Multiple drugs

Abstract

Multiple drugs Retroperitoneal-fibrosis, vomiting and diarrhoea: case reportA 41-year-old woman developed retroperitoneal fibrosis following treatment with caffeine/ergotamine/paracetamol/ prochlorperazine for migraine. She also developed vomiting and diarrhoea following treatment with mycophenolate mofetil for retroperitoneal-fibrosis [not all routes and dosages stated].The woman, who had a history of migraine for 20 years, presented with dull aching diffuse pain abdomen for 1 year. Ultrasonography (USG) of abdomen and pelvis findings showed an ovarian cyst. Hence, she had a hysterectomy and bilateral salpingooophorectomy. However, after the procedure, she experienced vomiting on the seventh day. Hence, a non-contrast-enhanced computerised tomogram scan (NCCT) of the abdomen was performed; it revealed diffuse omental thickening in subhepatic, infraumbilical, left iliac fossa, and pelvic region with mild thickening of peritoneal layer. Mild to moderate ascites with mild bilateral hydronephrosis, and mild thickening of ascending colon and prepyloric region with lymphocyte rich effusion was noted. Therefore, she was treated with antitubercular therapy (ATT) for 3 months with no improvement, and vomiting persist. In further investigation, the tuberculosis test showed a negative result, and cancer antigen 125 was noted as elevated. Exploratory laparotomy of the abdomen was observed in the diagnostic dilemma. Omentum was noted adhered to the pelvis and anterior abdominal wall on multiple bands. She underwent numerous laboratory tests and biopsies, which confirmed the diagnosis of retroperitoneal-fibrosis. Upon further inquiry, it was found that for the last 20 years, she was treated with caffeine/ergotamine/paracetamol/prochlorperazine [vasograin] for migraine. Later, it was confirmed that retroperitoneal-fibrosis was attributed to ergotamine, and caffeine/ergotamine/ paracetamol/prochlorperazine was discontinued. Subsequently, she started receiving treatment with prednisolone and mycophenolate mofetil 2 gm/day tablet. However, she experienced recurrent vomiting and diarrhoea after twelve weeks, for which mycophenolate-mofetil was considered as the culprit. Hence, mycophenolate-mofetil was discontinued. The dose of prednisolone tapered slowly, and tamoxifen was given as a steroid-sparing agent. After 2.5 years, an MRI scan was performed; it showed no significant retroperitoneal soft tissue thickening; the normal course of the ureters, and a gradual decrease in hydronephrosis. She remained on prednisolone and tamoxifen with no abnormal metabolic activity [times to reactions onsets not stated].