Reactions 1334 - 15 Jan 2011

STheophylline

Seizures with postictal fever and leucocytosis in anelderly patient: case report

A 70-year-old man developed seizures with postictal feverand leucocytosis during treatment with theophylline.

The man, who had a history of hypertension, gastric ulcerand chronic obstructive pulmonary disorder, was receivingtheophylline 400 mg/day [route not stated], cimetidine andlosartan. He was admitted following a left hemiconvulsionlasting for 2 hours [duration of therapy to reaction onset notstated]. On examination, he had a BP of 216/100mm Hg, anirregular heart rate of 145/min, a body temperature of 36.3°C,impaired consciousness, left conjugate eye deviation, andtonic-clonic seizure of the left side of his body.

The man was given diazepam, and his seizures stopped.Laboratory tests revealed abnormal haematology and liverfunction. He had a theophylline concentration of 21.8 ng/mL. Ahead MRI showed high intensity signal on diffusion weightedimaging in the right singular gyrus, right insula and rightthalamus. Theophylline, losartan and cimetidine werestopped, and he received phenytoin, diltiazem, heparin andedaravone. Five and a half hours after his seizuresdisappeared, he had a fever in excess of 38°C. Vitamin Bcomplex was administered for possible theophylline-associated seizures. A lumbar puncture, on day 2, revealedleucocytosis [pleocytosis]. On day 3, he continued to have analtered level of consciousness, and was referred for furtherinvestigations. He was given midazolam, phenobarbital andcorticosteroids. On day 4, his fever rapidly resolved.Midazolam was discontinued, and his consciousness levelgradually recovered. On day 17, phenytoin was switched tocarbamazepine due to impaired liver function. He wasdischarged with no residual effects. At last follow-up, therewere no reports of seizure episodes, and his MRI abnormalitieshad disappeared.Yaguchi M, et al. A case of theophylline-associated seizures with postictal feverand postictal pleocytosis. Brain and Nerve 62: 1089-93, No. 10, Oct 2010[Japanese; summarised from a translation] - Japan 803048066

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Reactions 15 Jan 2011 No. 13340114-9954/10/1334-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved