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1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431539

RESUMO

We present a kidney-pancreas transplant recipient who achieved complete recovery from COVID-19. A 45-year-old patient with T3 paraplegia underwent kidney-pancreas transplantation 18 years ago, followed by a subsequent kidney transplant 9 years ago, and presented with fever, hypoxia and hypotension after exposure to two confirmed cases of COVID-19. History of solid organ transplant, pre-existing renal impairment, asthma and an elevated D-dimer were identified as established risk factors for severe COVID-19. Supportive management was provided, baseline immunosuppression with everolimus was continued, and oral prednisolone was increased. A complete recovery was observed. Given the favourable outcome despite risk factors for severe COVID-19, we identify and review the potential mitigating roles of immunosuppression and mammalian target of rapamycin (mTOR) inhibitors in this disease. Further investigation is required to establish whether mTOR inhibitors could be used as therapeutic agents to treat COVID-19, or as alternative immunosuppression implemented early in the COVID-19 disease course.


Assuntos
/complicações , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Transplante de Pâncreas , Paraplegia/complicações , Acidentes de Trânsito , Asma/complicações , /fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/cirurgia , Everolimo/uso terapêutico , Febre/fisiopatologia , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Hipotensão/fisiopatologia , Hipóxia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores
4.
Clin Nucl Med ; 46(1): 1-7, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33181743

RESUMO

PURPOSE: The aim was to explore whether baseline total lesion glycolysis (TLG) can improve the prognostic value of the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in primary gastric diffuse large B-cell lymphoma (PG-DLBCL) patients treated with an R-CHOP-like regimen. MATERIALS AND METHODS: Ninety-four PG-DLBCL patients who underwent baseline PET/CT between July 2010 and May 2019 were included in this retrospective study. FDG-avid lesions in each patient were segmented to calculate the SUVmax, total metabolic tumor volume (TMTV), and TLG. Progression-free survival (PFS) and overall survival (OS) were used as end points to evaluate prognosis. RESULTS: During the follow-up period of 5 to 108 months (35.3 ± 23.5 months), high TLG and a high NCCN-IPI were significantly associated with poor PFS and OS. Total lesion glycolysis and the NCCN-IPI were independent predictors of PFS and OS. Patients were stratified into 3 groups according to the combination of TLG and the NCCN-IPI for PFS (P < 0.001) and OS (P < 0.001): high-risk group (TLG > 1159.1 and NCCN-IPI 4-8) (PFS and OS, 57.7% and 61.5%, respectively, n = 42), intermediate-risk group (TLG > 1159.1 or NCCN-IPI 4-8) (PFS and OS, both 76.9%, n = 26), and low-risk group (TLG ≤ 1159.1 and NCCN-IPI 0-3) (PFS and OS, 97.6% and 100.0%, respectively, n = 26). CONCLUSIONS: Both TLG and the NCCN-IPI are independent predictors of PG-DLBCL patient survival. Moreover, the combination of TLG and the NCCN-IPI improved patient risk stratification and might help personalize therapeutic regimens.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Glicólise/efeitos dos fármacos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/tratamento farmacológico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/farmacologia , Ciclofosfamida/uso terapêutico , Doxorrubicina/farmacologia , Doxorrubicina/uso terapêutico , Feminino , Humanos , Linfoma Difuso de Grandes Células B/metabolismo , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prednisolona/farmacologia , Prednisolona/uso terapêutico , Intervalo Livre de Progressão , Estudos Retrospectivos , Neoplasias Gástricas/metabolismo , Vincristina/farmacologia , Vincristina/uso terapêutico
5.
Medicine (Baltimore) ; 99(50): e23491, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327284

