Abstract

This case is unique because it involves multiple lithium adverse effects in one patient, showcasing a rare dermatological and genital complication. It has longitudinal laboratory monitoring (lithium assays); it brings to light challenges of drug access in low-resource settings and the impact of all the above on patients' quality of life.
A retrospective descriptive case report of a patient on long-term lithium therapy being managed for bipolar affective disorder in a tertiary facility, prepared following the CARE (CAse REport) guidelines.
Analysis of serum lithium assays, electrocardiography readings, thyroid function tests, and kidney function tests spanning across 8-10 years was done, followed by correlation of the temporal changes in serum lithium levels and dosing to the clinical findings to assess lithium toxicity patterns.
Specialist evaluations were extrapolated to characterize the systemic manifestations and rare complications.
Longitudinal serum lithium levels, assessed at intervals not exceeding three months, demonstrated values within the therapeutic range. Despite this, the patient developed multisystem complications, including psoriatic plaques involving the limbs, genitals, and umbilicus. Metabolic complications included significant weight gain, hypertension, and subclinical hypothyroidism. Progression to chronic kidney disease evidenced by an eGFR of 56ml/min/1.73m², genitourinary complications notably penile telescoping.
The patient's lithium levels were mostly within the accepted therapeutic range, yet he developed multi-organ complications and a rare genital complication (acquired penile telescoping). This emphasizes the need for proactive clinical inquiry about the whole system for patients on lithium therapy.

Key words: Lithium, Adverse-effects, Case report, BAD, Penile telescoping