scholarly journals Successful Treatment of IgA Vasculitis With Prolonged Cutaneous Manifestation With Colchicine in a 10-Year-Old Boy

2021 ◽  
Author(s):  
Yuka Okura ◽  
Yasuyoshi Hiramatsu ◽  
Masaki Shimomura ◽  
Kota Taniguchi ◽  
Mitsuru Nawate ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Colchicine Treatment ◽  
Pulse Therapy ◽  
Cutaneous Manifestation ◽  
Iga Vasculitis ◽  
Cutaneous Manifestations ◽  
Gastrointestinal Manifestation ◽  
Sparing Effect ◽  
Intravenous Methylprednisolone Pulse ◽  
Multiple Drugs

Abstract We report a 10-year-old boy with IgA vasculitis (IgAV) with prolonged cutaneous manifestations who was successfully treated with colchicine. At the age of 9, he was diagnosed as having IgAV by typical purpura, abdominal pain, and hematochezia. Initially, his severe gastrointestinal manifestation subsided by prednisolone 60 mg/day and intravenous methylprednisolone pulse therapy. However, his gastrointestinal manifestation was glucocorticoid-dependent and refractory to factor XIII concentrate, intravenous immunoglobulin G, and mycophenolate mofetil. His abdominal pain and hematochezia responded to the combination therapy with dapsone and low dose of prednisolone 5 mg/day and did not relapse even after discontinuation of dapsone. On the other hands, the effect of dapsone on his cutaneous manifestation was dose-dependent. As well dapsone had no glucocorticoid-sparing effect. Approximately 12 months after onset, colchicine treatment was started, which resulted in remission of his chronic cutaneous manifestation. After prednisolone was tapered off, his cutaneous manifestation is currently well-controlled on colchicine 0.5 mg/day without adverse events. He had never complicated by kidney involvements. In conclusion, colchicine treatment exerts a beneficial effect in IgAV patients with prolonged cutaneous manifestation refractory to multiple drugs.

scholarly journals Multiple Fixed Drug Eruption Mimicking Parapsoriasis en Plaque in a Patient with Hepatitis C Virus Infection

2020 ◽  
Vol 12 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Michie Katsuta ◽  
Akihiko Asahina ◽  
Tetsuo Shiohara
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Immune Responses ◽  
Drug Eruption ◽  
Hcv Rna ◽  
Fixed Drug Eruption ◽  
Cutaneous Manifestations ◽  
Fixed Drug ◽  
Per Se ◽  
Multiple Drugs

Although hepatitis C virus (HCV) infection is often associated with extrahepatic cutaneous manifestations such as lichen planus, it is unclear whether HCV per se or HCV-specific immune responses play a pathophysiological role in the development of HCV-related cutaneous diseases. We recently treated a patient who developed parapsoriasis en plaque-like lesions after ingestion of various drugs. She showed hypersensitivity to multiple drugs after interferon therapy. Her clinical course was complicated by flares of parapsoriasis-like lesions which returned at precisely the same sites. The flares had begun within hours of ingesting nicardipine hydrochloride, amlodipine besilate, candesartan cilexetil and atenolol for the first time despite showing a low level of HCV RNA. Interestingly, the flares gradually subsided during continued treatment with these drugs while her HCV RNA level paradoxically increased: thus, there was an inverse correlation between flares and HCV RNA level. The eruptions were eventually diagnosed as fixed drug eruption, although the clinical manifestations mimicked parapsoriasis en plaque. Our results suggest that multiple drug hypersensitivity could be induced by antiviral immune responses that are cross-reactive to multiple drugs, but not by HCV per se.

Treatment of Graves' ophthalmopathy with high-dose intravenous methylprednisolone pulse therapy

1987 ◽  
Vol 116 (4) ◽  
pp. 513-518 ◽  
Author(s):  
Yuji Nagayama ◽  
Motomori Izumi ◽  
Takeshi Kiriyama ◽  
Naokata Yokoyama ◽  
Shigeki Morita ◽  
...  
Keyword(s):  
Sodium Succinate ◽  
Total Duration ◽  
Pulse Therapy ◽  
Methylprednisolone Pulse Therapy ◽  
High Dose ◽  
Methylprednisolone Pulse ◽  
Methylprednisolone Sodium Succinate ◽  
Graves Ophthalmopathy ◽  
Preliminary Study ◽  
Intravenous Methylprednisolone Pulse

Abstract. This preliminary study was undertaken to investigate the efficacy of high-dose iv methylprednisolone pulse therapy in 5 patients with Graves' ophthalmopathy. One gram of methylprednisolone sodium succinate was given iv daily for 3 successive days. The 3-day infusion was repeated 3 to 7 times at intervals of 1 week; total duration of pulse therapy was 3 to 7 weeks. The clinical improvement of eye involvements by pulse therapy was assessed immediately after the last pulse therapy. The clinical assessment of the effect of pulse therapy for Graves' ophthalmopathy showed a good response in 3 patients, a fair response in one, and no response in one. However, in one patient, who was judged to show no response, complete improvement of the enlarged extraocular muscle was observed on orbital computed tomography. Moreover, two patients, who have been followed without any other therapies, showed no relapse of eye involvements for 32 and 10 months, respectively. Although it is impossible to determine whether pulse therapy is more effective than other immunosuppressive therapies, the results of this preliminary study suggest that pulse therapy may be a good immunosuppressive therapy for Graves' ophthalmopathy too. Controlled studies are desired.

