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Severe acute hypokalaemia associated with piperacillin/tazobactam in an HIV-infected patient under antiretroviral therapy with tenofovir alafenamide: case report and literature review.
Tai, CC, Chou, RY, Guo, JY, Chen, HP
Sexual health. 2020;(2):194-197
Abstract
Piperacillin/tazobactam is a commonly prescribed antimicrobial agent. Tenofovir alafenamide (TAF) is increasingly being used in antiretroviral therapy (ART) of HIV. Herein we report a case of a 57-year-old male with AIDS receiving TAF-containing ART in whom severe refractory hypokalaemia developed after coadministration of piperacillin/tazobactam for suspected hospital-acquired infection. Upon withdrawal of piperacillin/tazobactam, serum potassium concentrations returned to normal within 2 days. Hypokalaemia is a rare adverse effect of piperacillin/tazobactam and may be aggravated with the underlying use of TAF. We also reviewed past reported cases of hypokalaemia after piperacillin/tazobactam administration. We want to highlight that a more cautious approach should be considered when combining piperacillin/tazobactam and TAF in clinical practice.
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2.
Successful treatment of chronic hepatitis C virus infection with crushed glecaprevir/pibrentasvir administered via a percutaneous endoscopic gastrostomy tube: case report and review of the literature.
Tanaka, Y, Tateishi, R, Koike, K
Clinical journal of gastroenterology. 2019;(6):588-591
Abstract
Glecaprevir (GLE)/pibrentasvir (PIB) is a direct-acting antiviral regimen approved for patients infected with hepatitis C virus. No data are available on the safety and efficacy of this regimen when crushed and administered through a percutaneous endoscopic gastrostomy (PEG) tube. Here, we report a patient who successfully achieved a sustained viral response after treatment with GLE/PIB administered via a PEG tube. A 41-year-old female with chronic hepatitis C viral infection was referred to our department for treatment. She had a history of spina bifida and hydrocephalus, and she received a PEG tube for nutrition and medication due to an aftereffect of hydrocephalus. She received crushed GLE/PIB treatment through a PEG tube for 8 weeks and achieved a sustained viral response 12, without any treatment-related severe adverse events. This is the first documented case treated with GLE/PIB administered through a PEG tube. Based on this case report and a review of the literature, we discuss the safety and efficacy of direct-acting antiviral treatment via a PEG tube.
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3.
Oseltamivir-induced acute hemorrhagic colitis.
Manickam, P, Mogrovejo, E, Cappell, MS
Minerva gastroenterologica e dietologica. 2015;(4):299-301
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4.
Entecavir-associated myopathy: a case report and literature review.
Yuan, K, Guochun, W, Huang, Z, Lin, B, Zhou, H, Lu, X
Muscle & nerve. 2014;(4):610-4
Abstract
INTRODUCTION Entecavir, a nucleoside analog (NA), is effective for treatment of chronic hepatitis B virus (HBV) infection. METHODS We report the case of a patient we encountered with entecavir-associated myopathy. We also performed a literature review of myopathies associated with nucleoside analogs. RESULTS A 44-year-old man presented with a 3-month history of myalgia and progressive weakness. He had HBV infection and had received entecavir antiviral treatment for 5 years. Laboratory tests showed that serum creatine kinase levels were significantly elevated. Muscle histopathology showed abundant T-lymphocyte infiltration of muscle fibers, and HBV surface antigen and HBV core antigen were not present in muscle fibers. Entecavir-associated myopathy was subsequently diagnosed. The patient's symptoms eventually resolved, and serum CK levels decreased rapidly after he stopped receiving entecavir treatments. CONCLUSIONS Patients who receive NA therapy should be closely monitored for myopathic side effects. Muscle Nerve 49:610-614, 2014.
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5.
A boceprevir failure in a patient infected with HCV genotype 1g: importance and limitations of virus genotyping prior to HCV protease-inhibitor-based therapy.
