Multiple drugs

Abstract

Lack of efficacy: case report A 42-year-old woman exhibited lack of efficacy during treatment with ursodeoxycholic acid, calamine, colestyramine, rifampicin and unspecified antihistamines and corticosteroids for pruritus associated with cholestatic jaundice. The woman presented in December 2018 with increasing jaundice associated with itching, persistent from 6 months. Her jaundice was associated with prodromal symptoms and pruritus developed a month after the onset of jaundice. She received unspecified medications for the treatment of pruritus and jaundice for one month; however, no response was noted. At admission, she also developed new-onset hypercalcaemia. Differential diagnosis of systemic granulomatous and infiltrative disorders, druginduced liver injury or malignancy were considered. After further examinations, systemic granulomatous and infiltrative disorders and drug-induced liver injury were ruled out. She was treated with unspecified corticosteroids for 4 weeks; however, the treatment showed no response. Her corticosteroids were therefore tapered-off. Her disabling pruritus was treated with high-volume plasma exchange (5 cycles), ursodeoxycholic-acid, calamine lotion, colestyramine [cholestyramine], rifampicin and unspecified antihistamines [dosages and routes stated]; however, she showed no response to the therapy. Owing to the non-responding pruritus, she was significantly weakened. After subsequent examinations, a final diagnosis of hypercalcaemia and cholestatic jaundice due to papillary carcinoma of the thyroid was considered. She thus underwent a thyroidectomy and was discharged on unspecified antihistamines for pruritus and thyroid hormone replacement. At a follow-up at 3 months, she showed absence of pruritus.