ABSTRACT
Toxic shock syndrome is an uncommon condition in patients with neutropenia. We describe a 44-year-old man who developed toxic shock syndrome caused by hospitalacquired methicillin-resistant Staphylococcus aureus while pancytopenic after chemotherapy. He died of multiorgan failure despite high-level intensive care support and treatment with appropriate antibiotics and intravenous immunoglobulin. This case illustrates the need for a high index of suspicion for toxic shock syndrome in patients with febrile neutropenia, and also highlights the lack of highquality evidence for the various treatment modalities used in this syndrome.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cross Infection/microbiology , Methicillin-Resistant Staphylococcus aureus , Shock, Septic/microbiology , Staphylococcal Infections/microbiology , Adult , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cross Infection/drug therapy , Cytarabine/administration & dosage , Cytarabine/adverse effects , Etoposide/administration & dosage , Etoposide/adverse effects , Fatal Outcome , Humans , Idarubicin/administration & dosage , Idarubicin/adverse effects , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/drug therapy , Male , Multiple Organ Failure , Pancytopenia/chemically induced , Pancytopenia/immunology , Shock, Septic/drug therapy , Staphylococcal Infections/drug therapyABSTRACT
Dolasetron (Anzemet) overdose is uncommon, and, to our knowledge, this is the only case report of an intentional overdose. Dolasetron (dolasetron mesylate) is a selective 5-hydroxytryptamine 3 antagonist derived from pseudopelletierine, and is used in the prevention and treatment of nausea and vomiting. Transient and asymptomatic ECG changes, including QRS widening and PR and QTc prolongation, have been reported in therapeutic doses. The case of a 21-year-old woman who presented after an intentional overdose of 10x200 mg dolasetron tablets resulting in prolongation of the QTc interval and severe hypotension is reported here. Management of hypotension included intravenous fluid resuscitation and norepinephrine infusion with invasive monitoring in a high dependency unit. Sodium cardiac channel block contributes to cardiotoxicity observed in dolasetron overdose. Sodium bicarbonate was used in an attempt to reduce cardiac sodium channel block, although we observed no apparent benefit. As dolasetron becomes more commonly used in the outpatient setting, both doctors and patients need to be aware of the dangers of dolasetron in toxic doses. The pharmacology and toxicology of dolasetron are discussed.