Differential diagnosis of common presentations

2019 ◽  
pp. 863-890
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir H. Sam
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Back Pain ◽  
Chest Pain ◽  
Muscle Weakness ◽  
Joint Pain ◽  
Nausea And Vomiting ◽  
Cutaneous Manifestations ◽  
Internal Malignancy

This chapter explores the differential diagnosis of common presentations, including abdominal pain and distension, back pain, blackouts and collapse, breathlessness and dyspnoea, chest pain, confusion, constipation, cough, cutaneous manifestations of internal malignancy, diarrhoea, dysphagia, falls, fever, fits and seizures, haematemesis and melaena, haematuria, haemoptysis, headache, hemiparesis, hoarseness, itching and pruritus, joint pain and swelling, leg swelling, muscle weakness, nausea and vomiting, palpitations, tremor, unconsciousness and reduced consciousness, weak legs, and wheeze.

scholarly journals Intravenous γ Globulin for Intractable Abdominal Pain due to IgA Vasculitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
George Naifa ◽  
George Totikidis ◽  
Sonia Alexiadou ◽  
Christina Kolona ◽  
Elpis Mantadakis
Keyword(s):  
Abdominal Pain ◽  
Iga Vasculitis ◽  
Controlled Clinical Trials ◽  
Corticosteroid Administration ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Term Administration ◽  
Schonlein Purpura ◽  
Safe Treatment Option

IgA vasculitis (formerly known as Henoch–Schönlein purpura or anaphylactoid purpura) is a usually benign vasculitis that affects children of school age. The disease is characterized by the tetrad of palpable purpura, arthralgia/arthritis, abdominal pain, and hematuria. Treatment of IgA vasculitis is mainly supportive, with administration of simple analgesics. Corticosteroids have been shown to reduce and/or ameliorate the occurrence of abdominal pain which may be severe. We present two children with IgA vasculitis and severe abdominal pain despite corticosteroid administration, who responded promptly to intravenous γ globulin (IVIg) with complete resolution of their symptoms and review of the relevant medical literature. Given the toxicity and/or need for long-term administration of other second-line immunosuppressive therapies in corticosteroid-resistant IgA vasculitis, such as rituximab, cyclosporine, cyclophosphamide, azathioprine, or colchicine, we propose that IVIg may be a useful and safe treatment option, although randomized controlled clinical trials are needed in order to clarify its role in the treatment of abdominal pain in IgA vasculitis.

scholarly journals Low Back Pain and Swelling as an Atypical Presentation of IgA Vasculitis

2020 ◽  
Vol 4 (2) ◽  
pp. 241-243
Author(s):  
Clay Winkler ◽  
Raymond Dobson ◽  
Michael Tranovich
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Immunoglobulin A ◽  
Lumbar Pain ◽  
Low Back ◽  
Iga Vasculitis ◽  
Gastrointestinal Involvement ◽  
Cutaneous Manifestations ◽  
Schonlein Purpura ◽  
Immunoglobulin A Vasculitis

Introduction: Immunoglobulin A vasculitis (IgA vasculitis), formerly Henoch-Schonlein purpura, is the most common vasculitis in children. Case Report: A 6-year-old female presented with low back pain and swelling, difficulty ambulating, and rash two weeks after a respiratory infection. She was approached with a broad differential and ultimately diagnosed with IgA vasculitis. Discussion: Cutaneous manifestations, arthralgias, renal and gastrointestinal involvement are the most common presenting signs of IgA vasculitis. Only two cases of IgA vasculitis associated with lumbar pain and swelling were identified in the literature. Conclusion: While rash and joint pain are common presenting signs of IgA vasculitis, practitioners should be aware it can present atypically.

scholarly journals Successful Use of Plasma Exchange in the Treatment of Corticosteroid-Refractory Eosinophilic Granulomatosis with Polyangiitis Associated with Gastrointestinal Manifestations

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Kohei Tsujimoto ◽  
Masato Yagita ◽  
Masashi Taniguchi ◽  
Masaaki Fujita
Keyword(s):  
Abdominal Pain ◽  
Plasma Exchange ◽  
Paranasal Sinus ◽  
Granulomatosis With Polyangiitis ◽  
Pulse Therapy ◽  
Methylprednisolone Pulse Therapy ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Gastrointestinal Involvement ◽  
Gastrointestinal Manifestations ◽  
Eosinophilic Granulomatosis

We describe the case of a 33-year-old woman having corticosteroid-refractory eosinophilic granulomatosis with polyangiitis (EGPA) who presented with abdominal pain and responded dramatically to plasma exchange. Eosinophilia, asthma history, neuropathy, pulmonary infiltrates, and paranasal sinus abnormalities confirmed the diagnosis of EGPA. Treatment was initiated with 1 g/day of methylprednisolone pulse therapy for 3 days followed by 60 mg/day of intravenous prednisolone without relieving abdominal pain. Then, plasma exchange was performed thrice. Abdominal pain disappeared after the first plasma exchange. Indication of plasma exchange for EGPA remains controversial; however, it may represent a valid option in cases with gastrointestinal involvement.

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