Cento, V, Landonio, S, De Luca, F, Di Maio, VC, Micheli, V, Mirabelli, C, Niero, F, Magni, C, Rizzardini, G, Perno, CF, et al
Antiviral therapy. 2013;(4):645-8
Abstract
A patient classified as HCV-1a-positive by both LiPA Siemens 2.0 and Abbott RealTime HCV Genotype II was instead found to be infected with HCV-1g, as determined by phylogenetic analysis of NS3 sequences. HCV-1g NS3 sequences available to date naturally harbour the resistance substitution T54S, plus P131S and L135F changes, located in the highly conserved NS3 positions within the boceprevir-binding site, as determined by structural modelling. HCV-1g NS3 sequences show some similarities to HCV-4 and are poorly responsive to interferon/ribavirin and to boceprevir/telaprevir; this patient was also a null-responder to boceprevir treatment. Baseline genotypic resistance testing may provide crucial information for the management of first-generation protease-inhibitor-based regimens, including both HCV genotype/subtype and natural resistance.
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6.
Lactic acidosis during telbivudine treatment for HBV: a case report and literature review.
Jin, JL, Hu, P, Lu, JH, Luo, SS, Huang, XY, Weng, XH, Zhang, JM
World journal of gastroenterology. 2013;(33):5575-80
Abstract
All oral nucleoside analogues against hepatitis B virus, with an exception of telbivudine, have been reported causing lactic acidosis (LA). Here we report the first case of chronic hepatitis B developing severe refractory LA during telbivudine monotherapy. A 36-year-old man of Chinese origin received telbivudine antiviral treatment for chronic hepatitis B. After 11 mo of therapy, he developed anorexia, nausea, and vomiting with mild muscle weakness. The patient was found with elevated serum creatine phosphokinase up to 3683 U/L (upper limit of normal 170 U/L) and marked LA. LA did not resolve immediately following discontinuation of telbivudine. His condition began to improve after hemodialysis treatment for 16 times and usage of glucocorticosteroid. The patient fully recovered after 16 wk of treatment. This is the first documented case with severe LA caused by telbivudine monotherapy. Besides serum creatine phosphokinase, blood lactate level should also be closely monitored in patients receiving telbivudine.
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7.
Association of pancreatic autoantibodies and human leukocyte antigen haplotypes with resolution of diabetes mellitus after therapy for hepatitis C virus infection in patients with HIV infection: case report and review of literature.
Lo, YC, Chang, SY, Sheng, WH, Hung, CC, Chang, SC
European journal of gastroenterology & hepatology. 2009;(4):478-81
Abstract
Diabetes mellitus (DM) is a well known complication of interferon therapy for chronic hepatitis C virus (HCV) infection, but resolution of interferon-induced DM was rarely reported. In HIV and HCV co-infected patients, only two cases of incident DM during interferon therapy were reported and both cases required permanent insulin treatment. We report the first case of HIV/HCV co-infected patient who developed diabetic ketoacidosis during treatment for chronic HCV infection with complete resolution of DM after treatment cessation. Review of reported cases indicates that pancreatic autoantibodies and human leukocyte antigen haplotypes may predict the outcome of interferon-induced diabetes.
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8.
Can zinc be an adjuvant therapy for juvenile onset recurrent respiratory papillomatosis?
Bitar, M, Baz, R, Fuleihan, N, Muallem, M
International journal of pediatric otorhinolaryngology. 2007;(8):1163-73
Abstract
OBJECTIVES To report a severe case of juvenile onset recurrent respiratory papillomatosis (JORRP) controlled by zinc replacement therapy. To review the contemporary adjuvant therapies used in JORRP. METHODS The trial of zinc was described in terms of its effect on the inter-surgical interval, site score and clinical symptoms. Long-term follow-up with dose adjustment was detailed. Articles reporting trials of adjuvant therapies over the past 20 years were reviewed in terms of regimen used, mode of assessment, side effects and final outcome. RESULTS Zinc was effective in decreasing the severity of the disease, the rate of relapse and the need for surgery. There was an obvious relation between the dose used and the degree of improvement. Prolonged treatment seems to be needed to sustain the positive effect. No side effects were noticed over a 45-month follow-up period. The literature does support the role of zinc in modulating the immune system. Eight adjuvant therapies were reviewed as published in 40 reports. Interferon was the most used substance. It is definitely effective but often associated with relapse upon discontinuation. The effect of cidofovir was favorable yet not dramatic as initially expected. Other less commonly used therapies showed humble effects. The HspE7 vaccine seems to be promising awaiting further trials. CONCLUSIONS Zinc replacement therapy may benefit JORRP patients with zinc deficiency and should be investigated in more cases. Several adjuvant therapies are available for use in JORRP. They are generally beneficial though mostly not curative.
