Serum immunoglobulin G is a marker for the risk of opportunistic infection in steroid-dependent severe asthmatic patients.

BACKGROUND: Approximately 10% of asthmatic patients are refractory to inhaled corticosteroids and therefore need long-term oral corticosteroid therapy, which is associated with a risk of opportunistic infections due to immunosuppression. OBJECTIVE: To ascertain the applicability of serum Immunoglobulin G (IgG) as a marker for predicting the risk of opportunistic infections in patients undergoing oral corticosteroid therapy. METHODS: Three thousand asthmatics were screened, and 14 patients who had been administered daily oral corticosteroids for more than two years were enrolled. The patients enrolled were maintained under observation with ordinary check-ups and treatments for one year. After the observation period, the patients were divided into two groups according to the presence (OPI) or absence (non-OPI) of opportunistic infections during the period. The differences in the clinical parameters between the groups were investigated. RESULTS: There were no statistically significant differences in age, forced expiratory volume in 1 second (FEV(1)), smoking status or serum albumin between the groups. The serum IgG level of the OPI group was significantly lower than that of the non-OPI group (567.2±151.1 mg/dL vs. 931.6±198.8 mg/dL, p<0.01). The average total dose of corticosteroids administered during the one year period was higher in the OPI group (2,633±554.2 mg) than that in the Non-OPI group (1,793±466.2 mg) (p<0.05). There was a significant correlation between the serum IgG and total dose of corticosteroids administered during the one-year period (r = -0.75, p<0.01). The area under the receiver operating characteristic curve regarding the serum IgG and incidence of opportunistic infections was 0.97, which suggests that the serum IgG level has a high accuracy for predicting the risk of opportunistic infections. CONCLUSION: The serum IgG was therefore found to be a useful marker for predicting the risk of opportunistic infections in steroid-dependent asthmatics.

Tacrolimus and steroid treatment for acute exacerbation of idiopathic pulmonary fibrosis.

OBJECTIVE: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) occurs during the chronic progressive course of idiopathic pulmonary fibrosis. Mortality is estimated to be >70%, because no effective treatment has been established. We evaluated the effectiveness of combination therapy of tacrolimus and methylprednisolone for AE-IPF. METHODS: Patients of AE-IPF treated with methylprednisolone pulse therapy with or without tacrolimus (targeting 20 ng/mL) during the period between January 2001 and April 2010 were retrospectively reviewed. The primary endpoints were survival rate and duration. We also observed lactate dehydrogenase levels, partial pressure of arterial oxygen/fraction of inspired oxygen ratio (P/F ratio), KL-6, occurrence of re-exacerbation, and computed tomography score. RESULTS: Fifteen Japanese patients [tacrolimus group aged 74.2±6.0 years old (n=5), non-tacrolimus group aged 75.1±12.8 years old (n=10)] were identified. Pre-treatment clinical parameters were not significantly different between the two groups. Four of 5 tacrolimus group patients and 1 of 10 non-tacrolimus group patients survived (p<0.05). The median survival durations were >92 days (tacrolimus group) and 38 days (non-tacrolimus group) (p<0.05). Lactate dehydrogenase levels and the P/F ratio were also significantly favorable in the tacrolimus group. KL-6 and CT score were not significantly different in both groups. Four re-acute exacerbations were observed only in the non-tacrolimus group. CONCLUSION: Combined tacrolimus and methylprednisolone pulse therapy mitigates AE-IPF, prevents re-acute exacerbation, and contributes to a better prognosis.

Malignant mesothelioma associated with chronic empyema with elevation of serum CYFRA19: A case report.

Malignant neoplasms are reported to occur with long-standing tuberculous pleuritis or chronic empyema. During the clinical course of chronic empyema, subjective symptoms such as chest pain and deterioration of dyspnea and abnormal clinical signs such as increased abnormal chest shadows have frequently been found. Though difficult, differentiating the occurrence of malignant tumors from worsening chronic inflammation is crucial. We report here a case of malignant mesothelioma associated with chronic empyema with elevation of serum CYFRA19.