A rare case of neomercazole induced hepatitis

Neomercazole is one of the most commonly used drugs to treat hyperthyroidism. Common side effects include rash, hair loss and agranulocytosis. Hepatotoxicity is a common side effect of Propylthiouracil, the other major antithyroid drug, but it has been rarely described as a side effect of neomercazole. Here, a patient presents with hepatitis 6 months after starting neomercazole therapy for graves disease. Diagnosis is based on excluding other causes of hepatitis, and treatment involves removing the offending drug. This is followed by normalization of liver function. Rechallenging should not be done as it can lead to recurrence of symptoms

Unusual cause of nausea and vomiting

Adrenal insufficiency can manifest with various symptoms ranging from haemodynamic compromise to non-specific symptoms like myalgia, anorexia, and loss of weight. Aetiology can be primary adrenal disorder or secondary to suppression of HPA axis. We report a case of secondary adrenal insufficiency presenting with persistent nausea and vomiting

A rare case of neomercazole induced hepatitis

Neomercazole is one of the most commonly used drugs to treat hyperthyroidism. Common side effects include rash, hair loss and agranulocytosis. Hepatotoxicity is a common side effect of Propylthiouracil, the other major antithyroid drug, but it has been rarely described as a side effect of neomercazole. Here, a patient presents with hepatitis 6 months after starting neomercazole therapy for graves disease. Diagnosis is based on excluding other causes of hepatitis, and treatment involves removing the offending drug. This is followed by normalization of liver function. Rechallenging should not be done as it can lead to recurrence of symptoms

Glucose intolerance and insulin resistance in non-alcoholic fatty liver disease: A Hospital-based Cross-sectional Study from Southern Karnataka, India

Context: Non-alcoholic fatty liver disease (NAFLD) is associated with hepatic insulin resistance (IR) and glucose intolerance. Indian data in this area are sparse, and hence, we undertook this study to find the relationship between NAFLD and diabetes. Objective: The objective of this study is to find the relationship between NAFLD and various levels of glucose intolerance and IR. Settings and Design: A cross-sectional study on 150 patients aged 18 or above and diagnosed to have NAFLD by ultrasonography from October 2013 to June 2015 who were admitted or outpatients in the Department of General Medicine, Kasturba Medical College, Manipal. Methodology: NAFLD was graded as mild, moderate or severe by a single radiologist using high-resolution B-mode ultrasonography system. Basic anthropometric, clinical examination and relevant biochemical investigations were done for all patients. Glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and post-load plasma glucose (PG) were measured in all subjects, fasting insulin levels were measured in all subjects by chemiluminescence method to determine IR and it was calculated using homeostasis model assessment model. Statistical Analysis Used: Data were analysed using SPSS software version 15 and P < 0.05 considered as statistically significant. Results: The percentage of pre-diabetes and diabetes in NAFLD patients were 52.7% and 30.7% respectively, There was a greater proportion of pre-diabetics and diabetics in the higher grades of NAFLD (P < 0.001). We observed mean FPG, PG and HbA1c levels increased as the severity of NAFLD increased in this study. The overall mean HOMA-IR score in our subjects was found to be 4.68 ± 2.81 and 76.7% of patients had IR was significantly (P < 0.001) higher in Grade 2 and Grade 3 NAFLD. Conclusions: There is a high prevalence of pre-diabetes and diabetes in patients with NAFLD, and this is associated with increasing IR in higher grades of NAFLD