What is known and objective: The clinical features of terlipressin-induced ischemic skin necrosis are unknown. The purpose of this study is to explore the clinical features of terlipressin-induced skin necrosis.Methods: We searched Chinese and English databases to collect case reports of terlipressin-induced skin necrosis for retrospective analysis.Results and discussion: A total of 42 patients (31 males and 11 females) from 35 studies were included, with a median age of 54 years (range 0.17-84). The onset of skin ischemia ranged from a few hours to 21 days. The most common clinical manifestations were bulla (15 cases, 35.7%), cyanosis (12 cases, 28.6%), necrosis (11 cases, 26.2%), and purpura (10 cases, 23.8%). The following were often affected: the legs (26 cases), 61.9%), abdomen (13, 31.0%), scrotum (10 cases, 23.8%), feet (10 cases, 23.8%), upper extremities (8 cases, 19.0%), and hands (7 cases, 16.7%).Skin biopsy showed fibrin thrombus (7 cases, 38.9%), nonspecific inflammation

Myasthenia gravis (MG) is a rare but life-threatening adverse event with pembrolizumab. What is known about pembrolizumab-induced MG is largely based on case reports. This analysis collected pembrolizumab-induced MG cases from Chinese and English databases published from September 1, 2014, to June 30, 2022. Demographic and clinical information of the patients, management, and outcome data were collected and analyzed. Sixty-five patients with a median age of 73 years (range 30- 86), including 43 male patients (66.2%), were included. Eight patients (12.3%) with prior MG experienced worsening symptoms after receiving pembrolizumab. The median time to the onset of MG was four weeks (range 0.7-27). The most common symptoms were ptosis (81.5%, 53 patients), diplopia (50.8%, 33 patients), dyspnea (44.6%, 29 patients), trunk or peripheral weakness (43.1%, 28 patients), and dysphagia (30.8%, 20 patients). Concurrent myositis and myocarditis occurred in 13 (20.0%) and 17 patients (26.2%). Pembrolizumab was discontinued in 63 patients (96.9%). Forty-four patients (67.7%) received combination therapies based on steroids (intravenous immune globulin, plasmapheresis, or immunosuppressants). Twenty-seven patients (41.5%) had symptoms completely recovered. Fourteen patients (21.5%) died from immunotoxicity or primary cancers. Clinicians should consider the possibility of pembrolizumab-induced MG, especially during the first eight weeks of therapy. Patients should be treated as early as possible, regardless of the severity of the initial symptoms.

Objective: Although Fanconi syndrome (FS) induced by valproate (VPA) has occasionally been reported, the detailed clinical features of the disease remain unclear. The aim of this study was to elucidate the clinical features of patients with VPA-induced FS. Methods:We searched Chinese and English databases for all original studies, clinical reports, and case reports on VPA-induced FS published before March .Results: A total of articles including patients ( males and females) were included. The patients had a median age of years (rangeyears), had severely disabled ( . %), tube feeding ( . %), and received an average of . medications other than VPA. The median duration of VPA treatment was years (range . -. ). Pathological fractures ( . %), unexplained fever ( . %), muscle weakness ( . %), and edema ( . %) were the most common symptoms, while patients were diagnosed in incidental laboratory tests. Blood tests revealed hypokalemia ( . %), hypophosphatemia ( . %), and hypouricemia ( . %). Urinalysis revealed glucosuria ( . %), proteinuria ( . %), generalized hyperaminoaciduria ( . %), β macroglobulin ( . %). Decreased percent total reabsorption of phosphate (%TRP) found in . % of patients, and increased fractional excretion of uric acid (FEUA) were found in % of patients. The median time to resolution of FS after discontinuation of drug therapy was months (range . -). Conclusions:The possibility of FS needs to be considered with long-term VPA administration, especially in young, tube-fed, severely disabled patients who are co-administered with anticonvulsants. Patients receiving VPA should have regular blood and urine tests. Abnormal laboratory values returned to normal levels after VPA discontinuation.

