Abstract
Keywords
Azole Antifungals No. 232
Cross-Sensitivity
A 41-year-old male patient developed a mild rash, abdominal pain, and nausea approximately 2.5 weeks after being discharged on fluconazole therapy (dosage not provided). During hospitalization, the patient had positive coccidioidomycosis (Cocci) serology titers, positive Coccidioido immitis sputum, and bronchoalveolar lavage cultures. Concurrent medications included metformin and lisinopril. The patient was rehospitalized for renal failure and all medications were stopped. On admission, the eosinophil count was elevated (22%). Fluconazole (400 mg twice daily) was restarted but discontinued shortly thereafter (3 days) due to a persistent fever and exacerbation of a maculopapular rash that extended over the entire body. Once the rash improved, therapy was switched to voriconazole and the patient was discharged on the medication, having received a total of 4 doses in the hospital without event. Therapy was switched to itraconazole after discharge as the prescribed drug was unavailable on the patient’s insurance plan. Within 2 days, the patient was readmitted for a maculopapular rash with skin sloughing over 25% of his body. Treatment included the discontinuation of the new antifungal and eventual initiation of lipid-based amphotericin B, which was continued for 5 months without event. A rechallenge with voriconazole in a stepwise dose manner (25 mg titrated to 200 mg twice daily) was uneventful; voriconazole therapy was continued for approximately 2 years without further event.
The authors noted that this patient experienced a probable allergic reaction to fluconazole and a possible allergic reaction to itraconazole according to assessment via the Naranjo causality algorithm. However, the patient was able to tolerate voriconazole without event, suggesting a lack of cross-reactivity. The authors noted that this was the first case of a lack of cross-reactivity between itraconazole and voriconazole.
Azole Antifungals [“Voriconazole,” “Fluconazole,” “Itraconazole”]
Benjamin Lash D et al (D Benjamin Lash, College of Pharmacy, Western University of Health Sciences, 309 E Second Street, Pomona, CA 91766; e-mail:
Anabolic Steroids No. 233
Pulmonary Hemorrhage (First Report*)
Case reports of diffuse alveolar hemorrhage related to anabolic steroid use were described.
Patient 1. A 26-year-old man developed malaise, dyspnea, and hemoptysis 6 weeks after resuming anabolic steroids including metandienone (60 mg by mouth daily), 57 testosterone enanthate (1000 mg intramuscularly weekly), nandrolone (1 ampule intramuscularly weekly), and rapid-acting insulin (161 units daily). No other medications were used. Physical examination revealed tachypnea and testicular atrophy. Significant laboratory findings included elevated C-reactive protein (12.0 mg/L), leukocytes (13.0 × 109/L), creatinine (142 µmol/L), platelet count (378 × 109/L), international normalized ratio (1.3), and troponin T (20 ng/L). Chest X-ray revealed left apical infiltration and basal atelectasis. Echocardiography revealed slightly increased right and left ventricle size, normal ejection fraction, and slightly elevated tricuspid regurgitation gradient (27-30 mm Hg). Areas of ground-glass opacity in both lungs, predominantly in the peripheral regions, was revealed by high-resolution computed tomography. Anabolic steroids were discontinued. Repeat high-resolution computed tomography at 2 and 6 months revealed complete resolution of the previous abnormal findings.
Patient 2. A 19-year-old male developed cough, dyspnea, and hemoptysis after 3 years of anabolic steroid use including oxymetholone (orally), methandriol (orally), trienolone (intramuscularly), and nandrolone (intramuscularly) at unknown doses. No concurrent medications were ingested. Physical examination revealed tachypnea. Significant abnormal laboratory values included elevated C-reactive protein (14.0 mg/L) and D-dimer (0.72 mg/L FEU). Blood gas analysis revealed hypoxemia (arterial PO2 0.6 kPa) and no hypercapnia. Spirometry showed slightly reduced forced expiratory volume in 1 second (3.38 L; 74%) and forced vital capacity (4.53 L; 83%). A chest computed tomography was consistent with diffuse alveolar bleeding. Bronchoscopy showed multiple small blood clots in bilateral airways. Bronchoalveolar lavage fluid was bloody with 20% hemosiderin-containing macrophages. Anabolic steroids were discontinued, and no additional therapy was required. Pulmonary symptoms improved within 2 weeks; repeat high-resolution computed tomography and spirometry tests at 3.5 months were normal.
