scholarly journals AB0601 RAPID AND SUSTAINED EFFICACY OF AN INDUCTION TREATMENT WITH A TRIPLE THERAPY INCLUDING HIGH-DOSE INTRAVENOUS IMMUNOGLOBULINS, METHOTREXATE AND GLUCOCORTICOIDS IN ANTI-3-HYDROXY-3-METHYLGLUTARYL-COENZYME A REDUCTASE MYOPATHY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1597.1-1597
Author(s):  
E. Treppo ◽  
M. Infantino ◽  
M. Benucci ◽  
V. Ravagnani ◽  
B. Palterer ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Antibody Titer ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Sustained Remission ◽  
Red Rice ◽  
Gradual Improvement ◽  
High Doses ◽  
High Dose Ivig

Background:Anti-3-hydroxy-3-methylglutaryl-coenzime A reductase (HMGCR) myopathy is a new entity, which has been clearly associated to statin use, even if it can be diagnosed in patients without a history of exposure to statin or even in the childhood (1).Objectives:The aim of the study is to describe the efficacy of a triple therapy regimen consisting in high-doses of intravenous immunoglobulins (IVIG), methotrexate (MTX), and glucocorticoids (GC) in 16 patients with Anti-HMGCR myopathy enrolled in 6 specialized centres.Methods:A total of 16 patients with anti-HMGCR myopathy (7 females; 9 males) were collected. Mean (±standard deviation) age at the onset of disease was 72.4±10.3 years old. All patients were diagnosed having anti-HMGCR myopathy [anti-HMGCR antibodies were measured by chemiluminescence assay (BioFlash, Inova, CA)] (2). Median follow-up was 29.5 months (interquartile range: 15.75-60 months). Anti-HMGCR antibodies were available in the follow-up in 8/16 patients.Results:Thirteen out of 16 patients (81.3%) had been exposed to statin (1/13 to red rice), 3/16 (18.7%) were not exposed. As induction therapy, 11/16 patients have been treated with triple therapy (high-dose IVIG, MTX and GC), 2/16 with double therapy (high-dose IVIG and GC), 2/16 have been treated with GC alone, the patient exposed to red rice resolved only with red rice suspension. Clinical remission and normalization of CPK values within month +24 were obtained in all the patients. All the patients were in remission at the last follow-up. Gradual improvement started soon from the first month, and among the 13 patients treated with an aggressive immunosuppresssive therapy including IVIG (13/13), GC (13/13) and methotrexate (11/13), 9/13 normalized the CPK value within 6 months. Clinical and laboratory response was accompanied by significant decrease or normalization of the anti-HMGCR antibody titer. All the patients were either not taking GC (56.3%), or were taking low doses of GC (43.7%) at the last follow-up. Four patients had stopped GC within 6 months. No serious side effects were recorded. After persistent remission, a maintenance immunosuppressive therapy was then administered. Only 3 relapses in 3 different cases were recorded, all of them during drug-free remission in long-term follow-up. Reinduction was again effective in all.Conclusion:Anti-HMGCR myopathy is a rare and serious myopathy which usually affects older people during statin treatment. After statin suspension, a rapid and sustained remission can be achieved by induction with a triple aggressive therapy consisting in medium-to high doses of GC, high-dose IVIG, and MTX (3). GC should be tapered as soon as possible. Relapse appears infrequent during maintenance treatment. Monitoring anti-HMGCR antibody titer may be clinically relevant.References:[1]AL Mammen et al. N Engl J Med. 2016;374:664-9[2]Musset L et al. Autoimmun Rev. 2016;15:983-93.[3]Aggarwal A et al. Scand J Rheumatol. 2019; 1-7.Acknowledgments:We thank MD Francesca Grosso and MD Valentina Mecheri from the University of Florence, MD Angela Zuppa and MD Chiara De Michelis, from San Martino Hospital, Genova, for their valued collaboration in data collectionDisclosure of Interests:Elena Treppo: None declared, Maria Infantino: None declared, Maurizio Benucci: None declared, Viviana Ravagnani: None declared, Boaz Palterer: None declared, Marina Grandis: None declared, Martina Fabris: None declared, Paola Tomietto: None declared, Mariangela Manfredi: None declared, Arianna Sonaglia: None declared, Maria Grazia Giudizi: None declared, Francesca Ligobbi: None declared, Daniele Cammelli: None declared, Paola Parronchi: None declared, Salvatore De Vita Consultant of: Roche, GSK, Speakers bureau: Roche, GSK, Novartis, Luca Quartuccio Consultant of: Abbvie, Bristol, Speakers bureau: Abbvie, Pfizer

scholarly journals Treatment of Antibody-Mediated Renal Allograft Rejection: Improving Step by Step