Background Neurotoxicity is a rare adverse event for ertapenem. Given the limited evidence, large patient data are needed to aid in the identification and management of this fatal complication. Aim of the review, we summarize the characteristics, risk factors, and treatment of ertapenem-induced neurotoxicity. Methods Pubmed, Web of Science, Embase, Cochrane library, Wanfang, CNKI, China VIP database were searched up from 31 October 2001 to 31 December 2022. All articles concerning neurotoxicity induced by ertapenem were included. The retrieved articles were screened by two experienced clinicians by reading the titles, abstracts, and full texts. Results A total of 66 patients were included, with a median age of 71.5 years (range 40–92), of whom 45 (68.2%) were male. Twelve patients (18.2%) received irrational doses (exceeding the recommended dose), and 30 patients (45.5%) had chronic renal insufficiency. The median time to symptom onset was 5 (range 1–14). Epileptiform seizures (42.4%), visual hallucinations (36.4%), altered mental status (25.8%), and confusion (22.7%) were the most common symptoms of ertapenem-induced neurotoxicity. Of the 29 patients with reported albumin levels, 25 had serum albumin <3.5 g/dl. Ertapenem was discontinued in 95.5% of patients, and 90.9% recovered completely. Median time to symptom recovery was 7 days (range 1–42) after intervention including antiepileptic administration, or hemodialysis. Conclusion Neurotoxicity is a rare adverse event for ertapenem, especially in patients with advanced age, renal insufficiency, pre-existing neurological disease, and hypoalbuminemia. This adverse reaction usually resolves with medication interruption, or antiepileptic administration and hemodialysis.

Objective: To analyze the characteristics and clinical manifestations of liver injury caused by vancomycin, and to provide reference for clinical medication. Methods: Patients with liver function injury who received vancomycin treatment in the Third Xiangya Hospital of Central South University and Hunan Maternal and Child Health Hospital from 2016 to 2021 were selected for retrospective analysis of their general situation, course of vancomycin, dose, liver function index, severity of liver injury, combined medication, etc. Results: Of the 4562 patients who received vancomycin, 17 patients were finally included, with an incidence rate of 0.37%. There were 12 males (70.6%) and 5 females (29.4%); age 17-84, average 45.41±20.405. All patients were evaluated with Naranjo’s score, score ≥3. The dosage, time and plasma concentration of vancomycin in patients were analyzed, 9 patients (52.94%) had abnormal liver function when they received vancomycin at the initial dose of 1g Q12h. 14 patients (82.35%) with liver injury were combined with 2 ~ 4 drugs, and severe liver injury occurred in patients who combined with 2 drugs. Occurrence time of liver injury was 2-12 days after the initiation of vancomycin, average 4.53±2.401 days, 16 patients (94.1%) showed abnormal liver function within 7 days after medication, and 2 patients with grade 3-4 liver injury all showed abnormal within 3 days after medication. Only 4 of the 17 patients (23.53%) had vancomycin blood concentration within the normal range, and no correlation was found between blood concentration and severity of liver injury. The correlation between the severity of liver injury and vancomycin was analyzed, none of the patients had allergies such as rash, 2 patients (11.76%) had jaundice and fatigue occurred in 5 patients (29.41%); the remaining 10 patients (58.82%) had no symptoms related to liver injury. All 17 patients showed abnormal AST/ALT, and 9 patients also showed abnormal bilirubin; 15 patients (88.24%) liver injury severity was grade 1, indicating mild hepatic impairment, and no correlation between liver injury severity and creatinine was observed. Among the 17 patients, 1 patient received no intervention, 4 patients stopped taking vancomycin after developing liver damage, and 1 patient reduced dose; 11 patients (64.7%) were treated with hepatinica. Conclusion: Although the study concluded that the incidence of liver injury was not high, the liver toxicity of vancomycin should still be paid attention to and the liver function indicators should be monitored during the clinical use of vancomycin.