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Biomedical subjects

Giulio Cesare Nicotra

Publications and source records attributed to Giulio Cesare Nicotra.

17 recordsLinked to original sources
PubMed2004

Severe acquired hemophilia with factor VIII inhibition associated with acetaminophen and chlorpheniramine.

OBJECTIVE: To report a case of acquired hemophilia with a high-titer factor VIII inhibitor associated with the use of acetaminophen and chlorpheniramine in combination. CASE SUMMARY: An 83-year-old woman presented with a severe bleeding disorder 2 weeks after she was prescribed acetaminophen and chlorpheniramine for treatment of a flu-like illness. Laboratory studies showed severe anemia with greatly reduced factor VIII activity and the presence of a high-titer factor VIII inhibitor at 228 Bethesda units. Treatment with high-dose corticosteroids, transfusion of several units of red blood cells, and repeated infusions of factor VIII bypassing activity was successful. Complete clinical and laboratory remission was achieved after 4 weeks of treatment. Use of the Naranjo probability scale suggested a possible association between this adverse event and treatment with acetaminophen and chlorpheniramine. DISCUSSION: Acquired hemophilia due to factor VIII inhibitor(s) has been associated with the use of drugs such as thioxanthenes, interferon, and fludarabine. As of this writing, to the best of our knowledge, no other case has been reported among patients receiving acetaminophen or chlorpheniramine. CONCLUSIONS: We suggest that acquired hemophilia due to factor VIII inhibitor(s) should be considered in the appropriate setting when patients present with unexplained and even minor bleeding while on treatment with acetaminophen or chlorpheniramine alone or combined.

Acetaminophen↗
PubMed2003

Kikuchi Fujimoto lymphadenitis: case report and literature review.

We describe a young woman with two severe episodes of Kikuchi Fujimoto disease occurring 16 years apart. Both episodes were proven by biopsy, and on the second occasion the patient remained dependent on high-dose prednisone for more than 6 months in order to control inflammation and achieve a reduction in cervical lymph node size. The second lymph node biopsy showed leukocytoclastic vasculitis in addition to the typical features of Kikuchi Fujimoto disease, but, even though the clinical interpretation of this finding was unclear, we documented no clinical or laboratory evidence of the development of other serious systemic disease over 20 years of follow-up. Kikuchi Fujimoto disease is considered a disorder with a self-limited course and a favorable outcome. However, on the basis of our experience with this patient and data from peer-reviewed literature, we suggest that this generally accepted postulate should be revised.

Adult↗
PubMed2003

Jaundice and the sepsis syndrome: a neglected link.

The relationship between the sepsis syndrome and the development of jaundice is intriguing, with jaundice having been described as the presenting sign of septicaemia in very few cases. We describe a patient who developed a deep jaundice with conjugated hyperbilirubinaemia caused by Staphylococcus aureus during the early course of septicaemia, when no other sign of the sepsis syndrome could be recognised. It is generally accepted that a mild jaundice may complicate the course of the sepsis syndrome, but it is most unusual to observe such a protracted phase of jaundice before the emergence of other specific clinical signs and laboratory abnormalities. Clinicians should be aware of this presentation of the sepsis syndrome in order to avoid a potentially harmful delay in diagnosis and treatment.

Journal Article↗
PubMed2003

[Primary plasma cell leukemia. A fulminant case].

Primary plasma cell leukemia is a rare variant of malignant monoclonal gammapathies with de novo presentation in the leukemic phase. Only few series enrolling more than 20 patients have been reported in the literature. The authors deal with a patient who had a fulminant presentation of primary plasma cell leukemia with fatal outcome. Diagnosis of primary plasma cell leukemia was established based on Kyle's criteria, which include an absolute plasma cell count greater than 2 x 10(9)/L or a relative plasma cell number comprising greater than 20% of peripheral blood cells. The patient died within three days of diagnosis because of Streptococcus pneumoniae septic shock and multiple organ failure. This case report is worth of note due to the rarity of primary plasma cell leukemia and also because fulminant presentation is not commonly recognized among patients with malignant gammapathies.

Aged↗
PubMed2002

Catastrophic antiphospholipid syndrome in a patient with Behçet's disease.

We report on a patient who had a life-threatening relapse of Behçet's disease associated with a catastrophic antiphospholipid syndrome. The patient experienced over a short time a recurrent acute myocardial infarction, multiple venous thromboses, uveitis, and erythema nodosum. Search for thrombophilic factors was positive only for lupus anticoagulant (LAC) and criteria for the diagnosis of the antiphospholipid antibody syndrome were fulfilled. LAC was not found three months after the discharge. At that time the patient had no evidence of clinically active disease or thrombosis. We suggest that LAC was the main triggering factor for the repeated thromboses in this patient.

Acute Disease↗
PubMedDate not supplied

Flutamide-associated acute liver failure.

The nonsteroidal antiandrogenic drug flutamide [4'-nitro-3'-(trifluoromethyl)isobutyranilide] is a safe and generally well-tolerated drug used for the treatment of prostate cancer. We describe the case of a 74-year-old male who developed life-threatening acute liver failure during flutamide therapy. Other causes of acute liver failure were appropriately ruled out and there was no evidence of active prostate cancer or liver metastases. The use of the Naranjo probability scale indicated a highly probable relationship between the development of acute liver failure and flutamide therapy. Severe liver dysfunction has been rarely documented in patients treated with flutamide, even though cases of fulminant liver failure have been described. A few cases have been reported also among patients with hirsutism being treated with flutamide. The mechanisms responsible for the occurrence of hepatotoxicity during treatment with flutamide are unknown. Mitochondrial dysfunction seems to be implicated. The potential of flutamide to act as a potent hepatotoxin should be borne in mind when treatment with this drug is being planned.

Acute Kidney Injury↗