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Nils Lachmann ◽  
Michael Duerr ◽  
Constanze Schönemann ◽  
Axel Pruß ◽  
Klemens Budde ◽  
...  
Keyword(s):  
Graft Survival ◽  
Treatment Regimen ◽  
Low Dose ◽  
Immunosuppressive Treatment ◽  
Graft Function ◽  
Intravenous Immunoglobulins ◽  
Ivig Treatment ◽  
High Dose ◽  
Antibody Mediated Rejection ◽  
High Dose Ivig

Throughout the past years we stepwise modified our immunosuppressive treatment regimen for patients with antibody-mediated rejection (ABMR). Here, we describe three consecutive groups treated with different regimens. From 2005 until 2008, we treated all patients with biopsy-proven ABMR with rituximab (500 mg), low-dose (30 g) intravenous immunoglobulins (IVIG), and plasmapheresis (PPH, 6x) (group RLP,n=12). Between 2009 and June 2010, patients received bortezomib (1.3 mg/m2, 4x) together with low-dose IVIG and PPH (group BLP,n=11). In July 2010, we increased the IVIG dose and treated all subsequent patients with bortezomib, high-dose IVIG (1.5 g/kg), and PPH (group BHP,n=11). Graft survival at three years after treatment was 73% in group BHP as compared to 45% in group BLP and 25% in group RLP. At six months after treatment median serum creatinine was 2.1 mg/dL, 2.9 mg/dL, and 4.2 mg/dL in groups BHP, BLP, and RLP, respectively (p=0.02). Following treatment, a significant decrease of donor-specific HLA antibody (DSA) mean fluorescence intensity from8467±6876to5221±4711(p=0.01) was observed in group BHP, but not in the other groups. Our results indicate that graft survival, graft function, and DSA levels could be improved along with stepwise modifications to our treatment regimen, that is, the introduction of bortezomib and high-dose IVIG treatment.

Аcute transverse myelitis and Guillain – Barre overlap syndrome in a patient with СOVID-19

2022 ◽  
Vol 26 (6) ◽  
pp. 43-51
Author(s):  
E. A. Ruina ◽  
V. N. Grigoryeva ◽  
A. A. Lesnikova ◽  
K. M. Beliakov
Keyword(s):  
Spinal Cord ◽  
Transverse Myelitis ◽  
Bowel Dysfunction ◽  
Intravenous Immunoglobulins ◽  
Sensory Loss ◽  
Focal Lesion ◽  
High Dose ◽  
Bladder Bowel Dysfunction ◽  
Guillain Barré

We report a case of transverse myelitis and Guillain–Barre syndrome (GBS) overlap in the 42-year-old patient with moderate course of Coronavirus disease 2019 (СOVID-19). Nasopharyngeal SARS-CoV 2 RT-PCR was positive. Severe neck pain developed in this patient on the 5-th day of СOVID-19. A few hours later weakness in the feet arised and then spread to the thighs and arms. Quadriparesis, arefl exia in all limbs, sensory loss below the level of T4 and bladder/bowel dysfunction were present. Pyramidal signs were negative. There was no increase of COVID-19 severity at the time of neurological signs development. Magnetic resonance imaging of the spinal cord showed the focal lesion in the C2-T1 segments, which was consistent with the features of longitudinally extensive transverse myelitis. Along with the myelitis, acute motor axonal polyneuropathy was diagnosed. This diagnosis of GBS was supported by ascending weakness with arefl exia, albumin-cytological dissociation in cerebrospinal fl uid and the data of neuroelectrophysiological examination. We proposed that both myelitis and GBS had disimmune nature associated with COVID-19. The other possible causes of damage to the spinal cord and peripheral nervous system were excluded.Immunotherapy with high dose of intravenous immunoglobulins was administered. Steroids also were used taking into account the myelitis. At the follow up in 4 months the motor functions were found to be improved nonsignifi cantly, the patient was still severe disabled.