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9.
Effect of switching to tenofovir with emtricitabine in patients with chronic hepatitis B failing to respond to an adefovir-containing regimen.
Santos, SA, Uriel, AJ, Park, JS, Lucas, J, Carriero, D, Jaffe, D, Dieterich, DT
European journal of gastroenterology & hepatology. 2006;(12):1247-53
Abstract
BACKGROUND In patients with chronic hepatitis B, long-term use of lamivudine is limited by resistance mutations. Adefovir dipivoxil has a very low rate of resistance, but there have been recent reports describing resistance mutations. Tenofovir disoproxil fumarate and emtricitabine show potent activity against wild-type and lamivudine-resistant hepatitis B virus. METHODS We describe a series of seven HIV-seronegative patients who failed to achieve undetectable hepatitis B viral DNA on adefovir. No lamivudine resistance testing was performed. The antiviral regimen was changed to tenofovir (300 mg daily) and emtricitabine (200 mg daily). Variables collected included levels of hepatitis B viral DNA by polymerase chain reaction, alanine and aspartate aminotransferase, hepatitis B e antigen and hepatitis B e antibody. RESULTS The median hepatitis B viral DNA level while on adefovir was 430,000 copies/ml with a median fall in hepatitis B viral DNA levels of 2.0 log10 copies/ml. Patients were on adefovir for a median period of 10 months before a change in regimen to tenofovir and emtricitabine. This regimen change resulted in a median fall in hepatitis B viral DNA levels of 3.0 log10 copies/ml (range, 2-4) after a median treatment duration of 23 months (range, 14-28). All patients (100%) had achieved undetectable hepatitis B viral DNA levels following combination therapy. Anti-hepatitis B e seroconversion occurred in one patient. No change in serum creatinine was observed during therapy, and no significant adverse events were reported. CONCLUSIONS In patients failing to respond to adefovir monotherapy or an adefovir-containing regimen for chronic hepatitis B virus, a combination of tenofovir and emtricitabine resulted in undetectable hepatitis B viral DNA levels without any renal toxicity. Tenofovir, in combination with emtricitabine, may be an alternative treatment for those with detectable hepatitis B viral DNA on adefovir.
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10.
Resolution of diabetes in type 2 diabetic patient treated with IFN-alpha and ribavirin for hepatitis C.
Tahrani, A, Bowler, L, Singh, P, Coates, P
European journal of gastroenterology & hepatology. 2006;(3):291-3
Abstract
We report on a patient whose type 2 diabetes mellitus resolved during IFN-alpha therapy for hepatitis C virus (HCV). A 40-year-old man was diagnosed with type II diabetes in year 2000. His body mass index (BMI) was 30.8 kg/m and glycosylated haemoglobin (HbA1c) was 10.7%. He was treated with metformin. Later, his glycaemic control deteriorated despite additional dietary and lifestyle advice and the addition of glibenclamide. He was started on subcutaneous insulin in 2002 with the continuation of metformin. In 2003 he was diagnosed with chronic hepatitis caused by HCV. In September 2003 he was started on IFN-alpha and ribavirin. After 24 weeks of treatment his HCV polymerase chain reaction remained positive and treatment was stopped as per guidelines. At the commencement of antiviral therapy, HbA1c was 7.7%. In April 2004 his BMI of 29.38 kg/m had reduced and he then stopped insulin therapy because of repeated hypoglycaemia. After stopping insulin his HbA1c was 4.7%. Fasting plasma glucose of 6.2 mmol/l and anti-glutamic acid decarboxylase antibodies were negative. Urea and creatinine levels were normal. Most of the earlier literature describes diabetes developing in the course of IFN-alpha therapy for a variety of diseases. More recent research has described a relationship between hepatitis C infection and the development of diabetes and insulin resistance. Responders to IFN-alpha treatment manifest an improvement in insulin sensitivity compared with non-responders after the completion of IFN-alpha therapy. Our case shows the resolution of pre-existing diabetes in a patient with chronic HCV infection, which did not respond to IFN-alpha therapy. Whether this occurred as a direct result of IFN-alpha on insulin sensitivity or indirectly as a result of weight loss because the therapy for HCV precipitated additional lifestyle changes in the patient is as yet unclear.