by mitogen-activated extracellular signal regulated kinase inhibitors
    Shang Junmei, Liu Xin, Zhang Bo
    2021, 23(5): 247-251. https://doi.org/10.3760/cma.j.cn114015-20201230-01299
    Abstract ( ) PDF ( )
    Objective To explore the clinical features of dropped head syndrome(DHS) related to mitogen-activated extracellular signal regulated kinase inhibitors.　Methods Case reports of dropped head syndrome caused by MEK inhibitors were collected by searching PubMed and Embase databases as of December 20, 2020. The following information of patients including gender, age, primary diseases, use of MEK inhibitors, occurrence time and clinical symptoms of DHS, and treatments and outcomes were extracted and analyzed descriptively.　Results A total of 7 patients were entered; 4 from the United States, 2 from France, and 1 from Germany. There were 4 males and 3 females, aged from 56 to 76 years. The primary diseases were metastatic melanoma in 6 patients and Erdheim‐Chester disease in 1 patient. Of them, 3 patients were treated with selumetinib, 2 were with cobimetinib, and 1 was with binimetinib and trametinib respectively. Time from the first application of MEK inhibitors to the onset of DHS was from 0.5 to 20 months with a median time of 1 (1, 2) month. Major symptoms of DHS were neck pain, neck extensor weakness, and limited head lifting, which might be accompanied by neck stiffness in some patients. The pain on the neck could spread to the shoulders and occipital region, and a few patients might only have interscapular pain. At the time of diagnosis of DHS, the serum concentration of creatine kinase (CK) was elevated (150~1-011-U/L). After the diagnosis of DHS, 5 patients stopped taking MEK inhibitors and DHS symptoms were relieved or disappeared; 2 patients were treated with glucocorticoids for 1 to 4 weeks, but DHS symptoms were not relieved, then they stopped taking MEK inhibitors and DHS symptoms were improved. In total, the symptoms of DHS in the 7 patients were relieved after 14-30 days of MEK inhibitors withdrawal, with serum CK returning to within normal range. Three patients rechallenged MEK inhibitors with reduced doses; 1 patient had no recurrence of DHS and the remaining 2 patients had mild recurrences of DHS, which could resolve spontaneously or stay a stable condition.　Conclusions DHS related to MEK inhibitors usually occurs within 1 month of medication, accompanied by an increase in CK level. The symptoms can be relieved or disappear after stopping medication in time and CK level will return to normal.
  • Safety of cinepazide maleate injection in the treatment of stroke: a meta-analysis
    Zhu Jing, Yan Yingying, Zhai Suodi, Cui Yimin
    2021, 23(5): 252-259. https://doi.org/10.3760/cma.j.cn114015-20210317-00319
    Abstract ( ) PDF ( )
    Objective To systematically evaluate the safety of cinepazide maleate injection (cinepazide) in treatment of stroke.　Methods Randomized controlled trials (RCTs) of cinepazide combined or not combined with basic treatment (the trialed group) and basic treatment and other drugs except cinepazide alone or in combination (the control group) for stroke were collected by searching related databases at home and abroad (up to December 31, 2020). The outcome indicators were treatment-related adverse events (AEs), including symptoms such as headache, insomnia, drowsiness, and skin itching and abnormalities in laboratory tests such as liver and kidney function and blood system. The methodological quality of studies was evaluated using the Cochrane collaboration risk of bias tool. RevMan 5.3-software was used in meta-analysis and the effect values were expressed as relative risk (RR) and its 95% confidence interval (CI).　Results A total of 19 RCTs were included in the analysis, all of which were post-marketing studies conducted in China. The 19 RCTs involved 3-272 patients, including 1-650 in the trialed group and 1-622 in the control group. The quality evaluation results showed possibility of selection bias and measurement bias in the research. Meta-analysis showed that difference in the incidence of adverse events between the trialed group and the control group was not significant ［6.90%(114/1-650) vs. 7.64%(124/1-622), RR=0.92, 95%CI: 0.72-1.17, P=0.49］. The analysis results of 5 subgroups divided according to different doses (80, 160, 240, 320 and 400-mg/d) showed that difference in the incidence of adverse events between the trialed group and the control group was not significant ［8.77%(10/114) vs. 14.16%(16/113), RR=0.62, 95%CI: 0.29-1.31, P=0.21;  3.51%(4/112) vs. 0(0/101), RR=4.58, 95%CI: 0.55-38.49, P=0.16; 0.88%(1/114) vs. 1.85%(2/108), RR=0.64，95%CI: 0.10-3.86, P=0.62; 7.53%(96/1-275) vs. 8.30%(105/1-265), RR=0.92，95%CI: 0.71-1.19, P=0.51; 8.57%(3/35) vs. 2.86%(1/35), RR=3.00, 95%CI: 0.33-27.46, P=0.33］。Analysis of several concerned AEs showed differences in the incidences of adverse events such as headache, dizziness, insomnia, nausea, rash/itching, and hemocytopenia between the trialed group and the control group were not significant ［3.45%(57/1-650) vs. 3.45%(56/1-622), RR=1.02, 95%CI: 0.70-1.47, P=0.46; 2.24%(37/1-650) vs. 2.40%(39/1-622), RR=0.95, 95%CI: 0.60-1.51, P=0.76; 0.84%(41/1-650) vs. 2.10%(34/1-622), RR=1.23, 95%CI: 0.77-1.94, P=0.69; 0.67%(11/1-650) vs. 0.12%(2/1-622), RR=0.96, 95%CI: 0.39-2.39, P=0.64; 0.36%(6/1-650) vs. 0.37%(6/1-622), RR=1.06, 95%CI: 0.45-2.49, P=0.89; 0.06%(1/1-578) vs. 0(0/1-552), RR=3.00, 95%CI: 0.12-74.47, P=0.50］。　Conclusion Cinepazide marketed in China has good clinical safety.
