Anakinra as rescue therapy for steroid-dependent idiopathic recurrent pericarditis in children: case report and literature review

AbstractIn approximately 5% of patients with idiopathic recurrent pericarditis, the disease usually follows a chronic relapsing course, and children can develop dependence and side effects of prolonged high-dose corticosteroid regimens. In this setting anakinra, a recombinant human interleukin-1 competitive receptor antagonist that blocks the biologic effects of interleukin-1, thereby reducing systemic inflammatory responses, appears to be one of the most promising strategies. We report an adolescent with steroid-dependent idiopathic recurrent pericarditis that was successfully treated with anakinra, highlighting that this therapeutic option seems to be an effective, rapidly acting, steroid-sparing, and relatively safe agent for the treatment of this entity in children.

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Anakinra in the treatment of protracted paradoxical inflammatory reactions in HIV-associated tuberculosis in the United Kingdom: a report of two cases

International Journal of STD & AIDS ◽

10.1177/0956462420915394 ◽

2020 ◽

Vol 31 (8) ◽

pp. 808-812 ◽

Cited By ~ 3

Author(s):

Alexander J Keeley ◽

Vivak Parkash ◽

Anne Tunbridge ◽

Julia Greig ◽

Paul Collini ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Therapeutic Option ◽

Interleukin 1 ◽

High Dose ◽

Inflammatory Reactions ◽

Amyloid A ◽

The United Kingdom ◽

First Case ◽

Life Threatening ◽

Dose Corticosteroid

Paradoxical reactions, including immune reconstitution inflammatory syndrome (IRIS), are common in patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB). Paradoxical reactions may confer substantial morbidity and mortality, especially in cases of central nervous system (CNS) TB, or through protracted usage of corticosteroids. No high-quality evidence is available to guide management in this scenario. Interleukin-1-mediated inflammation has been implicated in the pathophysiology of TB–IRIS. We describe two cases where anakinra (human recombinant interleukin-1 receptor antagonist) was used as steroid-sparing therapy for life-threatening protracted paradoxical inflammation in HIV-associated TB. In the first case of disseminated TB with lymphadenitis, protracted TB–IRIS led to amyloid A amyloidosis and nephrotic syndrome. In the second case of disseminated TB with cerebral tuberculomata, paradoxical inflammation caused unstable tuberculomata leading to profound neuro-disability. In both cases, paradoxical inflammation persisted for over a year. Protracted high-dose corticosteroid use led to adverse events yet failed to control inflammatory pathology. In both patients, anakinra successfully controlled paradoxical inflammation and facilitated withdrawal of corticosteroid therapy. Following anakinra therapy, nephrotic syndrome and neuro-disability resolved, respectively. Anakinra therapy for protracted paradoxical inflammation in HIV-associated TB may be a viable therapeutic option and warrants further research.

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Rescue Therapy with Tacrolimus for a Patient with Severe Ulcerative Colitis Refractory to Combination Leukocytapheresis and High-Dose Corticosteroid Therapy

Internal Medicine ◽

10.2169/internalmedicine.46.6219 ◽

2007 ◽

Vol 46 (11) ◽

pp. 717-720 ◽

Cited By ~ 2

Author(s):

Hiroshi Nakase ◽

Sakae Mikami ◽

Minoru Matsuura ◽

Satoru Ueno ◽

Norimitsu Uza ◽

...

Keyword(s):

Ulcerative Colitis ◽

Corticosteroid Therapy ◽

Rescue Therapy ◽

High Dose ◽

High Dose Corticosteroid ◽

Severe Ulcerative Colitis ◽

Dose Corticosteroid

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High-Dose Corticosteroid Pulse Therapy Increases the Survival Rate in COVID-19 Patients at Risk of Cytokine Storm

SSRN Electronic Journal ◽

10.2139/ssrn.3633168 ◽

2020 ◽

Author(s):

Miguel Ángel López-Zúñiga ◽

Aida Moreno-Moral ◽

Ana Ocaña-Granados ◽

Francisco Padilla-Moreno ◽

Alba María Castillo-Fernández ◽

...

Keyword(s):

At Risk ◽

Survival Rate ◽

Pulse Therapy ◽

High Dose ◽

Cytokine Storm ◽

High Dose Corticosteroid ◽

Patients At Risk ◽

Corticosteroid Pulse Therapy ◽

Dose Corticosteroid

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Magnetic Resonance Imaging Evaluation in Patients with Linear Morphea Treated with Methotrexate and High-Dose Corticosteroid

Dermatology Research and Practice ◽

10.1155/2018/8391218 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Mohammad Shahidi-Dadras ◽

Fahimeh Abdollahimajd ◽

Razieh Jahangard ◽

Ali Javinani ◽

Amir Ashraf-Ganjouei ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Dose ◽

Skin Thickness ◽

Resonance Imaging ◽

High Dose Corticosteroid ◽

Before And After ◽

Lesion Extension ◽

Dose Corticosteroid ◽

Mri Changes

Background. Morphea is an inflammatory disease of the connective tissue that may lead to thickening and hardening of the skin due to fibrosis. The aim of this study was to document magnetic resonance imaging (MRI) changes in patients with linear morphea who were treated with methotrexate (MTX) and high-dose corticosteroid. Methods. This study was conducted on 33 patients from the outpatient’s dermatology clinic of our institute, who fulfilled the inclusion criteria. Patients received 15 mg/week of MTX and monthly pulses of methylprednisolone for three days in six months. The effectiveness of the treatment was evaluated by MRI, modified LS skin severity index (mLoSSI), and localized scleroderma damage index (LoSDI). Results. All parameters of mLoSSI and LoSDI including erythema, skin thickness, new lesion/lesion extension, dermal atrophy, subcutaneous atrophy, and dyspigmentation were also noticeably improved after treatment. Subcutaneous fat enhancement was the most common finding in MRI. MRI scores were significantly associated with clinical markers both before and after the treatment with the exception of skin thickness and new lesion/lesion extension which were not associated with MRI scores before and after the treatment, respectively. Limitations. The lack of correlative laboratory disease activity markers, control group, and clearly defined criteria to judge the MRI changes. Conclusion. MRI could be a promising tool for the assessment of musculoskeletal and dermal involvement and also monitoring treatment response in patients with morphea.

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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.

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