The authors concluded that these cases described the first reports of diffuse alveolar hemorrhage related to anabolic steroid abuse. The proposed mechanisms included a ventilation-perfusion mismatch and local and systemic toxic and inflammatory responses.
Anabolic Steroids [Anabolic Steroids]
Hvid-Jensen HS et al (HS Hvid-Jensen, Vestre Ringgade 80B, 8000, Aarhus C, Denmark; e-mail:
Dietary Supplement No. 234
FDA Public Notification: Undeclared Drug Ingredient
On August 16, 2016, the US Food and Drug Administration alerted health care professionals and patients regarding a hidden drug ingredient in a dietary supplement (Master Zone 1500) promoted for the use of sexual enhancement. A laboratory analysis of the product confirmed that it contained sildenafil and tadalafil, both prescription products used for erectile dysfunction. Use of these agents has been associated with hypotension and cause significant interactions with other drugs, notably nitrates.
Dietary Supplement [“Master Zone 1500”]
Public Notification: Master Zone 1500 contains undeclared drug ingredients. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm516776.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Aug 16) 2016
Venlafaxine No. 235
Euprolactinemic Galactorrhea, Hypersexuality
A 32-year-old woman developed bilateral galactorrhea, mastalgia, and increased libido approximately 1 month after initiating venlafaxine extended-release (75 mg daily) for the treatment of depression and anxiety. Concurrent medications included clonazepam (0.25 mg) as needed for panic symptoms, omeprazole, fexofenadine, pseudoephedrine, fluticasone, albuterol, and budesonide/formoterol (doses not reported). Prior antidepressant therapy did not cause similar symptoms and included escitalopram, paroxetine, buspirone, and sertraline. Breastfeeding had been discontinued 14 months prior to symptom onset. No other manic of hypomanic symptoms were reported. Menstruation continued regularly, and no weight gain, visual changes, or headaches were reported. Laboratory values including β-human chorionic gonadotropin, thyroid-stimulating hormone, free T3 and T4, prolactin, follicle-stimulating hormone, complete blood count, liver function, and renal function were normal. Brain magnetic resonance imaging revealed no abnormalities. Initial treatment included reducing venlafaxine dose (37.5 mg daily); however, galactorrhea and hypersexuality continued. Additional treatment included discontinuation of venlafaxine and initiation of fluoxetine (20 mg daily). No mood or anxiety changes occurred, and complete resolution of galactorrhea and hypersexuality occurred within 3 weeks.
The author concluded that this case described new-onset hypersexuality and euprolactinemic galactorrhea in a patient receiving low-dose venlafaxine. Proposed mechanisms included a 5-HT1A-mediated mechanism and omeprazole-mediated inhibition of venlafaxine metabolism resulting in elevated serum concentrations.
Venlafaxine [“Effexor,” “Effexor XR”]
Warren MB (MB Warren, Department of Psychiatry and Behavioral Sciences, University of Washington; Boise Veterans Administration Medical Center 500 W Fort St, Boise, ID; e-mail:
Pramipexole No. 236
Leg Edema
A 57-year-old male patient developed severe swelling of both feet and ankles that extended toward the knees during chronic maintenance therapy with extended-release pramipexole (2.1 mg) and sustained-release levodopa/carbidopa (200/50 mg 3 times daily for the management of Parkinson’s disease). Laboratory values and examinations obtained on admission did not indicate the presence of renal, cardiac, or hepatic abnormalities. Treatment included the discontinuation of pramipexole and substitution of levodopa/carbidopa (250/25 mg 3 times daily). Within a month, the edema in both legs was markedly improved.
The authors concluded that this patient experienced leg edema associated with pramipexole therapy based on the temporal relationship between the administration of the drug and the appearance and resolution of symptoms. Causality assessment via algorithms was not performed but the authors suggested that onset of this adverse event was gradual and appeared to be related to the duration of therapy. They theorized that the risk of leg edema with this agent may increase after 2 years of therapy.
