Pregnancy outcome after in utero exposure to itraconazole: a prospective cohort study.

OBJECTIVE: This study was undertaken to determine whether itraconazole use during the first trimester of pregnancy was associated with increased risks of major malformations, spontaneous abortions, premature deliveries, and neonatal complications. STUDY DESIGN: In a prospective cohort study pregnant women exposed to oral itraconazole were matched with control subjects not exposed to any known teratogens. Primary outcome was the rate of major malformations. Secondary outcomes were live birth rate, rates of spontaneous abortion and therapeutic abortion, gestational age at delivery, birth weight, and neonatal complications. RESULTS: A total of 229 women exposed to itraconazole were reported to the manufacturer, 198 of whom used the drug during the first trimester of pregnancy. The rate of major malformations in the study group (156 live births) was 3.2%, compared with 4.8% in the control group (187 live births; relative risk, 0.67; 95% confidence interval, 0. 23-1.95). The rate of any pregnancy loss was higher in the exposed group (relative risk, 1.75; 95% confidence interval, 1.47-2.09). Birth weight was lower in the itraconazole group, although that difference may not be clinically significant. Gestational age at birth, rate of preterm delivery, Apgar scores at 1 and 5 minutes, and neonatal complications were comparable between the groups. CONCLUSION: Our study supports the hypothesis that the use of itraconazole during pregnancy is safe. Further surveillance and reporting of pregnancy outcomes will help to support this conclusion.

Reporting bias in retrospective ascertainment of drug-induced embryopathy.

The rate of congenital malformations after first-trimester exposure to itraconazole was four times higher when ascertained retrospectively than prospectively (13.0 vs 3.2%, p=0.006). Reporting bias in retrospective studies should be acknowledged in interpretation of such data.

Caterpillar induced kerato-conjunctivitis.

Caterpillar hairs disseminated by the wind can cause serious ocular problems in man. Although this ocular injury was already described in the past century, caterpillar keratoconjunctivitis remains occasional. A recent case of caterpillar keratoconjunctivitis will be described. The conjunctiva as well as the surrounding skin was involved in a huge erythematous rash. Since caterpillar hairs are equipped with barbed hooks, they can easily penetrate soft tissue and thus are very difficult to remove. Recurrent inflammatory reactions lasting for months and resulting in a granulomatous disease, is the rule. The name of keratitis nodosum was given to the granulomatous reaction, secondary to the presence of caterpillar hairs in corneal tissue.

Near fatal subacute thallium poisoning necessitating prolonged mechanical ventilation.

The authors describe a case of severe sensory-motor polyneuropathy caused by subacute thallium-intoxication rapidly progressing to respiratory failure due to complete muscle paralysis. After more than 2 months of mechanical ventilation, weaning from the ventilator was possible. Further intensive physical rehabilitation required an additional 6 months hospital stay, and 18 months later, neurological recovery was complete except for the distal lower limbs muscles. The authors discuss the different forms of thallotoxicosis and the present treatment is reviewed. Maximal prolonged therapeutic support should be offered in severe thallotoxicosis because of possible near complete recovery.

Hypothermia: an unusual side effect of paracetamol.

We report 4 cases of children who presented hypothermia after normal therapeutic doses of paracetamol. Possible mechanisms of the antipyretic action of paracetamol are reviewed in an attempt to explain this rather exceptional description. Comparison is made with other cases in the literature and the experiences of other Poison Control Centers.

Mercury intoxication after topical application of a metallic mercury ointment.

Two cases of mercury poisoning with predominantly dermatological symptoms are reported. The mercury intoxication was caused by the application of an over-the-counter metallic mercury ointment. The calculations of mercury excretion suggest strongly that cutaneous absorption could have been a significant route of entry.