Reactions 1704, p112 - 2 Jun 2018
Various toxicities: case report
A man in his late 40s [exact age at reaction onset not clearly
stated] developed anorexia, weight loss, nausea, malaise, liver
dysfunction and acute kidney injury during treatment with
clofazimine and tigecycline [dosages and duration of
treatments to reaction onsets not stated; not all routes stated].
The man underwent left total hip arthroplasty at the age of
48 years due to avascular necrosis of the left femoral head.
Two weeks following the surgery, he underwent an open
revision due to recurrent subluxation of the prosthesis.
Additionally, he had a medical history of gout. Within a month
of arthroplasty, he underwent trochanter advancement
osteotomy because of prosthesis dislocation. One year later,
he developed bulging cyst at the left hip, which was
considered as haematoma. However, non-tuberculous
mycobacteria (NTM) was cultured from the cyst fluid. Hence,
empirical treatment was initiated. Later, Mycobacterium
abscessus subspecies massiliense susceptible to clarithromycin
and tigecycline was isolated. After one month, he discontinued
anti-NTM treatment by himself. Few months later, he
developed recurrent pain of the left hip and draining sinus
tract. The pus grew Mycobacterium abscessus subspecies
massiliense. Thereafter, the prosthesis was removed and
treatment with IV tigecycline, clofazimine, clarithromycin and
amikacin was initiated. He discontinued the therapy due to
anorexia, weight loss, nausea, malaise, liver dysfunction and
acute kidney injury.
The man’s symptoms improved following the
discontinuation of clofazimine and tigecycline.
However, the same symptoms reappeared on re-challenge
with tigecycline and clofazimine. Thereafter, he was started on
oral suppressive anti-NTM therapy [final outcome not stated].
Author comment: "The patient again stopped anti-NTM
therapy due to nausea, malaise, anorexia, weight loss, acute
kidney injury and liver dysfunction. Symptoms improved after
discontinuing clofazimine and tigecyline. The same symptoms
appeared after rechallenge with clofazimine and tigecycline."
Wang L-S, et al. Incurable hip prosthesis infection due to Mycobacterium
abscessus subspecies massiliense. International Journal of Antimicrobial Agents 50
(Suppl. 2): S203 (plus poster) abstr. PS 356, Nov 2017. Available from: URL:
https://doi.org/10.1016/S0924-8579(17)30423-5 [abstract] - Taiwan
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved