Presumed isotretinoin-induced, concomitant autoimmune thyroid disease and ocular myasthenia gravis: a case report (original) (raw)

Ocular myasthenia gravis and auto-immune thyroiditis in children

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2005

A 7-year-old girl presented at a university hospital with ptosis of the left eye. This resolved spontaneously within 4 weeks but then the right eye became similarly affected but responded to prostigmine. Left hypertropia with restriction of the right inferior rectus, mild exophthalmos, non-tender diffuse enlargement of the thyroid, normal thyroid function tests, anti-thyroglobulin, and anti-microsomal antibodies indicated an association of autoimmune thyroiditis and ocular myasthenia. The ptosis was remedied with pyridostigmine and short-course oral prednisolone, but the hypertropia persisted.

Isotretinoin-Induced Facial Hyperpigmentation: Idiosyncratic Reaction?

Journal of Dermatologic Research And Therapy, 2015

Isotretinoin is notorious for having a myriad of mucocutaneous side effects including cheilitis, xerodermia, facial erythema, pruritis, hair thinning, and brittle nails, among others. Although photosensitivity is considered to be one of the side effects of oral isotretinoin therapy, cutaneous hyperpigmentation has not, to the best of our knowledge, yet been reported as a side effect. This report presents a case of striking facial hyperpigmentation in a patient on oral isotretinoin.

Drug-induced ocular side-effects with isotretinoin

Ophthalmic and Physiological Optics, 2008

Whereas there are numerous reported ocular side-effects from isotretinoin medication, we present the first case report of corneal steepening after systemic treatment with isotretinoin for seven and a half weeks. The case was associated with a significant drop in visual acuity which could not be explained from the refractive error change. All signs and symptoms were absent seven and a half weeks after the medication was withdrawn. The case indicates that eye care professionals need to be vigilant about the possibility of adverse ocular manifestations associated with the use of systemic medications.

The evaluation of isotretinoin induced adverse drug reactions

2011

Adverse drug reactions (ADRs) are a major cause of morbidity and mortality and have become one of the major health problems. So assessment, detection and monitoring of ADRs allow us to prevent and manage ADRs. Currently, isotretinoin is the effective therapy for the treatment of severe recalcitrant nodular acne unresponsive to conventional therapy. It can cause severe adverse reactions and teratogenic effects. So, we conducted this study to assess the rate and pattern of isotretinoin ADRs. The causality and seriousness of ADRs was also evaluated. All the patients using isotretinoin from July 2007 to January 2008 were followed up to detect ADRs. Patient demographics, drug history and the dose of isotretinoin used were recorded. A total of 239 patients using Isotretinoin were entered in the study. More than 90% of patients reported at least one ADR. The most affected system organ was the skin and appendages disorders (91%) with dried lips as the most frequent adverse effect. In this study, we could show there was no significant relationship between the incidence of isotretinoin ADRs with patients' sex, age, weight, dose and treatment period of isotretinoin. It seems that the incidence of isotretinoin ADRs is not dose-depended. However, more large and well-designed studies are needed to confirm these finding.

Prevalence and impact of autoimmune thyroid disease on myasthenia gravis course

Brain and Behavior, 2016

Objectives: Autoimmune thyroid diseases (ATDs) frequently accompany myasthenia gravis (MG) and may influence its course. We aimed to determine the association and impact of ATD with early-(<50 years), late-onset MG, or thymoma-MG. Materials and Methods: Prevalence of ATD was measured in a cross-sectional study of 343 consecutive patients with MG (236 F, 107 M) aged 4-89 years; 83.8% were seropositive, in 2.9%, anti-MuSK antibodies were detected. Concentrations of antithyroid peroxidase antibodies, antithyroglobulin antibodies, antithyrotropin receptor antibodies, and TSH level were measured in all patients. MG clinical course, treatment received, and treatment results were evaluated. Results: Autoimmune thyroid diseases were diagnosed in 92 (26.8%) of MG patients including 4.4% with Graves (GD), 9% with Hashimoto thyroiditis (HT), and 13.4% with antithyroid antibodies only. GD patients had ocular symptoms more often than patients with antithyroid antibodies or HT (p = .008). ATD prevalence was comparable in MG with early and late onset, while non-ATDs were more frequent in thymoma-MG (p = .049). Immunosuppressive therapy was less frequently needed in the patients with MG and ATD, indirectly indicating milder MG course (p = .005). Risk of myasthenic crisis and the results of treatment did not differ between patients with and without ATD. Conclusions: Autoimmune thyroid diseases are frequently accompanied by early-and late-onset MG, while thymoma-MG is related to higher risk of non-ATD. Myasthenia coexisting with ATD follows milder course than MG alone.

Two new adverse effects of isotretinoin

British Journal of Dermatology, 2003

Two new adverse effects of isotretinoin SIR, Retinoids, both naturally occurring and synthetic, are vitamin A derivatives. The widespread use of retinoids requires that not only dermatologists but also physicians must be aware of the wide spectrum of adverse reactions that may develop in patients receiving retinoids. Isotretinoin is a first-generation synthetic vitamin A derivative that is widely used orally. Adverse reactions involving skin and mucous membranes, cardiorespiratory, gastrointestinal, genitourinary, nervous and musculoskeletal systems, eyes and ears, have been the most commonly reported side-effects. 1-4 Pregnant women must be also cautious of isotretinoin intake. 5 Haematopoietic and lymphatic complications have also been described. 1,3,6 We report two new adverse effects observed in an 18-yearold caucasian man who had been taking isotretinoin 1 mg kg)1 daily for severe acne for 3 months. His medical history was noncontributory and he had not had any previous relevant illness. He was admitted to our hospital complaining of fever, headache, rigidity of the neck and limbs, masseter twitch and diffuse myalgias mainly localized at the buttocks and lumbar areas. At admission his acne severity was Erosive pustular dermatosis of the scalp successfully treated with calcipotriol cream SIR, A 95-year-old woman, resident in a home for the elderly, presented with a thickly crusted area on her frontal scalp. This area had been injured 2 years previously when she had fallen out of bed and hit her head. According to her clinical notes, following the injury she had a superficial abrasion that did not require suturing, and a haematoma. The skin initially healed but subsequently became red and irritable and broke down repeatedly. Treatment with topical antibiotics (fusidic acid cream and mupirocin ointment) and systemic antibiotics (flucloxacillin and ciprofloxacillin) was unsuccessful and the area involved extended gradually. Eventually a thick crust formed and the patient was referred for dermatological review with a suspected diagnosis of skin malignancy. Examination showed an approximately 10 • 10 cm thickly crusted area of alopecia over the frontal scalp. Gentle removal of the crust revealed a moist, atrophic surface with prominent