Michel Biour

Cytolytic Hepatitis Possibly Related to Levonorgestrel/Ethinylestradiol Oral Contraceptive Use: 2 Case Reports

This letter to the editor reports on two cases of biopsy-confirmed cytolytic hepatitis induced by a levonorgestrel/ethinylestradiol combination oral contraceptive pill.

Pioglitazone-Induced Acute Rhabdomyolysis

Pioglitazone, a peroxisome proliferator–activated receptor γ agonist, is a relatively new oral antidiabetes agent. It has been shown to decrease insulin resistance in patients with type 2 diabetes, resulting in lowered blood glucose concentrations and A1C values. It can be used alone or in combination with metformin or a sulfonylurea. The adverse effects of pioglitazone include weight gain, headache, and edema. We report here a case of a patient who developed severe acute rhabdomyolysis after receiving pioglitazone. A 52-year-old man had a 2-year history of type 2 diabetes that was treated with gliclazide (60 mg/day). Six weeks after addition for pioglitazone (15 mg/day), the patient was admitted to hospital for 4 …

Isoniazid-Induced Recurrent Pancreatitis

CONTEXT Drug induced pancreatitis are rare but potentially serious. Thus, drug withdrawal is warranted. CASE REPORT A 79-year-old woman who was treated with antituberculosis therapy for 5 weeks was admitted to our unit for pancreatitis. Usual etiologies of pancreatitis were eliminated. Because of vomiting, antituberculosis therapy was withdrawn and symptoms disappeared. Eight days later, the same treatment was reintroduced and the patient presented recurrent pancreatitis; thus, treatment was withheld again followed by disappearance of clinical and biological abnormalities. Two days later, a treatment without isoniazid was reintroduced and no recurrence of symptoms was observed. CONCLUSIONS We have experienced a case of isoniazid induced pancreatitis. This is a rare cause of pancreatitis but potentially fatal thus recognition of drug induced pancreatitis and definitive withdrawal of the drug is required.

Acute Pancreatitis in the Course of Meprobamate Poisoning

CONTEXT We report a case of massive poisoning with meprobamate leading to acute pancreatitis. CASE REPORT A 43-year-old patient with a history of schizophrenia and multiple suicide attempts was admitted to the intensive care unit for severe poisoning with meprobamate (voluntary ingestion of 60 g). On admission, the patient was deeply comatose with low blood pressure and hypothermia. Laboratory analysis revealed leukocytosis and high lipase and amylase serum levels. There was no eosinophilia. Abdominal computed tomography showed pancreatitis grade A. The patient was intubated and ventilated, and intravenous dopamine was infused. The patient regained consciousness and was extubated five days later. Improvement in pancreatic tests was noted several days later. The outcome was favorable. DISCUSSION According to the Naranjo probability scale, meprobamate-induced acute pancreatitis was probable. Acute pancreatitis in meprobamate poisoning is exceptional. The pathogenesis of pancreatitis-induced meprobamate poisoning may be explained by two mechanisms: stimulation of pancreatic secretion secondary to cholinergic activation and pancreatic ductal hypertension. CONCLUSIONS The signs of severe meprobamate toxicity are numerous including cardiovascular and central nervous symptoms. Acute pancreatitis should also be added as a possible manifestation of meprobamate poisoning.

Fulminant Hepatitis Possibly Related to Pizotifen Therapy

1. Lange R, Volkmer M, Heesen C, Liepert J. Modafinil effects in multiple sclerosis patients with fatigue. J Neurol 2009;256:645-50. DOI 10.1007/s00415-009-0152-7 2. Lou JS. Physical and mental fatigue in Parkinson’s disease: epidemiology, pathophysiology and treatment. Drugs Aging 2009;26:195-208. DOI 10.2165/00002512-200926030-00002 3. Blackhall L, Petroni G, Shu J, Baum L, Farace E. A pilot study evaluating the safety and efficacy of modafinal for cancer-related fatigue. J Palliat Med 2009;12:433-9. DOI 10.1089/JPM.2008.0230 4. Fava M, Thase ME, DeBattista C, Doghramji K, Arora S, Hughes RJ. Modafinil augmentation of selective serotonin reuptake inhibitor therapy in MDD partial responders with persistent fatigue and sleepiness. Ann Clin Psychiatry 2007;19:153-9. DOI 10.1080/10401230701464858 5. Roth T, White D, Schmidt-Nowara W, et al. Effects of armodafinil in the treatment of residual excessive sleepiness associated with obstructive sleep apnea/hypopnea syndrome: a 12-week, multicenter, double-blind, randomized, placebo-controlled study in nCPAP-adherent adults. Clin Ther 2006;28:689-706. DOI 10.1016/j.clinthera.2006.05.013 6. Czeisler CA, Walsh JK, Wesnes KA, Arora S, Roth T. Armodafinil for treatment of excessive sleepiness associated with shift work disorder: a randomized controlled study. Mayo Clin Proc 2009;84:958-72. DOI 10.4065/84.11.958 7. Mendoza T, Wang X, Cleeland C, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 1999;85:1186-96. DOI 10.1002/(SICI)1097-0142(19990301)85:5<1186::AID -CNCR24> 3.0.CO;2-N