High-dose (5000-μg) Intravitreal Ganciclovir Combined with Highly Active Antiretroviral Therapy for Cytomegalovirus Retinitis in HIV-Infected Patients in Venezuela

2005 ◽  
Vol 15 (5) ◽  
pp. 610-618 ◽  
Author(s):  
J.F. Arevalo ◽  
R.A. Garcia ◽  
A.J. Mendoza
Keyword(s):  
Visual Acuity ◽  
Highly Active Antiretroviral Therapy ◽  
Control Group ◽  
High Dose ◽  
Complete Regression ◽  
Cmv Retinitis ◽  
Highly Active ◽  
High Doses ◽  
Haart Therapy

Purpose To describe the use of high doses of intravitreal ganciclovir combined with highly active antiretroviral therapy (HAART) for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients. Methods Thirteen HIV-infected patients (18 eyes) with active CMV retinitis (83.3% in zone 1 and 38.4% resistant) participated in this prospective interventional case series. Patients were treated with high dose intravitreal ganciclovir (5.0 mg/0.1 mL once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed if there was a significant increase in CD4+ count (any increase of ≥50 cells/μL to levels over 100 cells/μL sustained for at least 3 months). Mean follow-up was 15.6 months. Main outcome measures included assessment of visual acuity and retinal inflammation (CMV retinitis activity). A matched historical control group of 20 eyes (15 patients) with CMV retinitis treated with systemic ganciclovir (intravenous [induction] and oral [maintenance]) was included. Results Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 88.8% of eyes (two patients died during follow-up) at a mean of 4.5 weeks (2 to 8 weeks). Visual acuity improved two or more lines in 61.1% of eyes. No ganciclovir retinal toxicity was identified. Three eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (33.3%) included retinal detachment (RD; 3 eyes), immune recovery uveitis (IRU; 2 eyes), and endophthalmitis (1 eye). In our control group complete regression of the retinitis was obtained in 100% of eyes at a mean of 4 weeks (3 to 7 weeks). However, 12 eyes (60%) presented with CMV retinitis relapse at a mean of 29 days (21 to 32 days) after initiating oral ganciclovir (maintenance). Complications included RD (7 eyes, 35%) and IRU (3 eyes, 15%). Severe neutropenia occurred in 2 patients (13%). Conclusions High doses of intravitreal ganciclovir (5.0 mg) once a week in combination with HAART therapy is effective to control CMV retinitis, and may be discontinued after CMV retinitis has healed if immune reconstitution with a significant increase in CD4+ count has occurred.

Treatment of Severe Relapsing-Remitting Multiple Sclerosis with High-Dose Immunosuppressive Therapy and Autologous Hematopoietic Cell Transplantation: 2-Year Follow-up Results of the HALT MS Clinical Trial (Immune Tolerance Network: ITN033AI)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 962-962
Author(s):  
Richard A. Nash ◽  
George J. Hutton ◽  
Michael K Racke ◽  
Uday R. Popat ◽  
Steven M. Devine ◽  
...  
Keyword(s):  
Clinical Trial ◽  
T Cells ◽  
Cd8 T Cells ◽  
Hematopoietic Cell Transplantation ◽  
Brain Mri ◽  
High Rate ◽  
High Dose ◽  
Lesion Volume ◽  
Sustained Remission

