Low-dose oral hydroxychloroquine led to impaired vision in a child with renal failure

Abstract

Introduction: Hydroxychloroquine (HCQ) has received much attention in the treatment of coronavirus disease 2019 recently. However, it can cause irreversible vision loss. Few cases have been reported in pediatric patient with HCQ-related adverse reactions. Appropriate administration and early disease recognition are important for reducing the adverse drug reactions of HCQ. Patient concerns: We report a case of a 14-year-old Chinese girl who sought treatment for rapidly decreasing vision in the left eye over 3 days. The simulation results of the population pharmacokinetic model of HCQ revealed that the plasma concentration of HCQ abnormally increased before the visual acuity of the eye decreased. Diagnosis: She was diagnosed as HCQ related drug adverse reaction. Interventions: The daily dose of HCQ for this patient was adjusted from 100 mg/d to 50 mg/d. Outcomes: Follow-up for 6 months showed no more vision loss recurrence. However, the existing decreased visual acuity of the eye did not recover either. Conclusion: Although decreased visual acuity is an infrequent symptom, ophthalmologists should be aware of the possibility of HCQ concentration enrichment and consider minimizing HCQ use when a child with renal hypofunction seeks treatment for shortsightedness.

Predicting Hydroxychloroquine Clearance in Healthy and Diseased Populations Using a Physiologically Based Pharmacokinetic Approach

“…Jallouli et al [37] analyzed the factors associated with drug concentration variability among SLE patients and found that renal dysfunction increased the systemic blood concentration of HCQ but was not significantly altered and was still in the therapeutic window. Moreover, two other studies also reported an increase in blood concentration of HCQ during renal impairment [38,39]. In the extrapolation of the model to CKD, disease-specific pathophysiological changes such as gastric emptying time, small intestinal transit time, hematocrit, and glomerular filtration rate were integrated [24,25].…”

Hydroxychloroquine administration exacerbates acute kidney injury complicated by lupus nephritis

“…We inferred that different doses and treatment times of HCQ may lead to the different effects on AKI between Tang’s study and ours. In addition, similar to retinopathy induced by HCQ use, acute renal impairment may inhibit renal elimination of HCQ, which in turn elevates the renal level of HCQ and its toxicity [ 53 – 55 ]. Thus, the nephrologist should pay attention to HCQ use in proteinuric LN patients during AKI, and monitoring the blood level of HCQ is suggested.…”

Physiologically-Based Pharmacokinetics Modeling for Hydroxychloroquine as a Treatment for Malaria and Optimized Dosing Regimens for Different Populations

“…Special populations include mild, moderate, and severe renal impairment (GRFL, GRFM, and GFRS) populations; morbidly obese (MO) population; geriatric Northern European Caucasians (NEC) population; obese population; pregnant population; pediatric; and rheumatoid arthritis (RA) populations. The renal impairment populations were taken into consideration because patients accepting HCQ treatment with renal impairment conditions have been reported in several studies to have retinal toxicity [ 36 , 37 ], hypoglycemia [ 38 ], and QT interval prolongation caused by delayed HCQ excretion during the treatment because of reduced renal function [ 39 , 40 ], while the administration of HCQ in patients with renal disease is still not well documented. MO population was included in this research because their body weight will lead to a lower drug plasma level [ 41 ], thus leads to reduced treatment effect.…”