RESUMO
OBJECTIVE: To describe the outcome and tolerance in patients treated with anti-TNFα in severe and refractory major vessel disease in Behçet's disease (BD). METHODS: A multicenter study evaluating 18 refractory BD patients with major vessel involvement [pulmonary artery (nâ¯=â¯4), aorta (nâ¯=â¯4) or peripheral artery aneurysm (nâ¯=â¯1) and/or pulmonary artery (nâ¯=â¯7), inferior vena cava (nâ¯=â¯5), or intra-cardiac (nâ¯=â¯3) thrombosis or Budd Chiari Syndrome (nâ¯=â¯2)] treated with anti-TNFα agents. RESULTS: Vascular remission was achieved in 16 (89%) patients. The 9â¯months risk of relapse was significantly higher with conventional immunosuppressants used prior anti-TNFα agents as compared to anti-TNFα therapy [ORâ¯=â¯8.7 (1.42-62.6), pâ¯=â¯0.03]. The median daily dose of corticosteroids significantly decreased at 12â¯months. Side effects included infection (nâ¯=â¯4) and pulmonary edema (nâ¯=â¯1). CONCLUSION: TNFα-antagonists are safe and might be associated with a decreased risk of relapse at 9â¯months compared to conventional immunosuppressants in BD patients with major vessels disease.
Assuntos
Adalimumab/uso terapêutico , Antirreumáticos/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Infliximab/uso terapêutico , Trombose/fisiopatologia , Adulto , Doenças da Aorta/etiologia , Doenças da Aorta/fisiopatologia , Síndrome de Behçet/complicações , Síndrome de Behçet/fisiopatologia , Síndrome de Budd-Chiari/etiologia , Síndrome de Budd-Chiari/fisiopatologia , Feminino , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Humanos , Imunossupressores/uso terapêutico , Infecções , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/fisiopatologia , Edema Pulmonar , Recidiva , Indução de Remissão , Estudos Retrospectivos , Índice de Gravidade de Doença , Trombose/etiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia , Veia Cava Inferior/fisiopatologia , Adulto JovemRESUMO
INTRODUCTION: Human herpesvirus 6 (HHV-6), the causative agent of the common exanthem subitum, is a known cause of central nervous system infection in immunocompromised patients. It has been suggested that HHV-6 participate in the development of drug-induced hypersensitivity syndrome. CASE REPORT: We reported a case of HHV-6 encephalitis associated with hypersensitivity syndrome induced by trimethoprim-sulfamethoxazole in a 72-year-old HIV-negative woman. DISCUSSION: Our case confirmed that reactivation of HHV-6 infection may contribute to the development of the hypersensitivity syndrome.