Pramipexole [“Mirapex”]
Cicero CE et al (M Zappia, Department G.F. Ingrassia, Section of Neurosciences, University of Catania, Via Santa Sofia 78, Catania 95123, Italy; e-mail:
Non–Vitamin K Antagonist Oral Anticoagulants No. 237
Gastrointestinal Bleeding
A meta-analysis including 8 cohort studies was performed to investigate the association between non–vitamin K antagonist oral anticoagulant use and gastrointestinal bleeding and evaluate various factors associated with gastrointestinal bleeding risk as compared to warfarin. A total of 106 626 participants received dabigatran and 10 713 received rivaroxaban. Dabigatran was associated with a 21% increased risk of gastrointestinal bleeding as compared to warfarin in the adjusted analysis (relative risk = 1.21, 95% confidence interval = 1.05-1.39) with a moderate-to-high heterogeneity (I2 = 69%, Pheterogeneity = .004). Rivaroxaban was not associated with an increased risk of gastrointestinal bleeding compared to warfarin (relative risk = 1.09, 95% confidence interval = 0.92-1.30) with no significant heterogeneity (I2 = 0%, Pheterogeneity = .42). Of 5 cross-sectional studies, no increased risk of gastrointestinal bleeding was observed for apixaban or dabigatran versus warfarin or for rivaroxaban versus dabigatran use. A total of 1442 gastrointestinal bleeding cases were observed among 106 626 dabigatran users and 184 gastrointestinal bleeding cases among 10 713 rivaroxaban users, resulting in a pooled incidence rate of gastrointestinal bleeding of 4.5 (95% confidence interval = 3.17-5.84) and 7.18 (95% confidence interval = 2.42-12.0) per 100 patient years, respectively. Sensitivity analyses excluding individual studies did not significantly affect results. Subgroup analyses evaluating dabigatran dose revealed a significantly greater risk of gastrointestinal bleeding for dabigatran 150 mg twice daily (relative risk = 1.51, 95% confidence interval = 1.4-1.70) but not for 75 mg twice daily (relative risk = 1.01, 95% confidence interval = 0.78-1.31) or 110 mg twice daily (relative risk = 0.53, 95% confidence interval = 0.29-0.98). Subgroup analysis by indication revealed similar results between subgroups. Dabigatran was associated with a significantly greater risk of major gastrointestinal bleeding (relative risk = 1.30, 95% confidence interval = 1.17-1.47), but no significant association was observed for non–major gastrointestinal bleeding (relative risk = 0.85, 95% confidence interval = 0.40-1.79). A significant difference was not observed between subgroups that had adjusted or not adjusted for nonsteroidal anti-inflammatory drug use. A high impact of concomitant proton pump inhibitor or H2-receptor antagonist use was observed on dabigatran-associated gastrointestinal bleeding (I2 = 83.8%, Pheterogeneity = .01) but not for rivaroxaban-associated gastrointestinal bleeding (I2 = 46.7%, Pheterogeneity = .17).
The authors concluded that results of this study suggested a slightly greater risk of gastrointestinal bleeding associated with dabigatran use versus warfarin; however, no increased risk was observed for rivaroxaban use.
Apixaban [“Eliquis”]
Dabigatran [“Pradaxa”]
Rivaroxaban [“Xarelto”]
He Y et al (EW Chan, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, 2/F Laboratory Block FMB, 21 Sassoon Road, Hong Kong SAR, China; e-mail:
Dietary Supplement No. 238
FDA Public Notification: Undeclared Drug Ingredient
On August 16, 2016, the US Food and Drug Administration (FDA) alerted health care professionals and patients regarding a hidden drug ingredient in a dietary supplement (Natural Eruption) promoted for the use of weight loss. A laboratory analysis of the product confirmed that it contained sibutramine, a product removed from the US market in October 2010 for safety reasons. This notification from the FDA is a reminder that there is a trend of hidden drugs and chemicals in dietary supplements or conventional foods.