Abstract Abstract 962 Most patients with relapsing-remitting multiple sclerosis (RRMS) do not achieve a sustained remission after disease-modifying therapy. A phase II clinical trial of high-dose immunochemotherapy (HDIT; BCNU, etoposide, ara-C, melphalan and antithymocyte globulin) and autologous hematopoietic cell transplantation (HCT) was conducted in patients with highly active RRMS who had failed conventional therapy to assess if a high rate of sustained remission could be induced. Eligibility required an EDSS of 3.0 (moderate disability, fully ambulatory) to 5.5(severe disability, ambulatory only 100 meters without aids) and >2 relapses on treatment in previous 18 months. Treatment-failure was defined as a composite endpoint including 1) mortality 2) relapse 3) new MRI lesions or 4) disability increase >0.5 EDSS points. Adverse events (AE) were recorded according to NCI-CTCAE v3.0. 25 patients at a median age of 38(27-53) years were treated with G-CSF to mobilize the autograft; prednisone was given at the same time to prevent MS flares. The autograft was CD34-selected (Baxter, Isolex). One patient withdrew after mobilization secondary to HIT/pulmonary embolus. 24 patients had HDIT/HCT according to protocol. Median follow-up was 131 (52, 282) weeks. After initially stabilizing, one patient died from progressive loss of neurological function at 32 months. No patient had delayed recovery of blood counts. In the 1st year after HDIT, there were 42 grade 3 and 6 grade 4 non-hematopoietic AE. Grade 4 AE included: one suicide attempt (with 3 grade 4 AE); hyperuricemia; hypokalemia; and elevated ALT. In the 2ndyear, there were 13 grade 3 and 1 grade 4 non-hematopoietic AE. The 1-year and 2-year probabilities of event-free survival (i.e. without treatment-failure) were 95.8% (90% CI: 80.2%-99.2%) and 82.8% (90% CI: 65.0%-92.0%), respectively. Progression-free and relapse-free survival at 1 year were 100% (90% CI: 100%-100%) and 95.8% (90% CI: 80.2%-99.2%) and at 2 years were 91.7% (90% CI: 75.7%-97.3%) and 91.7% (90% CI: 75.7%-97.3%), respectively. The probability of freedom from disease activity detected by brain MRI was 95.8% (90% CI: 80.2%-99.2%) at both year 1 and 2. In comparison, a randomized clinical trial of placebo vs natalizumab (Havrdova E et al, Lancet Neurology, 2009) showed that 7% and 37% of RRMS patients were free of disease activity (i.e. progression, relapse and MRI) at 2 years, respectively. T2-weighted MRI scans measure disease burden from MS. T2 lesion volume was significantly reduced by 6 months and was sustained at 2 years (Table 1). T1 lesion volume was increased at 1 year. There was a significant loss of brain volume at 6 months but stabilized after this time point. Flow cytometry of peripheral blood was done at baseline and at 1, 2, 6 and 12 months. There was near complete depletion of naïve CD4 and CD8 T cells (CD45RA+) at 1 month. Memory CD4 and CD8 T cells (CD45RO+) were not completely eliminated from the blood after in vivo depletion from HDIT. Within 2 months of transplant, there was rapid expansion of memory CD8 T cells. The numbers of CD4 naïve and memory T cells were not recovered at 1 year. CD4 and CD8 recent thymic emigrants (CD45RA+, CD31+) were increased at 1 year compared to the nadir at 1 month but did not completely recover. Recovery of naïve and memory B cells was complete between months 6 and 12. HDIT/HCT for highly active RRMS resulted in profound immunosuppression and induced a high rate of sustained remissions at 2 years. The small increase in T1-weighted lesion volume in the absence of persistent brain inflammation may have resulted from damage due to previous brain injury. No further loss in brain volume was observed after 6 months. Follow-up is planned through 5 years. Table 1: Brain MRI: Changes after HDIT/HCT as compared to baseline* or screening**. Disclosures: No relevant conflicts of interest to declare.

Long-term efficacy of adding intravenous immunoglobulins as treatment of refractory dysphagia related to myositis: a retrospective analysis

Rheumatology ◽  
2020 ◽  
Author(s):  
Margherita Giannini ◽  
Maria Luisa Fiorella ◽  
Marilina Tampoia ◽  
Francesco Girolamo ◽  
Marco Fornaro ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Assessment Tool ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Treatment Schedule ◽  
Inflammatory Myopathies ◽  
Endoscopic Evaluation ◽  
Sparing Effect

Abstract Objective Dysphagia is a life-threating manifestation of idiopathic inflammatory myopathies (IIM). However, we lack a univocal protocol for its treatment. The aim of this retrospective analysis was to evaluate the effectiveness of a step-up strategy by adding a 1-day pulse of IVIGs to immunosuppressants in IIM patients with refractory dysphagia diagnosed by Eating Assessment Tool (EAT)-10 and fibreoptic endoscopic evaluation of swallowing (FEES). Methods Dysphagia was defined as a pharyngo-oesophageal disturbance associated with EAT-10 score ≥3 and at least one FEES abnormality among propulsion failure, solid or liquid stasis. Eighteen out of 154 IIM patients had FEES-confirmed dysphagia and underwent 1 day IVIG 2 g/kg repeated 1 month apart for 3 months, because of dysphagia refractory to high-dose glucocorticoids with methotrexate and/or azathioprine. Clinical characteristics along with myositis-specific antibodies and muscle histopathological findings were studied in FEES-dysphagia IIM and IIM control patients. Results After three monthly doses of IVIG, EAT-10 score dropped with complete recover of defective propulsion and progressive decrease in percentage of both solid and liquid stasis. At 52-weeks’ follow-up, reached in 12 patients, all these parameters were stable or further improved. An improvement in manual muscle strength test and a steroid-sparing effect of IVIG were also observed. Anti-PM/Scl 75/100 antibodies were much more frequent in the FEES-dysphagia group, while anti-Jo1 antibody was rarely detected. Conclusion Our treatment schedule with 2 g/kg IVIG was effective for IIM-associated refractory dysphagia assessed by the combination of EAT-10 and FEES. These findings need to be prospectively tested in a larger cohort of IIM patients.

