Neutropenia, thrombocytopenia and hepatic injury associated with dexketoprofen trometamol therapy in a previously healthy 35-year-old woman.

This case report describes a previously healthy 35-year-old woman, with an episode of fever, neutropenia, thrombocytopenia and elevation of biochemical markers of liver injury, 10 days after beginning drug therapy with dexketoprofen trometamol. Infectious and autoimmune causes of neutropenia, and viral or autoimmune hepatitis were excluded. The resolution following withdrawal of dexketoprofen trometamol confirms the possibility of an adverse drug reaction.

Taquicardia ventricular en mujer portadora de distrofia muscular de Duchenne / Ventricular tachycardia in a female with Duchenne’s muscular dystrophia

La distrofia muscular de Duchenne (DMD) se debe a mutaciones en el gen de la distrofia en el locus Xp21 del brazo corto del cromosoma X y es la distrofia muscular más prevalente en la población general, apareciendo en 1 de cada 3.500 varones. Las mujeresportadoras pueden presentar síntomas a nivel de la musculatura esquelética así como afectación miocárdica, con alteraciones de la conducción y el ritmo que se manifiestan como bloqueos auriculoventriculares, bloqueos de rama y arritmias (taquicardia sinusal, flutterauricular, taquicardia supraventricular, fibrilación auricular, taquicardiaventricular y muerte súbita).Presentamos una mujer de 64 años, portadora de DMD cuya primera manifestación de afectación miocárdica fue una taquicardia ventricular que cedió con amiodarona. Un estudio posterior mostró un ventrículo izquierdo dilatado con aquinesia de segmentos posteriores y lateral medio y fracción de eyección del 47%.Se comenta la rareza de estos hallazgos y se insiste en la necesidad de seguir sistemáticamente a estas pacientes, mediante electrocardiograma y ecocardiograma periódicos (AU)

Duchenne’s muscular dystrophia is due to mutations in the dystrophinegene in the Xp21 locus in the short arm of the X chromosome. It is the most prevalent muscular dystrophia among the general population, occurring in 1 out of every 3,500 males. Female carriers may evidence skeletal musculature symptoms as well as myocardial involvement, with derangements of conduction and rhythm manifesting as atrioventricular blockade, bundle branch blockade and arrhythmias (sinus tachycardia, atria flutter, supraventricular tachycardia, atrial fibrillation, ventricular tachycardia and sudden cardiac death).We here report the case of a 64-year-old female, Duchenne’s dystrophia carrier, in whom the first manifestation of myocardial involvement was ventricular tachycardia remitting under amiodarone therapy. A later study evidenced a dilated left ventricle with acynesia of posterior, lateral and medial segments and with a 47% ejection fraction. The rarity of these findings is stressed, as well as the need to systematically follow-up these patients through regular angio- and echocardiography (AU)