RESUMO

RATIONALE: The rarity of adult T cell leukemia/lymphoma (ATLL) in China, coupled with its clinicopathologic mimicry of primary skin disease, poses a diagnostic challenge. The method of diagnosis and mechanism of immune regulation in ATLL are discussed in the present report. PATIENT CONCERNS: A 51-year-old Chinese man was admitted to the hospital with 2-years history of systemic plaque lesions and 1-year history of left ankle joint pain. DIAGNOSES: The patient was diagnosed with ATLL based on the results of flow cytometry immunophenotype and human T-cell lymphotropic virus type 1 (HTLV-1) serology. INTERVENTIONS: The patient received 3 cycles of cyclophosphamide, epirubicin/ vinorelbine, and dexamethasone (CHOP) chemotherapy. However, he relapsed and did not respond to epirubicin, vindesine, etoposide, dexamethasone (EPOCH) chemotherapy. OUTCOMES: His family discontinued the treatment and opted for hospice care. LESSONS: Patch and plaque ATLL types exhibits a better survival rate, but atypical skin patches delays the diagnosis of ATLL and negatively affects the patient survival. Based on the present findings, we suggest that patients with petal-like nuclear lymphocytes in blood smears, a high CD4: CD8 ratio, and strong CD25 expression should undergo HTLV-1 serology testing.


Assuntos
Leucemia-Linfoma de Células T do Adulto/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Doxorrubicina/uso terapêutico , Etoposídeo/uso terapêutico , Citometria de Fluxo , Vírus Linfotrópico T Tipo 1 Humano/genética , Humanos , Leucemia-Linfoma de Células T do Adulto/sangue , Leucemia-Linfoma de Células T do Adulto/complicações , Leucemia-Linfoma de Células T do Adulto/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Prednisona/uso terapêutico , Dermatopatias/etiologia , Vincristina/uso terapêutico
6.
J Med Case Rep ; 14(1): 246, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33339534

RESUMO

BACKGROUND: In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events. CASE PRESENTATION: We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury. CONCLUSIONS: Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).


Assuntos
Anemia Hemolítica Autoimune/sangue , Infecções Assintomáticas , Proteína C-Reativa/imunologia , Interleucina-6/imunologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Idoso de 80 Anos ou mais , Anemia Hemolítica Autoimune/tratamento farmacológico , Anemia Hemolítica Autoimune/etiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , /tratamento farmacológico , Teste de Coombs , Eletrocardiografia , Inibidores Enzimáticos/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Prednisolona/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
7.
BMJ ; 371: m4328, 2020 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-33268527

RESUMO

OBJECTIVE: To evaluate and compare benefits and harms of three biological treatments with different modes of action versus active conventional treatment in patients with early rheumatoid arthritis. DESIGN: Investigator initiated, randomised, open label, blinded assessor, multiarm, phase IV study. SETTING: Twenty nine rheumatology departments in Sweden, Denmark, Norway, Finland, the Netherlands, and Iceland between 2012 and 2018. PARTICIPANTS: Patients aged 18 years and older with treatment naive rheumatoid arthritis, symptom duration less than 24 months, moderate to severe disease activity, and rheumatoid factor or anti-citrullinated protein antibody positivity, or increased C reactive protein. INTERVENTIONS: Randomised 1:1:1:1, stratified by country, sex, and anti-citrullinated protein antibody status. All participants started methotrexate combined with (a) active conventional treatment (either prednisolone tapered to 5 mg/day, or sulfasalazine combined with hydroxychloroquine and intra-articular corticosteroids), (b) certolizumab pegol, (c) abatacept, or (d) tocilizumab. MAIN OUTCOME MEASURES: The primary outcome was adjusted clinical disease activity index remission (CDAI≤2.8) at 24 weeks with active conventional treatment as the reference. Key secondary outcomes and analyses included CDAI remission at 12 weeks and over time, other remission criteria, a non-inferiority analysis, and harms. RESULTS: 812 patients underwent randomisation. The mean age was 54.3 years (standard deviation 14.7) and 68.8% were women. Baseline disease activity score of 28 joints was 5.0 (standard deviation 1.1). Adjusted 24 week CDAI remission rates were 42.7% (95% confidence interval 36.1% to 49.3%) for active conventional treatment, 46.5% (39.9% to 53.1%) for certolizumab pegol, 52.0% (45.5% to 58.6%) for abatacept, and 42.1% (35.3% to 48.8%) for tocilizumab. Corresponding absolute differences were 3.9% (95% confidence interval -5.5% to 13.2%) for certolizumab pegol, 9.4% (0.1% to 18.7%) for abatacept, and -0.6% (-10.1% to 8.9%) for tocilizumab. Key secondary outcomes showed no major differences among the four treatments. Differences in CDAI remission rates for active conventional treatment versus certolizumab pegol and tocilizumab, but not abatacept, remained within the prespecified non-inferiority margin of 15% (per protocol population). The total number of serious adverse events was 13 (percentage of patients who experienced at least one event 5.6%) for active conventional treatment, 20 (8.4%) for certolizumab pegol, 10 (4.9%) for abatacept, and 10 (4.9%) for tocilizumab. Eleven patients treated with abatacept stopped treatment early compared with 20-23 patients in the other arms. CONCLUSIONS: All four treatments achieved high remission rates. Higher CDAI remission rate was observed for abatacept versus active conventional treatment, but not for certolizumab pegol or tocilizumab versus active conventional treatment. Other remission rates were similar across treatments. Non-inferiority analysis indicated that active conventional treatment was non-inferior to certolizumab pegol and tocilizumab, but not to abatacept. The results highlight the efficacy and safety of active conventional treatment based on methotrexate combined with corticosteroids, with nominally better results for abatacept, in treatment naive early rheumatoid arthritis. TRIAL REGISTRATION: EudraCT2011-004720-35, NCT01491815.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Glucocorticoides/uso terapêutico , Metotrexato/uso terapêutico , Abatacepte/uso terapêutico , Adulto , Idoso , Anticorpos Anti-Proteína Citrulinada/imunologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Artrite Reumatoide/imunologia , Proteína C-Reativa/imunologia , Certolizumab Pegol/uso terapêutico , Dinamarca , Quimioterapia Combinada , Intervenção Médica Precoce , Feminino , Finlândia , Humanos , Hidroxicloroquina/uso terapêutico , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Países Baixos , Noruega , Prednisolona/uso terapêutico , Fator Reumatoide/imunologia , Índice de Gravidade de Doença , Método Simples-Cego , Sulfassalazina/uso terapêutico , Suécia , Resultado do Tratamento
8.
Am J Gastroenterol ; 115(11): 1857-1868, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33156105

