Multiple drugs

Abstract

Multiple drugs Various toxicities: case reportAn approximately 33-year-old man developed focal segmental glomerulosclerosis (FSGS) and arterial hypertension following treatment with anastrozole and impaired fasting glucose following treatment with methylprednisolone and prednisone for FSGS and off-label treatment with dexamethasone for .The man presented to hospital at the age of 34 years due to mild diarrhoea, headache, fever, intermittent pain in his both lumbar and right hypochondriac areas, cough, fatigue, dyspnoea on exertion, ageusia and anosmia. At the presentation, his polymerase chain reaction was negative for COVID-19 and amoxicillin/clavulanate was initiated as per consultation. Subsequently, he underwent further evaluation due no improvement in his condition. His urine strip test two days prior to the presentation revealed 3+ protein and a blood test revealed high serum creatinine. He had further increase in the serum creatinine after presentation and urinalysis revealed protein level at 10.2 g/L along with urinary sedimentation of single hyaline-granular and granular casts and renal tubular epithelial cells. He also had mild hyponatraemia and serious hypoalbuminaemia. His aspartate transaminase (AST) and serum C-reactive protein (CRP) were found to be elevated. One year prior to the presentation, he was admitted to the hospital at the age of approximately 33 years due to acute kidney injury and acute heart failure with hypertension. At that time, his health manifested with proteinuria, fluid retention, oedema, increased serum creatinine, decreased left ventricle ejection fraction and concentric hypertrophy. He had been taking unspecified anabolic steroids for body building and had been receiving anastrozole. Subsequently, the man started receiving indapamide, ramipril followed by perindopril, nebivolol and amlodipine and discharged to home. After the presentation, his repeated test for SARS-CoV-2 showed positive result and a diagnosis of COVID-19 was made. Thereafter, he was shifted to nephrology department, where he excreted 1000-1500mL of urine every day for next two days. Thus, multi-electrolyte fluid was given and his body temperature was managed with dipyrone [metamizole]. Additionally, pantoprazole was given for ulcer prophylaxis and ceftazidime and levofloxacin were given for suspected bacterial infection. Indapamide and perindopril were stopped. But, his general condition further worsened and he experienced type I respiratory failure due to COVID-19 pneumonia. Thus, off-label treatment with two units of convalescent-anti-SARS-CoV-2-plasma [COVID-19 convalescent plasma] were given for COVID-19 and he started receiving off-label treatment with IV dexamethasone for COVID-19 pneumonia. Thereafter, he was shifted to the ICU, where ventilation support was provided and enoxaparin-sodium [enoxaparin], colecalciferol [cholecalciferol], fluconazole, torasemide, morphine and IV fluids were added to the therapy. He remained less hypoxemic for the next four days. After treatment of seven days in the ICU, ...