  • Analysis on safety of pamidronate disodium as adjuvant therapy in children with congenital pseudarthrosis of tibia
    Huang Yuan, Xie Jianhui, Mei Haibo, Tan Qian, Zhao Xin, Ouyang Yaqi, Yi Yinzhi, Mo Shasha
    2021, 23(5): 260-265. https://doi.org/10.3760/cma.j.cn114015-20210101-00001
    Abstract ( ) PDF ( )
    Objective To explore the safety of pamidronate disodium as adjuvant therapy in children with congenital pseudarthrosis of tibia (CPT).　　Methods Medical record data of children with CPT who received pamidronate disodium for the first time and completed 3 doses of treatment during hospitalization in Department of Orthopedics, Hunan Children′s Hospital from July 1, 2019 to June 30, 2020 were collected and analyzed retrospectively. The regimen of medication was slow IV infusion of pamidronate disodium 0.5-mg/kg on day 1 and 1.0-mg/kg on days 2 and 3, dissolved in 0.9% sodium chloride injection 250-ml (the infusion time was >3 hours). Adverse reactions were monitored during and after the IV infusion. Peripheral venous blood was collected 2-3 hours after finishing the 3rd dose of treatment and blood calcium and phosphorus levels were detected. The children were divided into ≤1 year old group, >1-3 years old group, and >3 years old group, and the occurrence of adverse reactions in different age groups were compared.　　Results A total of 81 children were enrolled in the analysis, including 54 males and 27 females, aged 0.4 to 15.4 years, with 10 cases in the ≤1 year old group, 46 in the >1 to 3 years old group, and 25 in the >3 years old group. After medication in the 81 children, fever with temperature ≥38.0-℃ occurred 53 times in 34 children (42.0%), of which 39 times were grade 1 (38.0-39.0-℃) and 14 times were grade 2 (>39.0-40.0-℃). The incidence of fever on the day after the 2nd dose was significantly higher than that after the 1st and 3rd doses (all P<0.05). The differences in the incidence of fever and the degree of fever among the 3 groups were not statistically significant (all P>0.05). The temperature of children with fever decreased to below 38.0-℃ within 1-16-hours after drug-therapy or physical cooling. After the 3rd dose of treatment, the levels of serum calcium and phosphorus were significantly lower than those before administration ［(2.06±0.17) mmol/L vs. (2.42±0.12) mmol/L, (1.01±0.23)mmol/L vs. (1.71±0.18)mmol/L, all P<0.001］. The incidences of hypocalcemia and hypophosphatemia were 56.8% (46/81) and 19.8% (16/81) respectively, but none of patients with hypocalcemia and hypophosphatemia had obvious related symptoms.　Conclusions Pamidronate disodium is safe as adjunctive therapy in children with CPT. The main adverse reactions are fever, asymptomatic hypocalcemia, and hypophosphatemia. Fever can be recovered quickly after intervention, and the levels of serum calcium and phosphorus can return to within the normal range after drug withdrawal.
