Penicillamine 250mg/5ml oral solution

Metamizole is an analgesic widely used after its introduction but later withdrawn in several countries due to the risk of agranulocytosis. Despite this, it remains frequently used worldwide. In June 2024, the Pharmacovigilance Risk Assessment Committee began reviewing metamizole-containing medicines. To assess the current evidence on this risk, we conducted a systematic review and a pharmacovigilance study using EudraVigilance to analyze data cases of agranulocytosis potentially associated with metamizole. In the systematic review, only 14 studies met our inclusion criteria, comprising case-control studies, registry-based descriptive analyses, and two pharmacovigilance studies. Current evidence on metamizole-induced agranulocytosis remains inconclusive. In our pharmacovigilance analysis (from 2003 to 2024), a total of 2244 reports were related to cases of agranulocytosis, of which 1397 (62.3%) related to female and adult patients 1148 (51.2%). The reporting odds ratio (ROR) with a 95% confidence interval (95% CI) showed a higher likelihood of reporting agranulocytosis with metamizole compared to clozapine (ROR: 5.50, 95% CI 5.18-5.82), sulfasalazine (ROR: 7.31, 95% CI 6.58-8.14), penicillamine (ROR: 34.4, 95% CI 11.70-167.89), and NSAIDs (ROR: 41.7, 95% CI 38.24-45.52). Our results confirm an increased likelihood of reporting agranulocytosis with metamizole. Given this risk and the availability of safer, effective alternatives, further research is needed.

Abstract licence: CC BY-NC-ND

Introduction: Wilson's disease (WD) and autoimmune hepatitis (AIH) are important causes of acute and chronic hepatitis; each can lead to serious complications. The coexistence of these two diseases in the same patient is rare and poses significant diagnostic and therapeutic challenges. The pathophysiological mechanism in WD involves hepatocellular necrosis and the exposure of intracellular antigens to the immune system, resulting in the production of low-titer autoantibodies, which may be misleading and complicate the differentiation between WD and AIH. Case Presentation: We report the case of an 11-year-old girl admitted with abdominal pain, fatigue, and scleral jaundice. Physical examination revealed mild hepatomegaly without splenomegaly. Laboratory investigations were consistent with Wilson's disease, and treatment with D-penicillamine was initiated. The initial clinical course was favorable; however, six weeks later, the patient again presented with acute hepatitis. A liver biopsy with histochemical analysis revealed findings highly suggestive of both Wilson's disease and autoimmune hepatitis, confirming a dual diagnosis. Conclusions: The overlap of clinical and biochemical features between AIH and WD can delay accurate diagnosis and treatment, potentially affecting patient outcomes. Although the coexistence of Wilson's disease and autoimmune hepatitis in the same child is rare, clinicians should maintain a high index of suspicion, given the complex management and the risk of complications associated with both disorders.

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Acute arsenic poisoning, a life-threatening condition, results from exposure to inorganic arsenic compounds such as arsenic trioxide (As2O3). This case report describes a 27-year-old male who ingested 25 g of As2O3 and presented with severe gastrointestinal (GI) toxicity and acute kidney injury. Management involved airway protection, GI decontamination with activated charcoal, chelation therapy using D-penicillamine, and supportive care including N-acetylcysteine (NAC) and dialysis for renal failure. GI endoscopy revealed diffuse mucosal ulceration consistent with arsenic's corrosive effects. The patient recovered following three sessions of sustained low-efficiency dialysis and was discharged with improved renal function. This case highlights the critical role of prompt supportive management, chelation, and hemodialysis in arsenic poisoning. It also highlights novel use of NAC as an adjunctive therapy and the importance of monitoring multi-organ involvement for improved outcomes.

Abstract licence: CC BY-NC-ND