Dietary Supplement [“Natural Eruption”]
Public Notification: Natural Eruption contains undeclared drug ingredients. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm516769.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Aug 16) 2016
Fentanyl No. 239
Overdose-Related Mortality
The University of Florida, Ohio Department of Public Health, and the Centers for Disease Control and Prevention analyzed a recent increase in fentanyl-associated deaths in Florida and Ohio during 2013 to 2015. An initial analysis demonstrated that during 2013 to 2014, fentanyl submissions (materials gathered during an arrest or police visit) increased 494% in Florida (from 33 to 196) and 1043% in Ohio (from 109 to 1246). This increase was also associated with a 115% and 526% increase in fentanyl deaths in Florida (from 185 to 397) and Ohio (from 84 to 526), respectively. However, annual fentanyl prescription rates increased only 5% over the same time period in Florida (from 19.3 to 20.3/1000 population) and decreased 7% in Ohio (from 21.6 to 20.1/1000 population). The highest fentanyl-related mortality death rates in Florida during this same time period occurred in individuals aged 26 to 34 years (3.2/100 000) and 35 to 50 years (2.9/100 000). In Ohio, deaths occurred most frequently in those aged 25 to 34 years (10.5/100 000) and 35 to 44 years (9.2/100 000). White males were also at risk in both areas. When compared to data from 2010 to 2012, the percentage of fentanyl deaths testing positive for other illicit substances increased significantly during 2013 to 2104. Specifically, there was an increase in fentanyl deaths testing positive for cocaine (17% to 33%) and heroin (0% to 19%). In Florida, there was also a significant increase in death that tested positive for morphine as well (7% to 28%).
The authors concluded that the data from this report suggest a need to improve fentanyl death surveillance and to improve public health support of heroin users by improving access to medication-assisted treatment programs. In addition, the authors suggested that improved access be provided for the use of the opioid antagonist, naloxone.
Fentanyl [Fentanyl]
Peterson AB et al (AB Peterson, Centers for Disease Control, Atlanta, GA; e-mail:
Trastuzumab No. 240
Thrombocytopenia
A 70-year-old female patient developed thrombocytopenia after the fourth cycle of treatment with trastuzumab for the management of early-stage hormone receptor negative HER2-positive breast cancer stage IA (pT1cpN0). Postsurgery, adjuvant chemotherapy initially included doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) followed by docetaxel (75 mg/m2) and trastuzumab (8 mg/kg every 3 weeks). Prior to trastuzumab and at the time of the second cycle, hematological values were within normal limits. However, after receiving the fourth cycle, the platelet count decreased to 39 000/mm3 without evidence of bleeding (eg, petechial bleeding, ecchymosis, rash, cutaneous hemorrhagic syndrome). Other routine laboratory values were within normal limits, including clotting parameters. A bone marrow analysis revealed normal megakaryocytes, moderate erythrocytic and granulocytic dysplasia series, and a lack of iron. Screenings for alternative etiologies were negative. Treatment included the discontinuation of trastuzumab and the initiation of corticosteroids (prednisone 1 mg/kg), which resulted in good response. Retreatment with the drug was withheld.
The authors concluded that this patient experience gradual thrombocytopenia associated with the administration of trastuzumab. They noted that other reports have been published but that this case was associated with a gradual decline in platelets over prolonged treatment.
Trastuzumab [“Herceptin”]
Miarons M et al (M Miarons, Department of Pharmacy, Hospital de Mataro, C/ Cirera w/n, 08304 Mataro, Spain; e-mail:
Ziprasidone No. 241
Sleep-Related Eating Episodes
A 28-year-old male patient reported episodes of sleepwalking with sleep-related eating episodes during the night after a dosage increase in ziprasidone therapy for the management of a schizoaffective disorder. The initial dose was 40 mg twice daily, which was increased to 60 mg twice daily. As a result of daytime sedation, the dose was changed to 40 mg in the morning and 60 mg in the evening. The evening dose was eventually increased to 80 mg, which resulted in significant improvement in psychiatric symptoms without causing daytime sedation. The patient was unable to remember the episodes the next day, but the episodes were observed by the patient’s girlfriend. It was reported that the episodes began only after the dose was increased from 40 mg twice daily to 60 mg twice daily. Additional activities during sleepwalking included cooking but there were no reports of driving or sexual activities. A sleep study was negative for sleep apnea.
Management included the discontinuation of the evening dose. Within 2 weeks, the patient reported resolution of sleepwalking and sleep-related eating activities. As the patient complained of sleep maintenance insomnia after ziprasidone discontinuation, the evening dose of ziprasidone (80 mg) was restarted. Within 1 week at this dose, sleepwalking and related eating episodes recurred. The evening dose of ziprasidone was replaced with quetiapine (100 mg) without further event or recurrences.
