Ali ÇAYKÖYLÜ, Görkem UĞURLU KARAKAŞ, Telat KELEŞ, Sinay ÖNEN, Semra Ulusoy KAYMAK

Pulmonary Hypertension due to Lithium Therapy: A Case Report

Lityum iki uçlu bozukluğun uzun dönemli tedavisinde altın standart olarak kabul edilmektedir. Bununla birlikte bu özgün ilacın kullanımını kısıtlayan çeşitli kardiyolojik yan etkileri vardır. Bildiğimiz kadarıyla yazında lityum tedavisine bağlı yalnızca bir olgu yer almıştır. Burada, daha önceden kardiyolojik veya pulmoner bir hastalık tanısı olmayan, uzun dönem lityum tedavisiyle ilişkili pulmoner hipertansiyon gelişen bir vakayı sunmaktayız. Hasta 43 yaşında iki uçlu bozukluk tanısı olan bir kadındır. Lityum tedavisinden önce, kardiyolojik muayenesi ve laboratuvar testleri normal saptanmıştır. Beş yıl düzenli 1200 mg/gün lityum ve 300-600 mg/gün ketiyapin tedavisi sonrasında başlayan "çarpıntı" yakınması sebebi ile kardiyoloji uzmanlarınca detaylı olarak irdelenen hastaya pulmoner hipertansiyon tanısı konuldu. Pulmoner hipertansiyonun diğer bilinen nedenleri araştırıldı ve laboratuvar ve muayene ile elimine edildi. Bu koşullarda pulmoner hipertansiyon lityum tedavisiyle ilişkilendirildi ve tedavi değişimi kararı verildi. Değişim sırasında hastada bir manik dönem başladı. Lityum tedavisinin kesilmesinden 45 gün sonra, kardiyolojik değerlendirme sırasında 30-35 mmHg olarak belirlendi. Bu hastanın eş zamanlı ketiyapin kullanı- yor olmasına rağmen pulmoner basınç düşerken hastanın kullandığı lityum kesilmiş ancak ketiyapin dozu yükseltilerek devam edilmiştir. Lityum ile ilgili güncel araştırmalar, ilacın davranışsal ve nörokimyasal etkilerine odaklanmaktadır. Bazı yazarlar lityum gibi yarım yüzyılı aşkın süredir kullanılan ilaçların yeni yan etkilerinin tanımlanmasını beklemediklerini belirtseler de, bizler yan etkiler konusunda duyarlı olmalıyız. Bununla birlikte, yeni bir olası yan etki detaylı bir biçimde analiz edilmeli ve lityuma yeni bir yan etkiyle ilgili sorumluluk atfedilmeden önemli düzeyde kanıt gerekmektedir.

Lityum tedavisine bağlı pulmoner hipertansiyon: Bir vaka

Lithium is accepted as the gold standard for long term treatment in bipolar affective disorder. However, this specific drug has various side effects, which restrict its use such as cardiologic. To our knowledge, there is only one reported case of pulmonary hypertension due to lithium therapy in the literature. Here we are presenting a case that developed pulmonary hypertension associated with long-term lithium treatment without any prior diagnosis of a cardiac or pulmonary disease. A 43-year-old female patient had a diagnosis of bipolar disorder. Before lithium treatment, her cardiac examination and laboratory tests were normal. After a five year regular lithium 1200 mg/day lithium and 300- 600 mg/day quetiapine treatment she had palpitation. It was investigated in detail; a cardiologist diagnosed her as pulmonary hypertension. Other known causes of pulmonary hypertension were investigated and eliminated both clinically and laboratory. In these conditions pulmonary hypertension was attributed to lithium treatment and we decided to change her pharmacotherapy. During exchange, she had a manic episode. Forty-five days after lithium discontinuation, PAP was detected 30-35 mmHg in the cardiac examination. Although this patient had concurrent quetiapine medication when the pulmonary pressure decreased, lithium was discontinued but quetiapine was continued in higher doses. Current researches about lithium focus on the behavioural and neurochemical effects of this drug. Although some authors think that a new side effect should be expected for drugs like lithium, which was in use over half a century, we have to be aware of the side effects. However, any possible new side effect of lithium has to be analyzed in detail, and, before to attribute the responsibility of a new side effect to lithium, compelling evidence is required.

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