Early steroid pulse therapy for children with suspected acute encephalopathy

Abstract Background Steroid pulse therapy is widely used for virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We aimed to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels. Methods We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature > 38˚C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at six hours from onset, and AST elevation > 90 IU/L within six hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1–2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy. Results Fifteen patients with acute encephalopathy and five patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, p = 0.405). Conclusions Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with AST elevation.

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Vogt–Koyanagi–Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report

BMC Ophthalmology ◽

10.1186/s12886-020-01519-5 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Ryo Kikuchi ◽

Tatsukata Kawagoe ◽

Kazuki Hotta

Keyword(s):

Case Report ◽

Pulse Therapy ◽

Steroid Pulse Therapy ◽

Steroid Pulse

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A Kidney Transplant Recipient with Recurrent Henoch-Schönlein Purpura Nephritis Successfully Treated with Steroid Pulse Therapy and Epipharyngeal Abrasive Therapy

Nephron ◽

10.1159/000511166 ◽

2020 ◽

pp. 1-5

Author(s):

Mika Fujimoto ◽

Kan Katayama ◽

Kouhei Nishikawa ◽

Shoko Mizoguchi ◽

Keiko Oda ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplantation ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Pulse Therapy ◽

Steroid Pulse Therapy ◽

Steroid Pulse ◽

Schonlein Purpura ◽

Purpura Nephritis

There is no specific treatment for recurrent Henoch-Schönlein purpura nephritis (HSPN) in a transplanted kidney. We herein report a case of a kidney transplant recipient with recurrent HSPN that was successfully treated with steroid pulse therapy and epipharyngeal abrasive therapy (EAT). A 39-year-old Japanese man developed HSPN 4 years ago and had to start hemodialysis after 2 months despite receiving steroid pulse therapy followed by oral prednisolone, plasma exchange therapy, and cyclophosphamide pulse therapy. He had undergone tonsillectomy 3 years earlier in the hopes of achieving a better outcome of a planned kidney transplantation and received a living-donor kidney transplantation from his mother 1 year earlier. Although there were no abnormalities in the renal function or urinalysis 2 months after transplantation, a routine kidney allograft biopsy revealed evidence of mesangial proliferation and cellular crescent formation. Mesangial deposition for IgA and C3 was noted, and he was diagnosed with recurrent HSPN histologically. Since the renal function and urinalysis findings deteriorated 5 months after transplantation, 2 courses of steroid pulse therapy were performed but were ineffective. EAT using 0.5% zinc chloride solution once per day was combined with the third course of steroid pulse therapy, as there were signs of chronic epipharyngitis. His renal function recovered 3 months after daily EAT and has been stable for 1.5 years since transplantation. Daily EAT continued for >3 months might be a suitable strategy for treating recurrent HSPN in cases of kidney transplantation.

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