The author concluded that this patient experienced sleepwalking with eating episodes related to ziprasidone therapy based on the temporal relationship between the administration of the drug and the appearance and resolution of symptoms. They suggested that this event possibly occurs via 5-HT-2A/2C antagonism mediated mechanisms and may be dose dependent.
Ziprasidone [“Geodon”]
Das P (P Das, VA Medical Center Grand Island, NE and Creighton University Medical Center, Omaha, NE; e-mail:
Tobacco (Nicotine) No. 242
Dyskinesia on Withdrawal
A 17-year-old male inpatient with a 5-year history of tobacco smoking developed abnormal involuntary movements (eg, occasional chewing movements, trunk twisting, and truncal tremor) at 3 days after admission. At the time of presentation, the patient was smoking 20 to 30 cigarettes per day and exhibiting disruptive behavior. A mental state examination revealed agitation without other thought disorders. A physical examination revealed no significant abnormality. Urine drug screening was negative for substances of abuse. The diagnosis made was mental and behavioral disorder due to psychoactive substance use; nicotine dependence with comorbid conduct disorder. The movements often disappeared during sleep. Relief of symptoms was experienced with nicotine gum. Other therapy included diazepam (10 mg on the first night and twice daily for 5 days) in addition to nicotine gum use as needed. Hygiene habits and appetite improved approximately 2 weeks after admission in response to therapy. The abnormal movements were also decreased after 3 weeks on nicotine gum. The patient was discharged. No further events were noted.
The authors concluded that this patient experienced dyskinesia as a result of nicotine withdrawal based on the temporal relationship between the smoking patterns and the appearance and resolution of symptoms.
Tobacco [Nicotine]
Olashore AA et al (AA Olashore, Department of Psychiatry, University of Botswana Medical School, Gaborone, Botswana; e-mail:
Atorvastatin, Fluconazole No. 243
Drug Interaction: Cytochrome Inhibition of Atorvastatin Metabolism
A 70-year-old woman complained of muscle weakness and limb pain approximately 1 week after fluconazole therapy was added to her regimen for the treatment of urosepsis and pneumonia. Fluconazole was initiated as an intravenous loading dose (500 mg) followed by 200 mg daily and administered along with piperacillin/tazobactam (2.25 g every 8 hours). Concurrent medications included atorvastatin (20 mg daily), aspirin (100 mg daily), bisoprolol (2.5 mg daily), tramadol/acetaminophen (37.5/325 mg every 6 hours), NPH insulin (40 IU), and regular insulin (16 IU twice daily). Three days after initiation of the anti-infective agents, it was noted that the patient’s urine was orange-red colored. In addition, the serum low-density lipoprotein cholesterol concentration was substantially decreased compared to baseline values 4 months previously (56 mg/dL vs 166 mg/dL). A possible drug interaction was suspected between fluconazole and atorvastatin, resulting in the reduction of the atorvastatin dose to 20 mg every other day. The patient’s condition worsened, acute renal failure developed, and she was transferred to the intensive care unit. Statin-related rhabdomyolysis was suspected and atorvastatin was discontinued. Fluconazole therapy was maintained. Additional treatment included intravenous sodium chloride solution (0.45% NaCl) and sodium bicarbonate for urine alkalinization. The patient’s condition worsened, requiring hemodialysis. The patient gradually recovered and was discharged. Follow-up assessment at 2 months postdischarge revealed a normalization of liver and renal function.
The authors concluded that this patient experienced statin-related rhabdomyolysis as a result of a drug-drug interaction between fluconazole and atorvastatin. This conclusion was based on the temporal relationship between the administration of the 2 drugs and the appearance and resolution of symptoms once atorvastatin was discontinued. According to the Naranjo causality algorithm and the Drug Interaction Probability Scale, this event was classified as probable in relation to the drug therapy. The authors proposed that the fluconazole, a moderate CYP34A inhibitor, interfered with atorvastatin metabolism, thus increasing the exposure of the drug and leading to the adverse event.
