Clinical medicine (London, England)
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Vaccine-induced thrombosis with thrombocytopenia (VITT) is a recently-described condition associated with arterial and venous thrombosis following vaccination with the ChAdOx1 nCoV-19 (AstraZeneca) vaccine. This report describes two cases of stroke caused by arterial and venous thromboses presenting within 28 days of receiving the AstraZeneca vaccine. ⋯ Both cases had measurable immunoglobulin G platelet factor-4 antibodies detected via enzyme-linked immunosorbent assay, similar to those described in heparin-induced thrombocytopenia. These cases illustrate that physicians should be especially mindful of VITT in the context of evolving evidence on treatment and in view of the potentially rapid and catastrophic neurological deterioration, leading to fatality despite best supportive care.
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Case Reports
Lessons of the month 2: A case of inappropriate drug-drug interaction in kidney transplant.
Carbamazepine remains a first-line antiepileptic medication for the treatment of partial seizures. Despite its widespread use, carbamazepine has significant neurotoxicity and hypersensitivity reactions. We report a case of a patient post-kidney transplant who was on regular carbamazepine for childhood epilepsy and developed nystagmus, diplopia and a broad-base gait after receiving diltiazem. Understanding of the interaction between diltiazem and carbamazepine is necessary to prevent the neurotoxic effects.
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Case Reports
Images of the month 1: Histoacryl glue embolisation to the right ventricle following treatment for gastric varices.
A 46-year-old woman presented with decompensated liver disease. Upper gastrointestinal endoscopy demonstrated a gastric fundal varix with stigmata of recent bleeding. She was treated with Histoacryl glue and lipiodol injection. ⋯ The mass was initially assumed to be thrombus, but as the clinical story did not fit with this, she had further investigations. Computed tomography found the mass to be very radio-opaque with embolisation into the right lung. This is a rare appearance of glue embolisation, a recognised complication of treatment with Histoacryl glue.