Successful induction therapy with sequential CVD followed by high-dose lanreotide in for metastatic SDHB paraganglioma: Case report

: Kidney transplantation is a preferable treatment of children with end-stage kidney disease. All kidney transplant recipients, including pediatric need immunosuppressive medications to prevent rejection episodes and graft loss. : Induction therapy is used temporarily only immediately following transplantation while maintenance immunosuppressive drugs are started and given long-term. There is currently no consensus regarding the use of induction therapy in children; its use should be decided based on the immunological risk of the child. : The recent progress shows that the recommended strategy is to use as maintenance immunosuppressive therapy a combination of a calcineurin inhibitor (preferably tacrolimus) with an antiproliferative drug (preferably mycophenolate mofetil) with steroids that can be withdrawn early or late in low-risk children. The mTOR-inhibitors (sirolimus, everolimus) are used rarely in pediatrics because of common side effects and no evidence of a benefit over calcineurin inhibitors. The use of calcineurin inhibitors, mycophenolate, and mTOR-inhibitors should be followed by therapeutic drug monitoring. : Immunosuppressive therapy of acute rejection consists of high-dose steroids and/or anti-lymphocyte antibodies (T-cell mediated rejection) or plasma exchange, intravenous immunoglobulines and/or rituximab (antibodymediated rejection). : The future strategies for research are mainly precise characterisation of children needing induction therapy, more specific indications for mTOR-inhibitors and for the far future, the possibility to reach the immuno tolerance.

Download Full-text

High dose naloxone for acute tizanidine overdose in the emergency department: a case report

Clinical Toxicology ◽

10.1080/15563650.2020.1863977 ◽

2021 ◽

pp. 1-2

Author(s):

Amber Adams ◽

Colton Copley

Keyword(s):

Emergency Department ◽

Case Report ◽

High Dose

Download Full-text

Refractory eosinophilic fasciitis successfully treated with infliximab: A case report

Journal of Scleroderma and Related Disorders ◽

10.1177/23971983211004399 ◽

2021 ◽

pp. 239719832110043

Author(s):

Paulina Śmigielska ◽

Justyna Czarny ◽

Jacek Kowalski ◽

Aleksandra Wilkowska ◽

Roman J. Nowicki

Keyword(s):

Case Report ◽

Connective Tissue ◽

Treatment Failure ◽

Immunosuppressive Drugs ◽

Unknown Etiology ◽

High Dose ◽

Eosinophilic Fasciitis ◽

Line Treatment ◽

First Line ◽

First Line Treatment

Eosinophilic fasciitis is a rare connective tissue disease of unknown etiology. Therapeutic options include high-dose corticosteroids and other immunosuppressive drugs. We present a typical eosinophilic fasciitis case, which did not respond to first-line treatment, but improved remarkably after infliximab administration. This report demonstrates that in case of initial treatment failure, infliximab might be a relatively safe and effective way of eosinophilic fasciitis management.

Download Full-text

COVID‐19 reinfection in a healthcare worker after exposure with high dose of virus: A case report

Clinical Case Reports ◽

10.1002/ccr3.4257 ◽

2021 ◽

Vol 9 (6) ◽

Author(s):

Shahram Ahmadian ◽

Hadis Fathizadeh ◽

Saeid Shabestari Khiabani ◽

Mohammad Asgharzadeh ◽

Hossein Samadi Kafil

Keyword(s):

Case Report ◽

Healthcare Worker ◽

High Dose

Download Full-text

Nonepileptic Myoclonus in COVID-19: Case Report

The Neurohospitalist ◽

10.1177/19418744211004315 ◽

2021 ◽

pp. 194187442110043

Author(s):

Henly Hewan ◽

Annie Yang ◽

Aparna Vaddiparti ◽

Benison Keung

Keyword(s):

Case Report ◽

Critically Ill ◽

Recovery Phase ◽

Critically Ill Patient ◽

High Dose ◽

The Novel ◽

Neurological Manifestations ◽

Immune Mediated ◽

Novel Coronavirus ◽

Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

Download Full-text

Acute Tubulointerstitial Nephritis in a Patient on Anti-Programmed Death-Ligand 1 Triggered by COVID-19: A Case Report

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211014745 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110147

Author(s):

Dimitry Buyansky ◽

Catherine Fallaha ◽

François Gougeon ◽

Marie-Noëlle Pépin ◽

Jean-François Cailhier ◽

...

Keyword(s):

Case Report ◽

Severe Acute Respiratory Syndrome ◽

Tubulointerstitial Nephritis ◽

Checkpoint Inhibitor ◽

Checkpoint Inhibitors ◽

High Dose ◽

Programmed Death Ligand 1 ◽

Acute Tubulointerstitial Nephritis ◽

Programmed Death ◽

Kidney Involvement

Rationale: Immune checkpoint inhibitors are monoclonal antibodies used in the treatment of various types of cancers. The downside of using such molecules is the potential risk of developing immune-related adverse events. Factors that trigger these autoimmune side effects are yet to be elucidated. Although any organ can potentially be affected, kidney involvement is usually rare. In this case report, we describe the first known instance of a patient being treated with an inhibitor of programmed death-ligand 1 (anti-PD-L1, a checkpoint inhibitor) who develops acute tubulointerstitial nephritis after contracting the severe acute respiratory syndrome coronavirus 2. Presenting concerns of the patient: A 62-year-old patient, on immunotherapy treatment for stage 4 squamous cell carcinoma, presents to the emergency department with symptoms of lower respiratory tract infection. Severe acute kidney injury is discovered with electrolyte imbalances requiring urgent dialysis initiation. Further testing reveals that the patient has contracted the severe acute respiratory syndrome coronavirus 2. Diagnosis: A kidney biopsy was performed and was compatible with acute tubulointerstitial nephritis. Interventions: The patient was treated with high dose corticosteroid therapy followed by progressive tapering. Outcomes: Rapid and sustained normalization of kidney function was achieved after completion of the steroid course. Novel findings: We hypothesize that the viral infection along with checkpoint inhibitor use has created a proinflammatory environment which led to a loss of self-tolerance to renal parenchyma. Viruses may play a more important role in the pathogenesis of autoimmunity in this patient population than was previously thought.

Download Full-text

Indications for Tonsillectomy in Infectious Mononucleosis

PEDIATRICS ◽

10.1542/peds.48.2.338 ◽

1971 ◽

Vol 48 (2) ◽

pp. 338-339

Author(s):

Edward J. Feroli ◽

Gordon W. Mella ◽

Frank A. Pedreira ◽

Regis T. Storch ◽

Howard P. Gutgesell

Keyword(s):

Case Report ◽

Infectious Mononucleosis ◽

Community Hospital ◽

Nasotracheal Intubation ◽

Benign Disease ◽

Therapeutic Modality ◽

High Dose ◽

High Dose Corticosteroid ◽

Acute Airway Obstruction ◽

Dose Corticosteroid

We read with interest the recent report, "Acute Airway Obstruction in Infectious Mononucleosis."1 Dr. Gutgesell appropriately has called attention to a serious complication of a usually benign disease. He mentions brief, high-dose corticosteroid therapy, tracheotomy, nasotracheal intubation, and IPPB as potential modes of therapy. The following case report suggests an additional therapeutic modality in the management of these patients. A 4-year-old girl was admitted to a community hospital in acute respiratory distress associated with suspected infectious mononucleosis.

Download Full-text