  • Contrast-induced encephalopathy following angiography with iodixanol
    Shen Lili, Zhang Xinke, Fan Lujie, Li Xiaohua, Zhao Guoying
    2021, 23(5): 266-268. https://doi.org/10.3760/cma.j.cn114015-20201102-01107
    Abstract ( ) PDF ( )
    A 71-year-old male patient with severe stenosis of the right common carotid artery and internal carotid artery underwent aortography+cerebral arteriography+right internal carotid artery stenting under local anesthesia with contrast medium iodixanol injection. Head CT before operation showed no obvious abnormality. Ten hours after the operation, the patient developed neurological symptoms such as fever, drowsiness, choking in drinking water, incomplete motor aphasia, decrease of muscle strength and tension of left limb, convulsions, etc. Brain magnetic resonance imaging (MRI) showed increased signal intensity in the right cerebral sulcus and sulcus shallower. Contrast-induced encephalopathy caused by iodixanol was consi- dered. After 3 days of symptomatic treatments with rehydration, glucocorticoid, and mannitol, the patient′s symptoms were improved. Brain MRI showed that the hyperintensity of right cerebral cortex decreased and the sulcus gradually returned to normal.
  • Immune myocarditis induced by camrelizumab
    Sun Ying, Gu Yongli, Yang Guangsheng, Sun Zengxian
    2021, 23(5): 268-270. https://doi.org/10.3760/cma.j.cn114015-20201019-01054
    Abstract ( ) PDF ( )
    A 73-year-old male patient received immunotherapy (IV infusion of camrelizumab injection 200-mg once every 21 days) for mediastinal and right cervical lymph node metastasis after operation of esophageal cancer. Before immunotherapy, laboratory tests showed cardiac troponin I (cTnI) <0.01-μg/L, creatine kinase (CK) 69-U/L, and CK-MB 16-U/L。Electrocardiogram (ECG) showed no obvious abnormality. The day after the first IV infusion of camrelizumab, the patient developed fatigue, which were relieved without any treatment. The day after the second IV infusion of camrelizumab, he developed chest tightness, palpitation, and fatigue without obvious inducement. Laboratory tests showed cTnI 0.14-μg/L, CK 440-U/L, and CK-MB 39-U/L. ECG showed ST-T segment changes. Immune myocarditis due to camrelizumab was consi- dered. An IV infusion of methylprednisolone injection (60-500-mg/d) was given. After 16 days of treatment, the patient′s chest tightness and palpitations were improved. Laboratory tests showed cTnI 0.48-μg/L, CK 94-U/L, and CK-MB 37-U/L.
  • Ataxia induced by dexzopiclone
    Wen Huiping, Lyu Xinzhi, Chen Yiling, Huang Xuejuan, Huang Wenhui
    2021, 23(5): 271-272. https://doi.org/10.3760/cma.j.cn114015-20201128-01184
    Abstract ( ) PDF ( )
    A 68-year-old male patient with severe active ulcerative colitis developed sleep disorder after using hormone pulse therapy. He received dexzopiclone 3-mg orally once a night to improve sleep. On the next day of medication, the patient developed ataxia symptoms such as dizziness, head drooping, and body skewing when walking, etc. The patient had a history of Parkinson′s syndrome and treatment effect of levodopa and benserazide hydrochloride was good. Dyskinesia caused by levodopa and benserazide hydrochloride were suspected. Then the drug was stopped and symptomatic treatments were given for 3 days, but his symptoms were not improved. After consultation with the neurologist, the patient was diagnosed as having ataxia, which was suspected to be related to dextrzopiclone. Four days after dextrzopiclone withdrawal, the patient′s symptoms were improved obviously. The patient resumed to use levodopa and benserazide hydrochloride before discharge and the ataxia symptoms above mentioned did not recur.
  • Liver injury induced by Jingangteng capsules (金刚藤胶囊) combined with Kangfuyan capsules (康妇炎胶囊)
    Li Xiaojuan, Zhang Aiwu
    2021, 23(5): 273-274. https://doi.org/10.3760/cma.j.cn114015-20201119-01158
    Abstract ( ) PDF ( )
    A 46-year-old female patient was treated with Jingangteng capsules 2 g (4 capsules) thrice daily and Kangfuyan capsules 1.2 g (3 capsules) twice daily after hysterectomy. After 23 days of treatments, the patient developed gastrointestinal discomfort, and Jingangteng capsules and Kangfuyan capsules were stopped 2 days later. However, gastrointestinal discomfort gradually worsened and symptoms such as nausea, dark urine, and yellow staining of the skin and sclera appeared. After discontinuing the drug for 10 days, laboratory tests showed alanine aminotransferase (ALT) 366-U/L, aspartate aminotransferase (AST) 485-U/L, alkaline phosphatase (ALP) 145-U/L, gamma glutamyltransferase (γ-GT) 67-U/L, total bilirubin (TBil) 67.1-μmol/L, and direct bilirubin (DBil) 59.5-μmol/L. Viral hepatitis and biliary obstruction were excluded by laboratory tests and imaging examination, and drug-induced liver injury was diagnosed. Oral liver-protective drugs and IV infusions of compound glycyrrhizin injection and polyene phosphatidylcholine injection were given successively, but jaundice continued to deepen with the peak TBil and DBil values of 189.7-μmol/L and 159.4-μmol/L, respectively. An IV infusion of ademetionine 1,4-butanedisulfonate for injection 1 g dissolved in 5% glucose injection 250-ml was given once daily. Three days later, the patient′s symptoms were improved and the jaundice subsided obviously; 9 days later, the liver function was improved obviously and laboratory tests showed ALT 29-U/L, AST 50-U/L, γ-GT 36-U/L, TBil 66.5-μmol/L, and DBil 53.2-μmol/L; 1 month later, her liver function returned to normal.