RESUMO

INTRODUCTION: Up to 40% of patients with severe alcoholic hepatitis (AH) die within 6 months of presentation, making prompt diagnosis and appropriate treatment essential. We determined the associations between serum keratin-18 (K18) and histological features, prognosis, and differential response to prednisolone in patients with severe AH. METHODS: Total (K18-M65) and caspase-cleaved K18 (K18-M30) were quantified in pretreatment sera from 824 patients enrolled in the Steroids or Pentoxifylline for Alcoholic Hepatitis trial (87 with suitable histological samples) and disease controls. RESULTS: K18 fragments were markedly elevated in severe AH and strongly predicted steatohepatitis (alcoholic steatohepatitis) on biopsy (area under receiver operating characteristics: 0.787 and 0.807). Application of published thresholds to predict alcoholic steatohepatitis would have rendered biopsy unnecessary in 84% of all AH cases. K18-M30 and M65 were associated with 90-day mortality, independent of age and Model for End-stage Liver Disease score in untreated patients. The association for K18-M65 was independent of both age and Model for End-stage Liver Disease in prednisolone-treated patients. Modelling of the effect of prednisolone on 90-day mortality as a function of pretreatment serum K18 levels indicated benefit in those with high serum levels of K18-M30. At low pretreatment serum K18 levels, prednisolone was potentially harmful. A threshold of K18-M30 5 kIU/L predicted therapeutic benefit from prednisolone above this level (odds ratio: 0.433, 95% confidence interval: 0.19-0.95, P = 0.0398), but not below (odds ratio: 1.271, 95% confidence interval: 0.88-1.84, P = 0.199). Restricting prednisolone usage to the former group would have reduced exposure by 87%. DISCUSSION: In a large cohort of patients with severe AH, serum K18 strongly correlated with histological severity, independently associated with 90-day mortality, and predicted response to prednisolone therapy. Quantification of serum K18 levels could assist in clinical decision-making.


Assuntos
Hepatite Alcoólica/sangue , Queratina-18/sangue , Cirrose Hepática Alcoólica/sangue , Fragmentos de Peptídeos/sangue , Adulto , Biópsia , Doença Hepática Terminal , Feminino , Glucocorticoides/uso terapêutico , Hepatite Alcoólica/tratamento farmacológico , Hepatite Alcoólica/patologia , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Prognóstico , Índice de Gravidade de Doença
9.
Int Heart J ; 61(6): 1307-1310, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-33191347

RESUMO

Acute pericarditis is inflammation of the pericardium with or without pericardial effusion. In the pediatric population, most patients with acute pericarditis are diagnosed with idiopathic pericarditis. Herein, we present two children with idiopathic pericarditis who underwent immunological assessment of pericardial effusion for the first time. Both patients showed equally high levels of interleukin-6 in the pericardial effusion. However, they had different treatment responses, in accordance with the pericardial effusion and serum interleukin-10 concentrations. Our present cases suggest that interleukin-10 may be associated with the response to anti-inflammatory therapy in idiopathic acute pericarditis.


Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Interleucina-10/imunologia , Interleucina-6/imunologia , Derrame Pericárdico/tratamento farmacológico , Pericardite/tratamento farmacológico , Aspirina/uso terapêutico , Cardiotônicos/uso terapêutico , Cefotaxima/uso terapêutico , Pré-Escolar , Citocinas/imunologia , Dobutamina/uso terapêutico , Dopamina/uso terapêutico , Humanos , Lactente , Masculino , Meropeném/uso terapêutico , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/imunologia , Líquido Pericárdico/imunologia , Pericardite/diagnóstico por imagem , Pericardite/imunologia , Prednisolona/uso terapêutico , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(43): e22076, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120729

RESUMO

INTRODUCTION: Individuals with tuberculosis (TB) who are being treated with anti-tumor necrosis factor α (anti-TNFα) for coexisting conditions may experience unexpected exacerbations of TB after the initiation of antituberculous therapy, so-called anti-TNFα-induced TB-immune reconstitution inflammatory syndrome (anti-TNFα-induced TB-IRIS). Anti-TNFα-induced TB-IRIS is often treated empirically with corticosteroids; however, the evidence of the effectiveness of corticosteroids is lacking and the management can be a challenge. PATIENT CONCERNS: A 32-year-old man on long-term infliximab therapy for Crohn disease visited a clinic complaining of persistent fever and cough that had started 1 week previously. His most recent infliximab injection had been administered 14 days before the visit. A chest X-ray revealed a left pleural effusion, and he was admitted to a local hospital. DIAGNOSIS: A chest computed tomography (CT) scan revealed miliary pulmonary nodules; acid-fast bacilli were found in a sputum smear and a urine sediment sample; and polymerase chain reaction confirmed the presence of Mycobacterium tuberculosis in both his sputum and the pleural effusion. He was diagnosed with miliary TB. INTERVENTIONS: Antituberculous therapy was started and he was transferred to our hospital for further management. His symptoms initially improved after the initiation of antituberculous therapy, but 2 weeks later, his symptoms recurred and shadows on chest X-ray worsened. A repeat chest CT scan revealed enlarged miliary pulmonary nodules, extensive ground-glass opacities, and an increased volume of his pleural effusion. This paradoxical exacerbation was diagnosed as TB-IRIS associated with infliximab. A moderate-dose of systemic corticosteroid was initiated [prednisolone 25 mg/day (0.5 mg/kg/day)]. OUTCOMES: After starting corticosteroid treatment, his radiological findings improved immediately, and his fever and cough disappeared within a few days. After discharge, prednisolone was tapered off over the course of 10 weeks, and he completed a 9-month course of antituberculous therapy uneventfully. He had not restarted infliximab at his most recent follow-up 14 months later. CONCLUSION: We successfully managed a patient with anti-TNFα-induced TB-IRIS using moderate-dose corticosteroids. Due to the limited evidence currently available, physicians should consider the necessity, dosage, and duration of corticosteroids for each case of anti-TNFα-induced TB-IRIS on an individual patient-by-patient basis.


Assuntos
Glucocorticoides/uso terapêutico , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Infliximab/efeitos adversos , Prednisolona/uso terapêutico , Tuberculose Miliar/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Humanos , Masculino , Tomografia Computadorizada por Raios X , Tuberculose Miliar/diagnóstico por imagem , Tuberculose Miliar/etiologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/etiologia
11.
Rev Med Suisse ; 16(712): 2059-2073, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112521

RESUMO

Uveitis is an inflammation of the eye, resulting from infection or inflammation and is sometimes related to rheumatic and other auto-immune diseases. The condition is classified according to the anatomical site of inflammation: anterior, intermediate, posterior or panuveitis. Uveitis may result in a significant loss of visual acuity, that may however be avoided by controlling the inflammation. Anterior uveitis is the only form that responds to topical therapies (prednisolone acetate and mydriatics). The other forms of inflammatory and non-infectious uveitis often require treatment with systemic corticosteroids, followed by immunosuppressive or biological therapies, which requires close collaboration between the different medical sub-specialties.


