Surdez súbita em paciente em uso de tadalafil: um relato de caso clínico / Sudden deafness in a patient with tadalafil use: a clinical case report

Introdução: a Surdez Súbita (SS) é uma emergência médica de baixa prevalência, porém com potencial de perda auditiva irreversível para o paciente. Possui diversos e ainda incertos mecanismos etiopatológicos. Recentemente a literatura vem trazendo a associação da SS com a classe dos inibidores da fosdodiesterase-5 (IPDE-5), a qual inclui medicamentos para tratamento de impotência sexual. Objetivo: relatar caso clínico de paciente idoso que apresentou SS após fazer uso de medicamento da classe dos IPDE-5, pesquisando na literatura qual a provável fisiopatologia. Metodologia: trata-se de estudo qualitativo, descritivo do tipo relato de caso clínico, realizado através da coleta de dados do prontuário médico, que foram comparados com literatura especializada. Resultado: paciente masculino, 72 anos, engenheiro, procurou atendimento referindo hipoacusia e plenitude aural à direita notados subitamente há três dias. Relata ter feito uso de Tadalafil 5mg, anteriormente aos sintomas. Anamnese e exame físico direcionaram para hipótese diagnóstica de SS, de modo que exames complementares foram solicitados. À audiometria evidenciou-se perda auditiva sensorioneural moderada a severa em orelha direita. Após tratamento com prednisolona oral e mesilato de codergocrina, paciente apresentou melhora, com audiometria evidenciando perda sensorioneural leve em orelha direita. Conclusão: a relação entre SS e o uso de IPDE-5 está cada vez mais evidente de acordo com a literatura. É provável que possa haver ativação de vias de estresse celular, contribuindo para patologia

Anterior Ischemic Optic Neuropathy Associated with Udenafil

We report a case of anterior ischemic optic neuropathy associated with udenafil. A 54-year-old male presented with an acute onset visual field defect of the right eye after udenafil use. Examination revealed a relative afferent pupillary defect and a swollen disc. Automated visual fields revealed an enlarged blind spot and a narrowed visual field. Fluorescein angiography revealed both an inferior choroidal filling delay and an inferior sector filling delay of the optic disc in the arteriovenous phase as well as diffuse leakage of the optic disc in the late phase. Optical coherent tomography revealed increased thickness of the retinal nerve fiber layer, especially in the area of the inferior disc. The patient was counseled to discontinue the use of udenafil and to monitor his blood pressure regularly. The disc swelling was resolved with residual optic atrophy one month after discontinuing the use of udenafil.

[Cerebral venous sinus thrombosis following sildenafil administration; a case report]

Sildenafil is a selective inhibitor of phosphodiesterase type 5 [PDE5] which currently used for the treatment of erection dysfunction [ED]. Medicine approved by the FDA for treatment of pulmonary hypertension. Although there is no evidence of hypercoagulation states being associated with the use of PDE5 inhibitors, several animal studies suggest that PDE5 inhibitors may cause arterial and venous thrombotic or embolic events. The patient was a 37 year old man who had suffered sever headache and tonic- clonic generalized seizure. In neurological examination, he had decreased level of consciousness and he had no other positive finding in examination. The patient has been constantly taken 100 mg of Sildenafil once a day without medical supervision over the last month. Brain computerized tomography [CT] showed a small hemorrhage in left frontal lobe with suspicious to cerebral venous sinus thrombosis [CVST] lumbar puncture was performed. Increased cerebrospinal fluid pressure suggested the probability of CVST. Brain MRI result confirmed superior sagittal sinus thrombosis. Cerebral venous sinus thromboses need to be considered a potential side effect of Sildenafil administration