Current Drug Safety - Volume 18, Issue 4, 2023

Introduction: Pleural effusions can be caused by several conditions such as cancer, connective tissue disease, and infection. They are occasionally caused due to the adverse drug reaction. Most commonly, systemic minoxidil use can cause pleural effusions in patients with chronic kidney disease. Case Presentation: We present a case of a patient without chronic kidney disease who developed pleural effusion as a result of unintentional use of topical minoxidil orally. The patient's oxygen saturation was 90% on room air; there was dullness to percussion and asymmetrical chest expansion with diminished air entry on both sides. In chest x-ray there were bilateral pleural opacities. Minimal pleural effusions were shown in ultrasonography of the chest. The patient was managed with diuretics and airway management which resolved completely. Conclusion: Minoxidil is a commonly used drug by many people for the treatment of hair fall with or without doctor advice. We would like to stress that even though rare, physicians/pulmonologists should be aware of the rare side effects of topical minoxidil, and it should be kept in mind as a differential diagnosis for pleural effusion.

Introduction: Hemifacial spasm represents segmental myoclonus of muscles innervated by the facial nerve, which is usually and successfully treated with botulinum toxin. Botulinum toxin (BTX) acts as an acetylcholine release inhibitor at presynaptic cholinergic junctions and therefore is considered contraindicated (or administrable with caution) in patients with neuromuscular disorders like Myasthenia Gravis (MG). Moreover, to date, the association of hemifacial spasm and ocular MG is extremely rare and only a few cases have been described. Case Presentation: We report the case of a 73 years old man with a 3-year history of ocular MG who developed a left hemifacial spasm. The patient underwent hemispasm, treatment with BTX type A (abobotulinum toxin-A, total dose of 50 IU) that resulted in safe and successful 6 months re-evaluation. Conclusion: Our results suggest that in selected cases with concomitant MG and conditions characterized by orbicularis oculi spasms or hemispasm, BTX therapy may not be contraindicated and could be given at longer intervals due to prolonged effects.

Background: Patients with Cohn’s disease (CD) treated with thiopurines are at an increased risk of developing cancer. Leukemias are less frequent than other hematopoietic tumors and the development of Chronic myeloid leukemia (CML) after immunosuppression has not been proven. Case Report: We describe the case of a 61-year-old female who developed a CML after 8 years of treatment with azathioprine (AZA) for ileal Crohn’s disease associated with a duodenal localization. We reviewed the current evidence on the interactions between CD, CML and AZA as well as the potential underlying mechanisms of leukemia in AZA-treated patients. Conclusion: We concluded that the pathogenesis of CML is multifactorial in CD. The nature of the association between AZA and CML in CD patients warrants further investigation.

Introduction: Allergic rhinoconjunctivitis and asthma are the most common IgE-mediated diseases worldwide. Allergen-specific immunotherapy (AIT) is currently the only modifying treatment for these IgE-mediated diseases in both children and adults. Subcutaneous immunotherapy is widely used, but in patients over 65 years old, there may be an increased risk of adverse reactions and a worse response to treatment. Oral immunotherapy (OIT) has been proven to be effective and safe, but currently, in most countries, it has been licensed only for patients up to 65 years old based on its technical datasheet. So far, no studies on the efficacy and safety of this type of immunotherapy in patients older than 65 years old have been published. Case Presentation: We present four patients older than 65 years old with a diagnosis of moderate seasonal rhinoconjunctivitis and moderate-persistent seasonal pollen-induced asthma. Off-label use of oral immunotherapy (OIT) for grass pollen was prescribed due to the severity of their rhinoconjunctivitis symptoms and the worsening of asthma symptoms during the spring. Improvement in the rhinoconjunctivitis and asthma symptoms was reported by all patients since the first spring season and was maintained during the following two years of follow-up. There were no systemic reactions, and only two patients initially had self-limiting oral pruritus. Conclusion: Oral immunotherapy for pollens appears to be a convenient, effective, and safe option in older patients (>65 years) with comorbidities after a three-year treatment. This is, to the best of our knowledge, the first report on the off-label use of OIT in patients over 65 years old with symptoms of allergic rhinoconjunctivitis and asthma.

Background: The world has seen nearly 2 years of a pandemic caused by the SARS-CoV-2 virus, notoriously known as COVID-19. Several vaccines have been approved under Emergency Use Authorization (EUA) to combat the disease, one of which is Covaxin, an inactivated adjuvant SARSCoV- 2 vaccine that is generally well tolerated and has fewer side effects. However, we recently have seen a rare case of facial palsy (paralysis) following Covaxin vaccination in an adolescent girl. Case Presentation: A 16 years old adolescent girl presented with chief complaints of left side deviation of mouth with difficulty in closing right eye after 29 days of receiving the first dose of Covaxin, which was finally diagnosed as a "Covaxin induced facial palsy". Her symptoms were alleviated with some supportive measures, steroid and antiviral treatment, with full recovery. Conclusion: The case depicts facial nerve paralysis following Covaxin use, possibly the first of its kind. This case illustrates plausible explanation to Covaxin use and occurrence of facial palsy, however, further studies required to establish causal relationship.