Assuntos
Medicina Interna , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Humanos , Midriáticos , Prednisolona/administração & dosagem , Prednisolona/análogos & derivados , Prednisolona/uso terapêutico , Uveíte/etiologia
12.
BMJ Case Rep ; 13(11)2020 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-33051251

RESUMO

Sudden onset sensorineural hearing loss (SSNHL) is frequently seen by otolaryngologists. The exact pathophysiology of the disease is still unknown, with the most likely causative factor being following a viral infection. Immediate steroids are the best treatment to improve prognosis. Despite a plethora of papers in the literature describing SSNHL, there are only a few reported cases of hearing loss following COVID-19, none of which have been reported in the UK. This paper presents the first UK case of SSNHL following COVID-19. Physical examination and imaging excluded any other cause of hearing loss. A literature review showed that four other cases have been previously described. Hearing loss can be a significant cause of morbidity and can easily be missed in the intensive care setting. Being aware and screening for SSNHL following COVID-19 enables an early course of steroids, which offers the best chance of recovering hearing.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Perda Auditiva Súbita/complicações , Perda Auditiva Súbita/tratamento farmacológico , Hemissuccinato de Metilprednisolona/uso terapêutico , Pneumonia Viral/complicações , Prednisolona/uso terapêutico , Administração Oral , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Perda Auditiva Súbita/diagnóstico , Humanos , Injeções , Masculino , Hemissuccinato de Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Pandemias , Prednisolona/administração & dosagem
13.
Intern Med ; 59(19): 2343-2351, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32999263

RESUMO

Objective Anti-tumor necrosis factor (TNF)-α antibody-based regimens are effective in Behçet's disease (BD) with intestinal lesions. We therefore evaluated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance therapy of BD intestinal and non-intestinal lesions. Methods In this retrospective study, the response to the treatment was assessed endoscopically and clinically. Treatment responders were transferred to maintenance therapy. We evaluated the sustain rate of maintenance therapy, reductions in the dose of prednisolone (PSL), and the presence of non-intestinal BD involvement before and after the start of anti-TNF-α antibody-based the maintenance therapy. Patients We assessed 20 BD patients with intestinal lesions who underwent anti-TNF-α antibody-based therapy. Results Treatment was discontinued in 3 patients (18%). Loss of response was noted in 1 (5.9%) patient. Maintenance therapy was continued in 13 (76%) patients. The cumulative sustain rates to maintenance therapy after 2, 4, and 6 years were 94%, 87%, and 72%, respectively. In the 13 patients with remission of intestinal lesions, the mean PSL dose decreased from 13.4±2.16 mg/day before treatment to 0.92±0.47 after treatment (p<0.0001). PSL was discontinued in 9 (69%) patients. Five of the 13 (38%) patients developed clinical features of non-intestinal BD during the remission-maintenance treatment. Conclusion Our results demonstrated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance treatment against BD intestinal lesions. Nevertheless, some cases with well-controlled intestinal lesions developed active non-intestinal BD symptoms. The results highlight the importance of a carefully planned treatment strategy for BD patients with intestinal involvement.


Assuntos
Síndrome de Behçet/terapia , Fator de Necrose Tumoral alfa/uso terapêutico , Adulto , Anticorpos/uso terapêutico , Feminino , Humanos , Imunoterapia , Intestinos/patologia , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Estudos Retrospectivos
15.
Middle East Afr J Ophthalmol ; 27(2): 134-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874049

