Theophylline use-a conundrum in modern medicine: a case report

The theophylline toxidrome presents with multisystemic involvement that includes cardiovascular, neurologic, metabolic, musculoskeletal, and gastrointestinal manifestations. Considering such a varied spectrum of presentations, it is often difficult to ascertain the diagnosis of this particular toxidrome. Review of home medications is an important step when working with a patient presenting as a toxidrome.

The case report is about a 69-year-old female patient who was brought to the emergency room in status epilepticus and atrial fibrillation with rapid ventricular response. She had a prolonged state of drowsiness following an initial antiepileptic therapy and a toxicologic screen positive for toxic levels of theophylline at 59.7 mcg/mL. Emergent dialysis was performed leading to improvement of her overall clinical status. We suspect the patient had built up toxic levels of theophylline due to evolving drug interactions after she discontinued many of her routine home medications following her husband's death.

Theophylline is a methylxanthine derivative medication that is used sparingly in the treatment of airway diseases. It has become less favorable over the years due to its narrow therapeutic index and potential for development of toxicity. Monitoring serum drug levels and adjusting the dose frequently to maintain a therapeutic range is essential to prevent toxicity related to theophylline. There is emerging evidence that the drug might have anti-inflammatory properties to aid in treating many chronic airway disorders and pharmacovigilance is necessary for its continued use.