Paranoia Erotica (Clerambault Syndrome) Successfully Treated with Risperidone

Abstract

Spiramycin-induced liver injuryTO THE EDITOR: Spiramycin, a 16-membered lactone ring macrolide antibacterial, is well tolerated, with few adverse effects. Isolated cases of hepatitis attributed to this drug have been published. 1-3 This report highlights a case of liver abnormality associated with spiramycin use.Case Report. A 58-year-old woman was started on spiramycin 3 million units 3 times daily for symptoms of lower respiratory tract infection. After the first day of treatment, the patient started complaining of abdominal pain, nausea and vomiting, and became jaundiced. Generalized edema developed by the time she received the fourth dose. She discontinued the drug, and a physician was consulted. Physical examination revealed hepatomegaly, with laboratory measurements showing elevated serum concentrations of bilirubin (14.9 mg/dL), aminotransferases (aspartate aminotransterase 315 U/L, alanine aminotransferase 421 U/L), alkaline phosphatase (482 U/L), and γ-glutamyl transferase (494 U/L). Markers of hepatitis A, B, and C were negative, as well as cytomegalovirus and Epstein-Barr virus. The consulting physician diagnosed the patient as having liver injury.The woman denied alcohol consumption, smoking, and receiving other prescription or over-the-counter drugs except for acetaminophen, which was rarely needed. Herbal or homeopathic remedies, recent blood transfusion, or exposure to toxic chemicals were also ruled out. She did drink coffee.After spiramycin was discontinued, the patient's clinical symptoms improved gradually over the following 4 weeks. Two months after the onset of the liver syndrome, the patient became asymptomatic, and laboratory values returned to normal. Liver biopsy was not performed upon her request.