scholarly journals The Effect of Single High-dose Buprenorphine on Opioid Craving and Relapse

2019 ◽  
Author(s):  
Jamshid Ahmadi ◽  
Mina SefidfardJahromi ◽  
Dara Ghahremani ◽  
Edythe D. London
Keyword(s):  
Statistical Significance ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
High Dose ◽  
Opioid Use ◽  
Single High Dose ◽  
High Doses ◽  
Long Acting ◽  
Drug Free

Abstract Background: Buprenorphine, a treatment for Opioid Use Disorder, has liability for diversion and abuse. Use of single high doses of buprenorphine that are supervised avoid issues with diversion that occur with unsupervised or take home doses. Such doses have the potential to act as an initial opioid detox, facilitate transition to opioid antagonists or drug free treatments, as well as to maintenance treatment. Objective: To assess effects of a single, physician-administered high dose of buprenorphine on craving and on early relapse. Method: Sixty men who used heroin, opium or prescription opioids and met DSM-5 criteria for Opioid Use Disorder received a single, sublingual dose of buprenorphine (32 mg, 64 mg or 96 mg; n’s = 20, 21, and 19) as inpatients on a psychiatric unit. Buprenorphine was administered when patients were in moderate opioid withdrawal (4-5 symptoms). Self-reports of craving were taken at baseline and daily for the next 13 days, and relapse was assessed 1 and 2 months. Findings: Craving was reduced from baseline in each of the three groups (p < 0.0005), but the doseXtime interaction did not reach statistical significance (p= 0.069). Follow-up assessments at 1- and 2-months indicated significantly lower relapse rates for the higher-dose groups than for the low-dose group (p < 0.05). Conclusions: A single high dose of buprenorphine provides rapid relief of opioid craving and positively impacts relapse rate in the initial 1- and 2-months of outpatient treatment. Further investigation of single high-dose buprenorphine for early treatment of patients with Opioid Use Disorder is warranted as an alternative when buprenorphine/naloxone or long-acting buprenorphine dosage forms are not available. Keywords: Buprenorphine; opioid dependence; opioid withdrawal; craving

Hemoptysis and a cardiac murmur: is it primary or secondary antiphospholipid syndrome?

Lupus ◽  
2019 ◽  
Vol 28 (14) ◽  
pp. 1712-1715
Author(s):  
T Kolitz ◽  
O Fruchter ◽  
L Sasson ◽  
Y Geva ◽  
O Moreh-Rahav ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Infectious Agent ◽  
Intravenous Immunoglobulins ◽  
Clinical Findings ◽  
High Dose ◽  
Cardiac Murmur ◽  
Elective Procedure ◽  
Work Up

Endocarditis is most frequently infective in origin, and thus, when a patient presents with a clinical picture suggestive of endocarditis, an extensive work up aimed at finding the infectious agent is warranted. Among systemic lupus erythematosus (SLE) patients, cardiovascular disease is prevalent in more than 50% of patients including valvular disease and non-infective endocarditis, known as Libman–Sacks (LS) endocarditis. The prevalence of LS syndrome among SLE patients with secondary antiphospholipid syndrome (APS) is higher than in SLE without APS. Here, we present a case of a patient diagnosed with primary APS who presented with hemoptysis and a cardiac murmur. The diagnosis of SLE was established following the findings of non-infective verrucous vegetations together with diffuse alveolar hemorrhage (DAH). Treatment with high-dose corticosteroids and intravenous immunoglobulins yielded substantial resolution of the vegetations and regression of the DAH. Hence, aortic valve replacement was successfully performed as an elective procedure and without any postoperative complications. The patient is in remission after a 6-month follow-up. The clinical findings of DAH and double valve non-infectious endocarditis prompted the diagnosis of SLE with secondary APS.

