title: Unusual cause of flare in antineutrophil cytoplasmic antibody-associated vasculitis.
abstract: A 53-year-old woman attended for a routine outpatient appointment for follow-up of antineutrophil cytoplasmic antibody-positive vasculitis. Her disease had relapsed despite appropriate medical management with mycophenolate mofetil (MMF), as evidenced by rising acute phase response and antimyeloperoxidase titre with ongoing symptoms. On further questioning, she had been taking oral charcoal as part of a detoxification diet, which we postulate was causing significantly impaired MMF absorption. This case report summarises the presentation and highlights the importance of a thorough drug history, and should prompt the reader to keep an open mind with regard to drug interactions and treatment regimen adherence when treatment is, unexpectedly, seemingly failing.
authors.affiliation: Department of Rheumatology, London North West Hospitals NHS Trust, Harrow, UK.
authors.forename: James Robert William
authors.initials: JR
authors.lastname: Glanville
authors.affiliation: Department of Rheumatology, London North West Hospitals NHS Trust, Harrow, UK.
authors.forename: Henry
authors.initials: H
authors.lastname: Penn
mesh_terms: D065966:Absorption, Physicochemical / Q000187:drug effects; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000931:Antidotes / Q000009:adverse effects; D002606:Charcoal / Q000009:adverse effects; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D000931:Antidotes; D007166:Immunosuppressive Agents; D002606:Charcoal; D011239:Prednisolone; D009173:Mycophenolic Acid