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Neuralgic amyotrophy associated with antibiotic therapy.
[neuralgic amyotrophy]
To
report
a
case
of
neuralgic
amyotrophy
associated
with
antibiotic
therapy
.
A
22
-
year
-old
male
with
cystic
fibrosis
had
been
nonadherent
to
treatment
for
4
years
;
when
he
returned
to
the
clinic
with
symptoms
,
his
forced
expiratory
volume
in
1
second
dropped
from
84
%
predicted
to
43
%
predicted
.
He
was
admitted
to
the
hospital
for
treatment
after
failing
to
improve
on
oral
ciprofloxacin
and
inhaled
tobramycin
.
Treatment
was
initiated
with
intravenous
tobramycin
560
mg
daily
and
piperacillin
/
tazobactam
4
.
5
g
infused
every
6
hours
.
He
continued
inhaled
tobramycin
300
mg
twice
daily
,
his
home
doses
of
pancreatic
replacement
enzymes
and
vitamins
,
albuterol
2
.
5
mg
by
high
flow
nebulizer
(
HFN
)
4
times
daily
,
and
dornase
alpha
2
.
5
by
HFN
daily
.
Sputum
cultures
were
positive
for
methicillin-resistant
Staphylococcus
aureus
,
and
intravenous
vancomycin
1
g
every
8
hours
was
added
to
the
treatment
regimen
on
hospital
day
7
.
The
patient
developed
bilateral
shoulder
pain
followed
by
decreased
function
of
his
upper
extremities
2
days
later
.
He
was
treated
with
oral
ibuprofen
600
mg
every
6
h
and
oral
cyclobenzaprine
5
mg
daily
,
which
improved
his
pain
,
but
the
shoulder
stiffness
remained
throughout
his
hospital
stay
and
persisted
for
2
months
following
discharge
.
These
symptoms
resolved
but
recurred
rapidly
(
within
24
h
)
and
were
more
debilitating
following
a
second
exposure
to
the
same
antibiotics
at
the
same
doses
8
months
later
when
the
patient
was
readmitted
for
treatment
of
another
cystic
fibrosis
-related
pulmonary
exacerbation
.
To
our
knowledge
,
this
is
the
first
case
report
illustrating
neuralgic
amyotrophy
triggered
by
exposure
to
the
antibiotics
vancomycin
,
tobramycin
,
and
piperacillin
/
tazobactam
.
After
analysis
of
the
case
,
ruling
out
other
possibilities
and
using
the
Naranjo
probability
scale
,
we
found
that
there
is
a
highly
probable
likelihood
that
the
symptoms
presented
by
our
patient
were
secondary
to
his
drug
therapy
.
Neuralgic
amyotrophy
is
a
rare
condition
of
unknown
etiology
that
has
never
before
been
associated
with
administration
of
these
antibiotics
,
individually
or
in
combination
.
Because
of
the
specifics
of
the
clinical
history
,
we
were
unable
to
ascertain
whether
this
complication
was
due
to
a
single
antibiotic
or
to
the
combination
.
It
is
quite
possible
that
vancomycin
was
the
only
culprit
,
but
impossible
to
ensure
with
the
available
evidence
.
Clinicians
should
be
aware
of
this
adverse
reaction
when
facing
similar
complex
neurologic
symptoms
in
patients
who
are
receiving
the
antibiotic
treatment
described
here
,
especially
vancomycin
.
Diseases
Validation
Diseases presenting
"bilateral shoulder pain"
symptom
neuralgic amyotrophy
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