Utility of [18F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan in Inflammatory Myopathies: Case Report and Literature Review.

INTRODUCTION: Inflammatory myopathies are a rare group of diseases characterized by proximal weakness. Incidence ranges from 7.98/million/year and prevalence at 14/100,000. The utility of [18F] fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) scan is increasing for the complementary diagnosis of myopathies. CASE REPORT: An 84-year-old male was admitted with a history of difficulty rising from a chair and a fall. Laboratory results showed increased creatine kinase levels of more than 50 times the normal reference values. Electromyography (EMG) showed myopathic changes, and FDG-PET/CT scan showed increased FDG uptake in bilateral quadriceps. A biopsy was performed revealing lymphocytic predominant infiltrates and myonecrosis. Prednisone and intravenous immunoglobulin (IVIG) were administered with strength improvement. The patient was discharged for further follow-up. DISCUSSION: FDG-PET/CT in inflammatory diseases has proven useful as muscle fibers have increased FDG uptake. In some cases, FDG-PET/CT is also useful in determining associated neoplastic diseases.

Tratamiento de mantenimiento en las vasculitis asociadas a anticuerpos contra citoplasma de neutrófilos (ANCA) / Maintainance treatment of anti-neutrophil cytoplasm associated antibodies (ANCA)

Las vasculitis asociadas a ANCA son enfermedades raras y complejas con compromiso sistémico. El desarrollo de grupos colaborativos en Europa y los Estados Unidos de América ha facilitado la realización de estudios clínicos aleatorizados para garantizar la seguridad en el tratamiento de mantenimiento de estas enfermedades. Aunque la ciclofosfamida continúa vigente para la fase de inducción, sus efectos adversos a largo plazo han propiciado el estudio de otras drogas inmunosupresoras en la fase demantenimiento. Aquí revisamos estos estudios con especial atención a los que se refieren a la combinación de medicamentos inmunosupresores y a la duración del tratamiento (AU)

ANCA-associated vasculitides are rare and complex systemic diseases. Collaborative studies in both Europe and the United States of America have been particularly important in the development of randomized clinical trials that have studied the safety of maintenance therapy for these diseases. Although cyclophosphamide continues to be the main drug utilized during induction therapy, its long-term side effects have given rise to the study of other immunosuppressive drugs for the maintenance phase. We herein review these studies with particular attention to combination therapy and the duration of treatment (AU)

[Maintainance treatment of anti-neutrophil cytoplasm associated antibodies (ANCA)]. / Tratamiento de mantenimiento en las vasculitis asociadas a anticuerpos contra citoplasma de neutrófilos (ANCA).

ANCA-associated vasculitides are rare and complex systemic diseases. Collaborative studies in both Europe and the United States of America have been particularly important in the development of randomized clinical trials that have studied the safety of maintenance therapy for these diseases. Although cyclophosphamide continues to be the main drug utilized during induction therapy, its long-term side effects have given rise to the study of other immunosuppressive drugs for the maintenance phase. We herein review these studies with particular attention to combination therapy and the duration of treatment.

Long-term renal graft function and survival in patients with high-risk for cytomegalovirus infection receiving preemptive therapy.

BACKGROUND: Preemptive therapy reduces the risk of cytomegalovirus disease in high-risk kidney transplant patients. The advantage of this strategy is that only a fraction of patients receive antiviral drugs for a limited time, which decreases costs and toxicity but requires frequent monitoring and may not prevent complications of asymptomatic cytomegalovirus replication. MATERIAL AND METHODS: Long-term graft-function and patient survival of high-risk kidney transplant patients who received preemptive therapy guided by pp65 antigenemia was compared to those whose assay remained negative throughout the first post-transplant year. RESULTS: Between August 1997 and March 2005, 24 of 272 patients were CMV D+/R-. Thirteen of the 24 (54.2%) developed a positive CMV assay during follow-up; the time between transplant and first positive antigenemia was 66.7 +/- 58.3 days (range 29-251 days). Four patients developed symptoms associated with CMV, one of whom succumbed from complications of CMV neumonitis. Overall, no significant differences were observed in SCr, eGFR, delta SCr, and delta eGFR during a 60-month followup between patients who developed CMV infection or disease and those who remained pp65 antigenemia-negative throughout the first 12 post-transplant months. Additionally, no deaths or graft loss occurred during the long-term follow up of this cohort. CONCLUSIONS: Our results suggest that in this high risk group of kidney transplant recipients, treating CMV replication using a preemptive strategy during the first posttransplant year is associated with a low rate of CMV complications and probably interferes with the alleged long-term negative indirect effects of CMV on kidney function and survival.