Multiple drugs

Abstract

Multiple drugs Lack of efficacy: case reportA 48-year-old woman exhibited lack of effectiveness during treatment with nifedipine, furosemide, albumin human and plasma for preeclampsia and thiamazole for hyperthyroidism due to complication of perimenopausal giant hydatidiform mole [not all dosages stated; routes not stated].The woman (G6P4) was admitted due to vaginal bleeding for more than one month. Prior to admission, she had experienced intermittent nausea, increased abdominal circumference, dizziness, oedema, weight gain, poor diet and sleep. After admission, further to extensive investigation the initial diagnosis was hydatidiform mole complicated with hyperthyroidism and preeclampsia. She received nifedipine 10mg three times daily, furosemide 20mg once daily, albumin human [albumin] 10g once daily supplementation and plasma infusion 200mL for preeclampsia and thiamazole [methimazole] 10mg twice daily for hyperthyroidism; however, no remission of symptom was observed and oedema aggravated.The woman then underwent a total hysterectomy and bilateral adnexectomy. After the surgery, she was transferred to the ICU. On the first day after surgery, the serum HCG was increased and normal BP was noted on the third day after surgery. On the postoperative day 11, normal thyroid function was noted and oedema was also further reduced. Histopathological examination showed a complete hydatidiform mole. Her serum HCG level also decreased at the postoperative day 42. Chest CT scan revealed bilateral multiple lung nodules at about two months after the surgery. A diagnosis of gestational trophoblastic disease confirmed as invasive hydatidiform mole. She received therapy with fluorouracil [5-fluorouracil] and dactinomycin [actinomycin-D]. After one course of therapy, normal serum HCG level was noted suggesting that the invasive hydatidiform mole was sensitive to chemotherapy. She further received three courses of consolidation chemotherapy. During the last follow-up in November 2020, she recovered well and showed no abnormal lesions on imaging studies.