Reactions 1704, p340 - 2 Jun 2018 Various toxicities: case report A 6-month-old girl developed a slight increase in serum creatinine and cystatin C levels during compassionate use of serelaxin, and developed vasoplegia and poor perfusion during treatment with teicoplanin [duration of treatment to reactions onsets and outcomes not stated; not all routes and dosages stated]. The girl with dilated cardiomyopathy presented to the hospital due to cardiac arrest in context of an upper respiratory tract infection. Immediately, she received high dose of epinephrine. Additionally, lactic acidosis with reduced left ventricular ejection fraction was noted. Treatment with dobutamine, milrinone and levosimendan was initiated with an extracorporeal membrane oxygenation (ECMO). Over two weeks, the left ventricular function improved; however, ECMO was continued. Hence, she was listed for heart transplantation. Twenty days later, persistent left ventricular dysfunction was noted. Hence, she was started on compassionate use of serelaxin infusion 10 µg/kg/day for 4 hours followed by 30 µg/kg/day for 44 hours. During serelaxin infusion, an improvement in left ventricular dilatation, ejection fraction and decreased brain natriuretic peptide were noted. A slight increase in serum creatinine and cystatin C was also noted, which was considered to be related to serelaxin. On day 23, the girl’s ECMO support was discontinued following 24 hours of the serelaxin infusion. Both left ventricular function and ejection fraction improved. For the next 10 days, she was stable. Eventually, she developed Staphylococcus epidermidis sepsis. The inotropic support was increased. She received treatment with epinephrine, digoxin and unspecified empirical antibiotics. An acute worsening of the left ventricular distension was noted. Hence, 23 days following the cessation of ECMO, a second course of serelaxin infusion was started. For 48 hours, serelaxin was well tolerated with an improved left ventricular distension and ejection fraction. Prior to an hour of the completion of second serelaxin infusion course, she received teicoplanin for persistent Staphylococcus epidermidis sepsis. Immediately, she developed vasoplegia and poor perfusion, which were considered to be related to teicoplanin. Therefore, vasopressor support was increased, but she required ECMO support. Four days later, she died due to intractable Staphylococcus epidermidis sepsis from cellulitis and fasciitis around left axillary venous line of an unknown aetiology. Author comment: "[S]he received teicoplanin for persistent Staphylococcus epidermidis sepsis and immediately presented with vasoplegia and poor perfusion." "In our patient, serelaxin administration coincided. . .and was associated with a slight increase in serum creatinine and cystatin C." Myers PO, et al. Serelaxin for infant heart failure in congenital dilated cardiomyopathy. Cardiology in the Young 28: 734-736, No. 5, May 2018. Available from: URL: http://doi.org/10.1017/S1047951117002797 - Switzerland 803323921 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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