ABSTRACT
Purpose: To report a case of a drug-induced anterior uveitis secondary to the use ofintracameral moxifloxacin.Case report: A 64-year-old Colombian male patient presented with severe ocular pain and photophobia in his left eye 15 days after cataract surgery. In the ophthalmology and glaucoma specialist evaluation, pigment dispersion in the anterior chamber and camerular angle, severe anterior segment inflammation, and elevated intraocular pressure were observed. Poor response to treatment for a suspected viral origin and exclusion of other possible etiologies, led to the conclusion of intracameral moxifloxacin induced anterior uveitis.Conclusion and importance: We present the second published case worldwide about anterior uveitis secondary to intracameral moxifloxacin, which may rarely cause hypertensive uveitis that may be confused with viral uveitis. This provides evidence on the importance of postoperative follow-up by the surgeon for an early referral and treatment of these cases.
Subject(s)
Anterior Chamber/drug effects , Anti-Bacterial Agents/adverse effects , Drug-Related Side Effects and Adverse Reactions/etiology , Moxifloxacin/adverse effects , Uveitis, Anterior/chemically induced , Cataract Extraction , Diagnosis, Differential , Drug-Related Side Effects and Adverse Reactions/diagnosis , Endophthalmitis/prevention & control , Exfoliation Syndrome/chemically induced , Exfoliation Syndrome/diagnosis , Eye Pain/chemically induced , Eye Pain/diagnosis , Gonioscopy , Humans , Male , Middle Aged , Ocular Hypertension/chemically induced , Ocular Hypertension/diagnosis , Photophobia/chemically induced , Photophobia/diagnosis , Uveitis, Anterior/diagnosisABSTRACT
BACKGROUND: Icodextrin is a starch-derived, water soluble glucose polymer, which is used as an alternative to glucose in order to enhance dialytic fluid removal in peritoneal dialysis patients. Although the safety and efficacy of icodextrin is well-established, its use in everyday clinical practice has been associated with the appearance of skin rashes and other related skin reactions. CASE PRESENTATION: Herein, we report the rare case of a 91-year-old woman with a history of severe congestive heart failure, who initiated continuous ambulatory peritoneal dialysis with icodextrin-based dialysate solutions and 15 days after the initial exposure to icodextrin developed a generalized maculopapular and exfoliative skin rash extending over the back, torso and extremities. Discontinuation of icodextrin and oral therapy with low-dose methyl-prednisolone with quick dose tapering improved the skin lesions within the following days. CONCLUSIONS: This case report highlights that skin hypersensitivity is a rare icodextrin-related adverse event that should be suspected in patients manifesting skin reactions typically within a few days or weeks after the initial exposure.
Subject(s)
Dialysis Solutions/adverse effects , Exanthema/chemically induced , Exfoliation Syndrome/chemically induced , Icodextrin/adverse effects , Peritoneal Dialysis, Continuous Ambulatory/trends , Aged, 80 and over , Exanthema/diagnosis , Exfoliation Syndrome/diagnosis , Fatal Outcome , Female , HumansABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Etoricoxib is a non-steroidal anti-inflammatory drug (NSAID) that inhibits the inducible cyclooxygenase (COX-2) with a good safety profile. We describe the first case of two mucosal adverse events to etoricoxib in the same patient. CASE DESCRIPTION: Our patient developed stomatitis with mucosal exfoliation after etoricoxib assumption. Some months later, after a new etoricoxib intake, she presented with vaginal burning, tongue angioedema and erosions, oral exfoliation and wheals on the hands. A provocation test with diclofenac was negative. WHAT IS NEW AND CONCLUSION: The peculiarities of our case are the rare clinical manifestation and the selective hypersensitivity to COX-2 inhibitor with tolerance to a non-selective NSAID.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Exfoliation Syndrome/chemically induced , Mucous Membrane/drug effects , Pyridines/adverse effects , Sulfones/adverse effects , Adult , Cyclooxygenase 2 Inhibitors/adverse effects , Drug Hypersensitivity/etiology , Etoricoxib , Female , HumansABSTRACT
It is thought that dystrophic changes in the human aging anterior eye are due to lipid peroxidation in both the cortical and nuclear structures of the lens under the conditions of ischemia. These changes are often accompanied by only lens opacification (senile cataract-SC) or by formation of amorphous or fibrillar deposits in anterior eye, disturbances of eye hydrodynamics and lens opacification (pseudoexfoliation syndrome-PES). Our results suggest that the main reason of dystrophic changes in the tissues of the aging anterior eye is the disturbance of the haemato-ophthalmic barrier and that the plasma kallikrein-kinin system takes part in this disturbance. Penetration of plasma proteins, such as C-reactive protein, complement components, immunoglobulins and coagulation factors, from plasma into the aqueous humor is responsible for damaging epithelial structures of anterior eye and formation of pseudoexfoliative material. Using ELISA, the C-reactive protein, IgG and IgM antigens have been shown to localize on the surface of the opaque lenses. Presence of these complement binding proteins in the superficial lens structures as well as the high C3a concentration in the aqueous humor substantiates the pathogenic role of complement activation in the lenticular epithelium upon cataract and PES formation.
