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1.
Transpl Infect Dis ; 24(1): e13733, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34534396

RESUMO

Cytomegalovirus (CMV) disease caused by genetically resistant CMV poses a major challenge in solid organ transplant recipients, and the development of resistance is associated with increased morbidity and mortality. Antiviral resistance affects 5%-12% of patients following ganciclovir (GCV) therapy, but is more common in individuals with specific underlying risk factors. These include the CMV D+R- serostatus, type of transplanted organ, dose and duration of (Val)GCV ([V]GCV) prophylaxis, peak viral loads, and the intensity of immunosuppressive therapy. Guideline recommendations for the management of GCV resistance (GanR) in solid organ transplant recipients are based on expert opinion as there is a lack of data from controlled trials. Second-line options to treat GanR include foscarnet (FOS) and cidofovir (CDV), but these drugs are often poorly tolerated due to high rates of toxicity, such as renal dysfunction and neutropenia. Here, we report seven cardiothoracic transplant recipients with GCV resistance CMV infection from our centre treated with CMV immunoglobulin (CMVIG) +/- leflunomide (LEF) and reviewed the literature on the use of these agents in this therapeutic setting.


Assuntos
Infecções por Citomegalovirus , Farmacorresistência Viral , Globulinas , Leflunomida , Antivirais/uso terapêutico , Citomegalovirus , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Globulinas/uso terapêutico , Humanos , Leflunomida/uso terapêutico , Transplantados
2.
Exp Clin Transplant ; 20(4): 433-435, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35297329

RESUMO

The triple-combination cystic fibrosis transmembrane conductance regulator modulator elexacaftor/- tezacaftor/ivacaftor is known to improve lung function and have extrapulmonary benefits in people with cystic fibrosis. However, there is limited evidence for its use in patients with cystic fibrosis after lung transplant, where the donor lung expresses normal levels of the cystic fibrosis transmembrane conductance regulator. We describe the use of elexacaftor/tezacaftor/ivacaftor as a bridge to potential lung retransplant in a 37-year-old man with cystic fibrosis and chronic lung allograft dysfunction. Although forced expiratory volume in 1 second did not improve, the patient had decreased sputum volume, no pulmonary exacerbations of cystic fibrosis, and no longer required continuous antibiotic therapy. Pancreatic function, revised Cystic Fibrosis Questionnaire scores, sinus symptoms, weight, and corticosteroid dependence significantly improved. There were no reported side effects attributable to elexacaftor/tezacaftor/ivacaftor. However, the patient exhibited declined renal function, which had been initially attributed to lability in cyclosporin levels but which were corrected after lithotripsy for renal calculi. Triple-combination modulators of the cystic fibrosis transmembrane conductance regulator may offer benefits to carefully selected individuals awaiting retransplant, balanced against the risk of worsened immunosuppressant level control.


Assuntos
Regulador de Condutância Transmembrana em Fibrose Cística , Fibrose Cística , Adulto , Aminofenóis , Benzodioxóis , Agonistas dos Canais de Cloreto/efeitos adversos , Fibrose Cística/diagnóstico , Fibrose Cística/tratamento farmacológico , Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Regulador de Condutância Transmembrana em Fibrose Cística/uso terapêutico , Humanos , Indóis , Pulmão , Masculino , Mutação , Pirazóis , Piridinas , Pirrolidinas , Quinolonas , Resultado do Tratamento
4.
Lung India ; 32(5): 480-2, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26628763

RESUMO

We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.

5.
Indian J Tuberc ; 61(3): 254-6, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25241577

RESUMO

A 33-year-old man was denied work permit due to chest X- ray findings of bilateral upper lobe fibrosis, assumed to be due to tuberculosis. However, a detailed evaluation showed that the upper lobe fibrosis was due to Marfan's syndrome.


Assuntos
Síndrome de Marfan/complicações , Síndrome de Marfan/diagnóstico , Fibrose Pulmonar/etiologia , Tuberculose Pulmonar/diagnóstico , Adulto , Aorta/patologia , Dilatação Patológica , Humanos , Masculino , Fibrose Pulmonar/diagnóstico
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