RESUMO

Nodular posterior scleritis represents a small percentage of all cases of posterior scleritis. Because of the scarcity of nodular posterior scleritis, it may be confused or even misdiagnosed as an intraocular tumor or posterior uveitis. Here, we are reporting a case of nodular posterior scleritis in a 25-year-old medically free male. Furthermore, we reviewed previously reported cases of nodular posterior scleritis. Our patient presented with a choroidal mass of about one disc diameter in size. In addition, the patient had exudative retinal detachment and chorioretinal folds. B scan ultrasonography showed subretinal fluid, macular nodular thickening and underlying echolucent area along with medium internal reflectivity on A scan. Fluorescein angiography revealed early pinpoint areas of hyperfluorescence and late pooling under the detached retina. Indocyanine green angiography demonstrated early diffuse hypofluorescence corresponding to the area of detachment and late multiple pinpoint spots of hyperfluorescence. After intravenous methylprednisolone 1 g for 3 days followed by a course of oral prednisolone along with mycophenolate mofetil, the patient experienced rapid recovery with improvement in vision and complete resolution of subretinal fluid. On further follow-up, the patient regained 20/20 vision. Nodular posterior scleritis is a rare unilateral disease with strong female predominance. Multimodal imaging should be employed to confirm the diagnosis. The disease must be diagnosed correctly to avoid any unnecessary diagnostic work-up and aggressive management. Most cases carry excellent prognosis with no recurrence.


Assuntos
Neoplasias da Coroide/diagnóstico , Melanoma Amelanótico/diagnóstico , Descolamento Retiniano/diagnóstico , Esclerite/diagnóstico , Administração Oral , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Neoplasias da Coroide/tratamento farmacológico , Corantes/administração & dosagem , Quimioterapia Combinada , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Verde de Indocianina/administração & dosagem , Infusões Intravenosas , Masculino , Melanoma Amelanótico/tratamento farmacológico , Metilprednisolona/uso terapêutico , Imagem Multimodal , Ácido Micofenólico/uso terapêutico , Prednisolona/uso terapêutico , Descolamento Retiniano/tratamento farmacológico , Esclerite/tratamento farmacológico , Tomografia de Coerência Óptica
16.
Front Immunol ; 11: 2086, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32983161

RESUMO

Immunosuppressive therapies increase the susceptibility of patients to infections. The current pandemic with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compels clinicians to develop recommendations for successful clinical management and surveillance of immunocompromised patients at high risk for severe disease progression. With only few case studies published on SARS-CoV-2 infection in patients with rheumatic diseases, we report a 25-year-old male who developed moderate coronavirus disease 2019 (COVID-19) with fever, mild dyspnea, and no major complications despite having received high-dose prednisolone, cyclophosphamide, and rituximab for the treatment of highly active, life-threatening eosinophilic granulomatosis with polyangiitis (EGPA).


Assuntos
Betacoronavirus/genética , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/tratamento farmacológico , Infecções por Coronavirus/complicações , Ciclofosfamida/uso terapêutico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Imunossupressores/uso terapêutico , Pneumonia Viral/complicações , Adulto , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Quimioterapia Combinada , Glucocorticoides/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Prednisolona/uso terapêutico , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rituximab/uso terapêutico , Resultado do Tratamento
17.
Sci Rep ; 10(1): 15563, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32968109

RESUMO

Childhood-onset systemic lupus erythematosus (SLE) is associated with greater disease activity, more aggressive course, and high rates of organ damage. The prolonged use of corticosteroids in childhood SLE contributes to increased morbidity, including avascular necrosis (AVN). We conducted this retrospective study using claims data from the Taiwan National Health Insurance Research Database, enrolling 1,472 children with newly-diagnosed SLE between 2005 and 2013. The mean age at the diagnosis of SLE was 15.5 ± 3.3 years, and the female to male ratio was 6.2:1. Thirty-nine patients (2.6%) developed symptomatic AVN during a mean follow-up of 4.6 ± 2.5 years. In multivariate analysis, the risk of AVN was higher in the patients with a daily prednisolone dose between 7.5 mg and 30 mg (HR 7.435, 95% CI 2.882-19.178, p < 0.001) and over 30 mg (HR 9.366, 95% CI 2.225-39.418, p = 0.002) than in those with a dose ≤ 7.5 mg/day. In addition, AVN was inversely correlated with the use of hydroxychloroquine > 627 days (HR 0.335, 95% CI 0.162-0.694, p = 0.003). In conclusion, high daily doses of prednisolone were associated with a significant risk of AVN, whereas the use of hydroxychloroquine > 627 days conferred an advantage. We suggest that the judicious use of corticosteroids combined with hydroxychloroquine might be a promising preventive strategy for AVN.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Sistema Musculoesquelético/patologia , Osteonecrose/epidemiologia , Doenças Reumáticas/epidemiologia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/patologia , Masculino , Osteonecrose/complicações , Osteonecrose/patologia , Prednisolona/uso terapêutico , Doenças Reumáticas/patologia , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
19.
J Small Anim Pract ; 61(11): 676-683, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32989769

