Abstract
During the pandemic, symptoms of many diseases that can be confused with the symptoms of COVID-19 have been detected and reported. In this case report, we reported a patient who showed flu-like symptoms and sudden lymphopenia within two days of zoledronic acid infusion. A 40-year-old female patient with a COVID-19 history was admitted to our hospital with abdominal pain. Hypercalcemia due to parathyroid adenoma was detected. Zoledronic acid (5 mg) was given intravenously for the treatment of hypercalcemia. Following the infusion, fever, C-Reactive Protein (CRP) increase and lymphopenia were detected in the patient. There were no apparent causes to explain these symptoms. The side effects we detected in the patient were confusingly similar to the symptoms of COVID-19. Repeated PCR tests and CT results indicated that the patient did not have COVID-19. A week later, the patient’s symptoms improved and the laboratory findings along with the physical examination returned to normal. The patient's condition was considered to be due to zoledronic acid infusion. We would like to draw attention to the acute phase reaction after zoledronic acid infusion in the COVID-19 era in which the clinical situation could be confusing.
References
- Leere JS, Karmisholt J, Robaczyk M, Vestergaard P. Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review. Front Endocrinol (Lausanne). 2017 Apr 20;8.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 Feb;395(10223):497–506.
- Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar;34:101623.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020 Mar; 395(10229):1054–62.
- Coleman R, Burkinshaw R, Winter M, Neville-Webbe H, Lester J, Woodward E, et al. Zoledronic acid. Expert Opin Drug Saf. 2011 Jan 29;10(1):133–45.
- Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis. New England Journal of Medicine. 2007 May 3;356(18):1809– 22.
- Boonen S, Black DM, Colón-Emeric CS, Eastell R, Magaziner JS, Eriksen EF, et al. Efficacy and Safety of a Once-Yearly Intravenous Zoledronic Acid 5 mg for Fracture Prevention in Elderly Postmenopausal Women with Osteoporosis Aged 75 and Older. J Am Geriatr Soc. 2010 Feb;58(2):292–9.
- Schweitzer DH, Oostendorp-van de Ruit M, van der Pluijm G, Löwik CWGM, Papapoulos SE. Interleukin-6 and the acute phase response during treatment of patients with paget’s disease with the nitrogen-containing bisphosphonate dimethylaminohydroxypropylidene bisphosphonate. Journal of Bone and Mineral Research. 2009 Dec 3;10(6):956–62.
- Adami S, Bhalla AK, Dorizzi R, Montesanti F, Rosini S, Salvagno G, et al. The acute-phase response after bisphosphonate administration. Calcif Tissue Int. 1987 Dec;41(6):326–31.
- Cui M, Zhang N, Zhang G, Han L, Yu LZ. Investigation of Intravenous Zoledronic Acid Therapy on Circulating Lymphocyte Subpopulation in Patients with Primary Osteoporosis: A Pilot Study. Current Therapeutic Research. 2021;94:100634.
Abstract
Pandemi süresince, COVID-19 semptomlarıyla karıştırılan birçok hastalık tespit edilmiş ve bildirilmiştir. Bu vaka sunumunda, zoledronik asit infüzyonundan sonraki iki gün içerisinde grip benzeri semptomlar ve akut lenfopeni gösteren bir hastayı sunduk. Geçirilmiş COVID-19 öyküsü olan, 40 yaş kadın hasta, abdominal ağrıyla tarafımıza başvurdu. Paratiroid adenomuna bağlı hiperkalsemi saptandı. Hiperkalsemi tedavisi için IV Zoledronik asit (5mg) verildi. İnfüzyonu takiben hastada ateş, C reaktif protein yüksekliğinde artış ve lenfopeni tespit edildi. Hastada bu bulguları açıklayabilecek herhangi bir sebep bulunamamıştır. Hastada tespit ettiğimiz yan etkiler, kafa karıştırıcı bir şekilde COVID-19 semptomlarına benzemekteydi. Tekrarlanan PCR testleri ve BT sonuçları hastanın COVID-19 olmadığını göstermiştir. Bir hafta sonra ise hastanın semptomları gerilemiş ve labaratuvar bulguları, fizik muayene bulgularıyla birlikte normale dönmüştür. Hastanın bu durumunun zoledronik asit infüzyonuna bağlı olduğu düşünüldü.
Klinik durumun kafa karıştırıcı olabileceği COVID-19 döneminde zoledronik asit infüzyonu sonrası akut faz reaksiyonuna dikkat çekmek istiyoruz.
References
- Leere JS, Karmisholt J, Robaczyk M, Vestergaard P. Contemporary Medical Management of Primary Hyperparathyroidism: A Systematic Review. Front Endocrinol (Lausanne). 2017 Apr 20;8.
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 Feb;395(10223):497–506.
- Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar;34:101623.
- Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020 Mar; 395(10229):1054–62.
- Coleman R, Burkinshaw R, Winter M, Neville-Webbe H, Lester J, Woodward E, et al. Zoledronic acid. Expert Opin Drug Saf. 2011 Jan 29;10(1):133–45.
- Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis. New England Journal of Medicine. 2007 May 3;356(18):1809– 22.
- Boonen S, Black DM, Colón-Emeric CS, Eastell R, Magaziner JS, Eriksen EF, et al. Efficacy and Safety of a Once-Yearly Intravenous Zoledronic Acid 5 mg for Fracture Prevention in Elderly Postmenopausal Women with Osteoporosis Aged 75 and Older. J Am Geriatr Soc. 2010 Feb;58(2):292–9.
- Schweitzer DH, Oostendorp-van de Ruit M, van der Pluijm G, Löwik CWGM, Papapoulos SE. Interleukin-6 and the acute phase response during treatment of patients with paget’s disease with the nitrogen-containing bisphosphonate dimethylaminohydroxypropylidene bisphosphonate. Journal of Bone and Mineral Research. 2009 Dec 3;10(6):956–62.
- Adami S, Bhalla AK, Dorizzi R, Montesanti F, Rosini S, Salvagno G, et al. The acute-phase response after bisphosphonate administration. Calcif Tissue Int. 1987 Dec;41(6):326–31.
- Cui M, Zhang N, Zhang G, Han L, Yu LZ. Investigation of Intravenous Zoledronic Acid Therapy on Circulating Lymphocyte Subpopulation in Patients with Primary Osteoporosis: A Pilot Study. Current Therapeutic Research. 2021;94:100634.
Details
| Primary Language | English |
|---|---|
| Subjects | Endocrinology |
| Journal Section | OLD_Olgu Sunumu |
| Authors | |
| Publication Date | September 18, 2023 |
| Submission Date | October 4, 2022 |
| Published in Issue | Year 2023Volume: 62 Issue: 3 |