  • Thrombocytopenia induced by cefathiamidine
    Xu Yan, Li Yan, Yang Qiuhong
    2021, 23(5): 275-276. https://doi.org/10.3760/cma.j.cn114015-20201125-01176
    Abstract ( ) PDF ( )
    A 31-year-old pregnant woman received an IV infusion of cefathiamidine 2 g dissolved in 0.9% sodium chloride injection 100-ml twice daily for prevention of infection during the perioperative period of cesarean section. Her platelet count (PLT) before medication was 166×109/L. Routine blood cell tests after the 2nd medication (21-h after operation) showed PLT 40×109/L. At 30-hours after the operation, the PLT decreased to the lowest level (14×109/L) and no bleeding symptoms occurred. Cefathiamidine was stopped, symptomatic and supportive treatments such as platelet supplement and intravenous infusions of immunoglobulin and methylprednisolone sodium succinate for injection were given. Four days later, her PLT returned to normal. The patient was followed up for 3 months postnatally, and the platelet level was normal.
  • Drug eruption induced by metformin
    Shen Shan, Jiang Na, Li Weizhe, Zhang Wen, Lu Cuicui
    2021, 23(5): 277-278. https://doi.org/10.3760/cma.j.cn114015-20201025-01082
    Abstract ( ) PDF ( )
    A 64-year-old male patient with type 2 diabetes mellitus received metformin 0.5 g thrice daily, acarbose 100-mg thrice daily, and saxagliptin 5-mg once daily orally. The patient developed itching and erythema symptoms during the treatments. The patient learned that metformin could cause adverse reactions such as pruritus and rash by reading the drug label. Then the metformin was stopped by himself and his skin symptoms were relieved within a few days. Due to elevated blood glucose, the patient took metformin again and developed erythema and papules 2 days later, but he didn′t stop the drug. After that, swelling of both lower limbs, accompanied by skin erosion and exudation appeared gradually. Laboratory tests showed that eosinophil count was 0.66×109/L. Drug eruptions caused by metformin was considered. All oral hypoglycemic drugs were stopped and symptomatic treatments such as antihistamine and glucocorticoid were given. Five days later, his erythema and papules gradually subsided, and erosive surface of both lower limbs crusted without exudation. Laboratory tests showed eosinophil count 0.06×109/L. Dermatitis did not recur after the patient switched to insulin to control blood glucose.
  • Blood coagulation disorders caused by cefmenoxime in a patient  with renal failure and pancreatitis
    Yang Chunsheng, Meng Yumei, Jiang Wenyong, Wang Hongna, Liang Jinshan, Liu Yanmei, Kan Chunna, Zhu Xueliang, Liu Yu, Yu Jianpeng
    2021, 23(5): 279-280. https://doi.org/10.3760/cma.j.cn114015-20201130-01191
    Abstract ( ) PDF ( )
    A 65-year-old female patient with chronic renal failure undergoing continuous hemo- dialysis received an IV infusion of cefmenoxime 1 g twice daily for acute pancreatitis. The values of prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT) were within the normal range before treatment. After 11 days of treatment, the patient developed multiple ecchymoses on the skin and bleeding from the venipuncture site which was not easily stopped. The reexamination of coagulation function showed PT 127-s, INR 10.72, and APTT 86-s. Coagulation dysfunction was considered and an IV infusion of leukocyte-reduced fresh-frozen plasma 150-ml was given. Examination of coagulation function next day showed PT 101-s, INR 8.49, and APTT 65-s. Mixing study for evaluation of abnormal coagulation testing showed that PT and APTT could be corrected, suggesting coagulation factor deficiency. Blood coagulation disorders caused by cefmenoxime was considered. Then the drug was discontinued and switched to amoxicillin sodium and clavulanate potassium, and a subcutaneous injection of vitamin K1-10-mg was given once daily. Three days after the drug withdrawal, her coagulation function returned to within the normal range (PT 15-s, INR 1.19, APTT 36-s).
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