RESUMO

OBJECTIVE: To describe the clinical findings, magnetic resonance imaging features, management and outcome of canine cases with presumed optic neuritis of non-infectious origin that were presented to a UK referral centre from January 2000 to December 2015. MATERIALS AND METHODS: The clinical database was searched for optic neuritis. Dogs with acute-onset vision impairment, systemic immunosuppressive treatment and follow-up of ≥6 months were included. Information collected included: age; gender; breed; clinical signs and duration; physical, ophthalmic and neurological examination findings; concurrent systemic disease; and results of electroretinogram, magnetic resonance imaging, cerebrospinal fluid analysis, polymerase chain reaction and serology testing for Toxoplasma gondii, Neospora caninum and canine distemper virus, haematology and serum biochemistry profiles, abdominal ultrasound, thoracic radiography, treatment and outcome. RESULTS: Twenty-eight dogs were included, with a total of 48 affected optic nerves. Age at presentation ranged from 6 months to 10.5 years. Fundoscopic evidence of optic nerve disease was present in 34 of 48 (71%) optic nerves. Magnetic resonance imaging revealed enlargement of 32 of 48 (67%) nerves and contrast enhancement of 28 of 48 (58%) nerves. Cerebrospinal fluid analysis performed in 25 of 28 (89%) dogs revealed pleocytosis (>5 nucleated cells/uL) in 11 of 25 (44%) and increased protein (>0.35 g/L) in 11 of 25 (44%). Immunosuppressive prednisolone was administered to all dogs. Prednisolone was used alone in 9 of 28 (32%) dogs; the remaining 19 dogs received a combination of prednisolone with cytosine arabinoside, cyclosporine and/or azathioprine. Vision was recovered in 24 eyes (50%) of 18 affected dogs. CLINICAL SIGNIFICANCE: A positive response to treatment was observed in 64% of dogs with presumptively diagnosed optic neuritis treated with immunosuppressive medication.


Assuntos
Doenças do Cão , Neurite Óptica , Animais , Doenças do Cão/tratamento farmacológico , Cães , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética/veterinária , Neurite Óptica/tratamento farmacológico , Neurite Óptica/veterinária , Prednisolona/uso terapêutico
20.
Nihon Ronen Igakkai Zasshi ; 57(3): 321-326, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32893215

RESUMO

IgG4-related disease (IgG4-RD) which is characterized by an autoimmune abnormality and elevated serum IgG4 level often presents as swelling, nodules, and the thickening of multiple organs. It typically occurs in middle-aged to elderly patients, but its pathogenesis remains unclear. Lymphadenopathy is frequently seen in IgG4-RD, which clinically requires a differential diagnosis from malignant lymphoma. We herein report a case of malignant lymphoma with IgG4-RD arising in a very elderly man.An 85-year old man with a 6-year history of autoimmune pancreatitis was diagnosed as IgG4-related hypophysitis 13 months prior to admission. Hydrocortisone was prescribed for secondary adrenal insufficiency after this presentation. At 9 months before admission, he began to suffer from central diabetes insipidus, and desmopressin was also prescribed at that time. However, 9 months later, he presented with fever, weight loss, and systemic lymphadenopathy while demonstrating elastic hardness, flexibility, and no tenderness. A pathologic specimen obtained from a right axillary lymph node biopsy revealed diffuse large B cell lymphoma. Considering his age and performance status, palliative therapy was chosen, and thus prednisolone was administered. He was transferred to another hospital to receive palliative care on the 55th day after hospitalization.We should consider the clinical course, pathological findings, serum IgG4 level, and other involved organs in order to differentiate malignant lymphoma from IgG4-related lymphadenopathy. To our knowledge, this case is the oldest known patient to have ever been reported. Both IgG4-RD and malignant lymphoma are frequently seen in elderly people, therefore, we should deepen our knowledge of these diseases.


Assuntos
Doença Relacionada a Imunoglobulina G4 , Linfoma , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/uso terapêutico , Biópsia , Diagnóstico Diferencial , Humanos , Imunoglobulina G , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Linfoma/complicações , Linfoma/diagnóstico , Linfoma/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico
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