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Background
Serotonin-norepinephrine reuptake inhibitors (SNRI) are used to treat depressive disorders and certain types of chronic pain. 1 The most common adverse effects of SNRIs are nausea, dry mouth, dizziness and headache. 2 It remains unknown which drug is likely to cause drug-related concomitant taste and smell dysfunction. 3-5 Here we describe distortion of taste (dysosmia) and smell (dysgeusia) as new adverse effects of duloxetine.
Case presentation
A 68-year-old Japanese woman with medical histories of type 1 diabetes mellitus, hypertension, insomnia and reflux esophagitis presented to a local hospital with bilateral leg pain due to diabetic neuropathy and was treated with duloxetine. After 4 weeks, she vomited blood and was admitted to our hospital for further investigation. Prior to hospitalisation, she reported a 4-day history of a rotten egg smell, vomiting and an inability to eat. She described that she experienced the smell for the first time when she visited a coffee shop. She had no history of smoking, head trauma, allergic rhinitis or upper respiratory tract infection before the onset of symptoms and also showed no symptoms of chronic or acute recurrent rhinosinusitis or rhinitis.
Her medication included long-acting insulin analogue (glargine) 14 units at bed time, rapid-acting insulin analogue (aspart) 8 units each before meals, amlodipine (5mg/day), lansoprazole (15mg/day), brotizolam (0.25mg/day) and duloxetine (20mg/day).
Physical examination revealed a body mass index of 20.5kg/m2, temperature of 37.3°C, pulse of 127 beats/min, blood pressure of 184/100mm Hg, respiratory rate of 20 breaths/min and oxygen saturation of 96% in room air. She was alert and oriented, with no evidence of dementia. Her mouth was dry, but her capillary refill time was <2s. There was no sinus or abdominal tenderness. Neurological findings were normal, with no evidence of tremor at rest, rigidity and postural instability.
Investigations
The laboratory data were as follows: white cell count, 10.28x109/L; haemoglobin, 15g/dL; platelets, 25.9×104/[mu]L; haemoglobin A1c, 5.9%; casual plasma glucose level, 244mg/dL; blood urea nitrogen, 34mg/dL; creatinine, 0.49mg/dL; potassium, 2.9mmol/L; zinc, 49[micro]g/dL (65-110); and copper, 128[micro]g/dL (76-141). Upper gastrointestinal endoscopy showed an oesophageal erosive lesion but no bleeding or obstruction. Head MRI showed fluid intensity in the maxillary sinus but no atrophy of the hippocampus or diffuse changes in the temporal and frontal lobes.
Olfactory...