ABSTRACT
Myasthenia Gravis (MG) is a disorder of the neuromuscular junction (NMJ) that manifests as fluctuating fatiguable weakness of the muscles. There are many factors that can exacerbate myasthenia symptoms including a variety medications and drugs, systemic illness, and pregnancy. A number of medications have been implicated in exacerbating MG symptoms, including aminoglycosides. We present a case of an elderly female with newly diagnosed MG following the use of tobramycin eye drops for 3 days. There have been limited reports in the literature of topical medications that exacerbate MG symptoms. Clinicians prescribing tobramycin eye drops (or other associated medications) should have a high index of suspicion of MG as early discontinuation and therapy will limit long-term morbidity and mortality in these patients.
Subject(s)
4-Hydroxycoumarins/adverse effects , Anticoagulants/adverse effects , Blood Coagulation Disorders/chemically induced , Marijuana Use/adverse effects , Synthetic Drugs/adverse effects , Adult , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/therapy , Humans , Illinois , MaleABSTRACT
OBJECTIVES: Hypergammaglobulinemia is one of the manifestations of B-cell dysfunction associated with untreated HIV infection. Globulin levels are not routinely measured in HIV-infected patients on treatment. The purpose of this study was to evaluate the effect of highly active antiretroviral therapy (HAART) on calculated globulin levels. METHODS: The study group consisted of 75 HIV-infected treatment-naïve patients, starting HAART, and virologically suppressed for ≥6 months; 16 patients (21%) were HIV-HCV-co-infected. RESULTS: All patients experienced significant increases in CD4 cell counts at 6 and 12 months after HAART initiation compared to baseline (p<0.01 for all comparisons). The increase in CD4 cell counts was significant regardless of the HCV infection status. Significant increases in albumin levels (p<0.05 at 6 and 12 months), reductions in total protein (p<0.01 at 1 year; not significant at 6 months), and concomitant significant reductions in the calculated globulin levels (p<0.001 at 6 and 12 months) after HAART initiation compared to baseline were observed for the whole group. However, less than half the patients achieved a normal albumin/globulin ratio at 1 year. HIV-monoinfected patients had significant changes in albumin, total protein, and calculated globulin levels. In contrast, HIV-HCV-co-infected patients only showed significant increases in albumin levels. CONCLUSIONS: Future studies to evaluate the potential use of calculated globulin levels and albumin/globulin ratios as readily available surrogate markers of B-cell immune reconstitution in HIV-monoinfected patients are warranted.
