Remitting seronegative symmetrical synovitis with pitting oedema associated with rifampicin.

BACKGROUND: Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE syndrome) is a very rare condition incorporating a tenosynovitis of the hands and wrists, as well as the feet, ankles and shoulders. The aetiology of RS3PE syndrome is unknown, although it has been linked with infectious agents (including mycobacteria), other rheumatological conditions, HLA serotypes and malignancies. CASE: This report examines the case of a 72-year-old man with a heart transplant and infected knee prosthesis, who developed RS3PE syndrome after introducing antibiotic treatment with rifampicin. His symptoms resolved with cessation of this agent. CONCLUSIONS: This case demonstrates a possible direct aetiological link between rifampicin and RS3PE.

The macrolide clarithromycin inhibits experimental post-transplant bronchiolitis obliterans.

Chronic allograft dysfunction in form of bronchiolitis obliterans is the most important hurdle to improved longterm survival after clinical lung transplantation to date. Recently, it was observed that the progression of bronchiolitis obliterans in lung transplant recipients might be inhibited by macrolide antibiotics. The authors therefore tested whether macrolide therapy can attenuate fibrous obliteration of airways in an animal model of bronchiolitis obliterans. Rats with heterotopic tracheal allografts were treated intraperitoneally with clarithromycin and compared to untreated transplanted animals with respect to allograft histology and expression of selected cytokines. At day 21 after transplantation, the tracheal allografts of treated animals were free of fibrous material or partially occluded dependent of clarithromycin dosage. Untreated animals had completely obliterated allografts. In treated animals, tumor necrosis factor alpha (TNF-alpha) was down-regulated early (5 days) and late (21 days) post transplant, whereas interferon gamma (IFN-gamma) expression was decreased only early after transplantation. Transforming growth factor beta (TGF-beta) expression was not affected. Therapy with low-dose macrolides in post-transplant obliterative bronchiolitis is based on their immunomodulatory rather than antimicrobial properties. In the setting of lung transplantation, macrolides primarily act as modulators of the early inflammatory response to stressed, damaged, or infected cells.