P831Effect of high-dose statin pretreatment in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: meta-analysis of randomized controlled trials

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L M Burgos ◽  
L Battioni ◽  
J P Costabel ◽  
M Trivi
Keyword(s):  
Myocardial Infarction ◽  
Stent Thrombosis ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Primary Angioplasty ◽  
Medical Decision ◽  
High Dose ◽  
Coronary Syndrome ◽  
High Doses

Abstract Introduction Current guidelines recommend the use of high doses of statins in patients with acute coronary syndrome. However, up to now, there is not enough evidence about the time of its onset in patients with acute myocardial infarction with ST elevation (STEMI) undergoing primary angioplasty. We conducted a systematic review and meta-analysis with the aim of evaluating the efficacy of pre-treatment with statins in high doses in the short term in patients with STEMI treated with primary angioplasty. Methods A systematic search was carried out in Pubmed, EMBASE, Scopus and Cochrane database, LILACS, and references of relevant articles were searched manually. We included randomized clinical trials (RCTs) comparing pretreatment with high doses of statins (rosuvastatin/atorvastatin) with low doses or without treatment published until April 2018. We evaluated the incidence of MACE (death, spontaneous myocardial infarction, coronary revascularization and stroke) at 30 days. In addition the presence of final TIMI III flow, TIMI blush grade, CPK peak, stent thrombosis and death from any cause during follow-up were evaluated. The data were combined as relative risk (RR) or difference of means (DM) with their 95% confidence interval (CI), using RevMan software. The meta-analysis was performed with the fixed effects model or random effects according to the heterogeneity. Results Six RCTs met the inclusion criteria with a total of 1454 patients. The pretreatment with statins in high doses was associated with a decrease in MACE (RR 0.52 CI 95% 0.37–0.77, I2=0%, P=0.001). The pretreatment was not associated with a reduction of the final TIMI III flow (RR 1.03 CI 95% 0.98–1.09, I2=0%, P=0.1), CPK peak (MD 13.99 CI95% −12.68 to 40.6; I2=0%; P=0.3), or stent thrombosis (RR 0.54 CI95% 0.1–2.85; I2 = 0%; P=0.46), neither death in the follow-up (RR 0.52 CI95% 0.16–1.68, I2=0%, P=0.27). In addition, an improvement in the degree of myocardial blush TIMI was observed (MD 0.36 CI95% 0.20–0.52, I=0%, P<0.0001), Conclusion In this meta-analysis, treatment with high doses of statins prior to primary angioplasty in STEMI significantly reduced adverse cardiac events at 30 days. In addition, an improvement in the degree of myocardial blush was observed in the pretreatment group with high-dose statins. Therefore, the findings of this meta-analysis can help guide medical decision making regarding the time of onset of statins in STEMI.

scholarly journals Intracranial Hemorrhage in a Patient with TAFRO Syndrome Treated with Cyclosporine A and Rituximab

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 971
Author(s):  
Yuina Akagi ◽  
Takashi Kato ◽  
Yusuke Yamashita ◽  
Hiroki Hosoi ◽  
Shogo Murata ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Cyclosporine A ◽  
Thrombotic Microangiopathy ◽  
Clinical Symptoms ◽  
High Dose ◽  
Rapid Progression ◽  
Sustained Remission ◽  
Gradual Improvement ◽  
Tafro Syndrome ◽  
Life Threatening

TAFRO syndrome, a rare subtype of idiopathic multicentric Castleman disease, manifests as thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. Thrombotic microangiopathy, including renal dysfunction, is frequently associated with this syndrome. TAFRO syndrome can be life threatening and show rapid progression, and the diagnosis and management of this disorder remain challenging. A 48-year-old woman was diagnosed with TAFRO syndrome complicated by thrombotic microangiopathy based on the clinical and histopathological findings. After receiving high-dose steroids, her thrombocytopenia and anasarca did not improve. The patient subsequently received a combination of cyclosporine A and rituximab as second-line therapy, which resulted in a significant gradual improvement in the clinical symptoms. Meanwhile, her platelet count increased to more than 40 × 109/L; however, she developed intracranial hemorrhage. Following surgical evacuation, the patient recovered with an achievement of sustained remission. Based on these findings, attention should be paid to life-threatening bleeding associated with local thrombotic microangiopathy even when intensive treatment is administered for TAFRO syndrome.

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