Torsades de pointes occurring in association with terfenadine use.

Torsades de pointes is a form of polymorphic ventricular tachycardia that is associated with prolongation of the QT interval. Although found in many clinical settings, torsades de pointes is most often drug induced. This report describes the first association (exclusive of drug overdose) of symptomatic torsades de pointes occurring with the use of terfenadine in a patient who was taking the recommended prescribed dose of this drug in addition to cefaclor, ketoconazole, and medroxyprogesterone. Measured serum concentrations of terfenadine and its main metabolite showed excessive levels of parent terfenadine and proportionately reduced concentrations of metabolite, suggesting inhibition of terfenadine metabolism. We believe that a drug interaction between terfenadine and ketoconazole resulted in the elevated terfenadine levels in plasma and in the cardiotoxicity previously seen only in cases of terfenadine overdose.

Cardiovascular and bacteremic manifestations of Campylobacter fetus infection: case report and review.

A case of bacteremia due to Campylobacter fetus subspecies fetus with concomitant pleuropericarditis in a previously healthy patient is presented. The organism is ubiquitous, but most commonly causes infection in patients with chronic underlying illnesses. The pathogenesis of human infection has not been definitively elucidated. Bacteremia is the most common clinical manifestation of this infection, although cases of thrombophlebitis, mycotic aneurysm, endocarditis, and pericarditis have also been reported. The treatment of choice for most infections is gentamicin, with chloramphenicol recommended for infection involving the central nervous system. Tetracyclines and erythromycin are alternative agents. Prolonged therapy is essential to the prevention of relapse. A high index of suspicion is necessary for the recognition of this organism in the appropriate clinical settings.