| Autor: |
McCorry, L, Gray, A.P., Flannery, D., Collins, P, Devereux, C, Windrum, P, Gamble, Gareth, Toner, Emma, Chapman, Naomi, Convery, Rory, McKnight, J, Burns, J, McCann, S., Cousins, D, Kerr, E, Kayes, L, Comer, D, Sharkey, R, Kelly, MG, McCloskey, M, McDonald, S, McKee, N, Wright, G |
| Jazyk: |
angličtina |
| Rok vydání: |
2017 |
| Předmět: |
|
| Zdroj: |
The Ulster Medical Journal |
| ISSN: |
0041-6193 |
| Popis: |
A 78-year-old man with a long history of polyarteritis nodosa, ischaemic heart disease, chronic kidney disease and a cavitating lung lesion with mycobacterium malmoense was admitted with generalised muscular pain, fatigue, anorexia, decreased mobility and dizziness over the last month. His sputum had recently cultured aspergillus fumigatus and he had commenced on voriconazole six weeks prior. His maintenance therapy for polyarteritis was long term prednisolone and mycophenolate mofetil. His examination demonstrated that he was normotensive with generalised muscular tenderness, ankle oedema, an aortic murmur, bronchial breathing of the left upper lobe but was otherwise unremarkable with a normal postural blood pressure. Bloods demonstrated normal inflammatory markers, a new transaminitis, deteriorating renal function with urea of 37 and hyperkalaemia at 6.2, which required treatment. ANCA tests were negative. A synacthen test was inadequate with cortisol rising from 136 to 268 nmol/L at 30 minutes. Hypoadrenalism due to long-term steroid use was a working diagnosis. His prednisolone was increased to 20mg and he received intramuscular depomedrone 120mg. His voriconazole, mycophenolate and anti-tuberculous drugs were stopped 4 days post admission. He was discussed with renal who felt uraemia wasn’t driving his symptoms and agreed there was no evidence of vasculitis relapse. A random morning cortisol checked 12 days post admission was 463nmol/L. He could now mobilise independently and his renal/liver function returned to baseline. It was felt that the voriconazole was the culprit agent and he didn’t restart this on discharge, after consultation with respiratory. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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