Spectrum of digoxin-induced ocular toxicity: a case report and literature review

BMC Research Notes

Laura E. Rothuizen³  François-Xavier Borruat²  Nathalie Voide²  Eve Rubli¹  Delphine Renard³ 

[1] Service de gériatrie et réadaptation gériatrique, CHUV, CUTR Sylvana, Ch. de Sylvana 10, Epalinges, 1066, Switzerland;Département d’ophtalmologie, Université de Lausanne, Fondation Asile des Aveugles, Hôpital ophtalmique Jules-Gonin, av. de France 15, Lausanne 7, 1000, Switzerland;Division of Clinical Pharmacology, University Hospital of Lausanne, Bugnon 17-01, Lausanne, 1011, Switzerland

关键词: Photopsia;    Dyschromatopsia;    Vision impairment;    Drug intoxication;    Digoxin;   

Others  :  1230860
DOI  :  10.1186/s13104-015-1367-6

 received in 2014-08-22, accepted in 2015-08-18,  发布年份 2015

【 摘 要 】

Background

Digoxin intoxication results in predominantly digestive, cardiac and neurological symptoms. This case is outstanding in that the intoxication occurred in a nonagenarian and induced severe, extensively documented visual symptoms as well as dysphagia and proprioceptive illusions. Moreover, it went undiagnosed for a whole month despite close medical follow-up, illustrating the difficulty in recognizing drug-induced effects in a polymorbid patient.

Case presentation

Digoxin 0.25 mg qd for atrial fibrillation was prescribed to a 91-year-old woman with an estimated creatinine clearance of 18 ml/min. Over the following 2–3 weeks she developed nausea, vomiting and dysphagia, snowy and blurry vision, photopsia, dyschromatopsia, aggravated pre-existing formed visual hallucinations and proprioceptive illusions. She saw her family doctor twice and visited the eye clinic once until, 1 month after starting digoxin, she was admitted to the emergency room. Intoxication was confirmed by a serum digoxin level of 5.7 ng/ml (reference range 0.8–2 ng/ml). After stopping digoxin, general symptoms resolved in a few days, but visual complaints persisted. Examination by the ophthalmologist revealed decreased visual acuity in both eyes, 4/10 in the right eye (OD) and 5/10 in the left eye (OS), decreased color vision as demonstrated by a score of 1/13 in both eyes (OU) on Ishihara pseudoisochromatic plates, OS cataract, and dry age-related macular degeneration (ARMD). Computerized static perimetry showed non-specific diffuse alterations suggestive of either bilateral retinopathy or optic neuropathy. Full-field electroretinography (ERG) disclosed moderate diffuse rod and cone dysfunction and multifocal ERG revealed central loss of function OU. Visual symptoms progressively improved over the next 2 months, but multifocal ERG did not. The patient was finally discharged home after a 5 week hospital stay.

Conclusion

This case is a reminder of a complication of digoxin treatment to be considered by any treating physician. If digoxin is prescribed in a vulnerable patient, close monitoring is mandatory. In general, when facing a new health problem in a polymorbid patient, it is crucial to elicit a complete history, with all recent drug changes and detailed complaints, and to include a drug adverse reaction in the differential diagnosis.

【 授权许可】

   
2015 Renard et al.

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