Atorvastatin [“Lipitor”]
Fluconazole [“Diflucan”]
Hsiao SH et al (TJ Wu, Department of Internal Medicine, College of Medicine, National Cheng Kung University; 138 Sheng-Li Road, Tainan 704, Taiwan; e-mail:
Dietary Supplement No. 244
FDA Public Notification: Undeclared Drug Ingredient
On August 16, 2016, the US Food and Drug Administration (FDA) alerted health care professionals and patients regarding a hidden drug ingredient in a dietary supplement (One More Knight 1750) promoted for the use of sexual enhancement. A laboratory analysis of the product confirmed that it contained tadalafil and dapoxetine. Use of tadalafil has been associated with hypotension and may cause significant interactions with other drugs, notably nitrates. Dapoxetine is not a marketed agent, and thus, the safety of this product in unknown. This notification from the FDA is a reminder that there is a trend of hidden drugs and chemicals in dietary supplements or conventional foods.
Dietary Supplement [“One More Knight 1750”]
Public Notification: One More Knight 1750 contains undeclared drug ingredients. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/MedicationHealthFraud/ucm516780.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery (Aug 16) 2016
Drug-Related Hospitalizations No. 245
Incidence and Risk Factors in Elderly Patients With Dementia or Cognitive Impairment
A retrospective chart review was performed to assess the occurrence and characteristics of drug-related hospital admissions in older patients (at least 65 years old) with dementia or cognitive impairment. Records from orthopedic and internal medicine wards in 2 hospitals in Northern Sweden were reviewed. A total of 458 people aged 65 years or older with dementia or cognitive impairment were included in the study. Assessment of drug-related hospital admissions were initially rated as certain, probable, possible, or unlikely. Of the 458 acute hospital admissions, less than half (41.3%; n = 189) were determined to be drug related. There was no significant difference in the mean age of patients with drug-related admissions compared to those with non–drug-related admissions (83.8 years). The most frequently cited drug-related problem (86/189; 45.5%) was adverse drug reactions. A total of 264 drugs were involved in 189 drug-related admissions, with cardiovascular (29.5%) and psychotropic (26.9%) drugs the most frequently cited drug classes. The relationship between the drug-related problem and the admission was classified as certain in 25 cases, probable in 78 cases, and possible in 86 cases. Characteristic associated with an increased risk of drug-related admissions included polypharmacy (taking a higher number of drugs; odds ratio = 1.068; 95% confidence interval = 1.012-1.126; P = .016).
The authors noted that this study indicated that a significant number of hospitalizations among elderly patients with dementia or cognitive impairment are associated with drug-related issues.
Drug-Related Admissions [Drug-Related Admissions]
Gustafsson M et al (M Gustafsson, Department of Pharmacology and Clinical Neuroscience, Division of Clinical Pharmacology, Umeå University, Umeå, Sweden; e-mail:
Sulthiame No. 246
Drug Rash With Eosinophilia and Systemic Symptoms Syndrome
A 10-year-old female patient developed a maculopapular rash and fever approximately 5 weeks after starting sulthiame for the management of resistant left-sided focal tonic-clonic seizures. The drug was initiated as 50 mg once daily and titrated weekly to a maintenance dose of 200 mg twice daily (8.5 mg/kg/day) by week 4. Previous unsuccessful anticonvulsant therapy included carbamazepine, lamotrigine, levetiracetam, topiramate, and phenytoin. Concurrent therapy included sodium valproate and clonazepam for the last 1 year. On physical examination, it was noted that the diffuse erythematous morbilliform maculopapular rash covered approximately 70% of her body involving the trunk and proximal limbs. Laboratory assessments revealed atypical lymphocytes, thrombocytopenia, and elevated transaminases. Despite treatment with intravenous penicillin, the patient’s condition deteriorated further, and by day 3, the maculopapular morbilliform rash spread to the face and extremities and was accompanied by facial swelling. The patient’s condition continued to worsen, requiring transfer to intensive care support. Treatment included intravenous immunoglobulin (1 g/kg) and intravenous methylprednisolone (30 mg/kg/day) followed by oral prednisolone (60 mg). The fever resolved by day 9 and there was complete resolution of rash at day 30. At follow-up 6 months later, the patient was healthy.
The authors concluded that this patient experienced drug rash with eosinophilia and systemic symptoms syndrome associated with sulthiame therapy.
Sulthiame [“Ospolot”]
Fong CY et al (CY Fong, Division of Paediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; e-mail: