Sustained clinical response to infliximab in refractory Cronkhite-Canada syndrome

A 59-year-old man with refractory Cronkhite-Canada syndrome (CCS) had poor clinical response to high-dose intravenous steroids, azathioprine, total parenteral nutrition and best supportive care. He remained highly symptomatic with abdominal pain, diarrhoea, recurrent sepsis and profound weight loss. Infliximab induction was given as rescue therapy, with marked clinical improvement observed within 3 weeks. This allowed steroid taper. Within 12 months of infliximab therapy, he achieved complete clinical remission and returned to his baseline weight and a full oral diet. Sequential endoscopies observed significant regression of previous marked gastrointestinal polyposis, including histological remission on colonic biopsies at 3.5 and 5 years of treatment. He currently remains in remission following 6 years of combination therapy with 5 mg/kg 8 weekly infliximab and azathioprine, and there is ongoing discussion with regard to the benefits and risks of therapy de-escalation. This case demonstrates the effectiveness of infliximab in inducing and maintaining remission in refractory CCS.

Download Full-text

Faculty Opinions recommendation of High-dose dual therapy is superior to standard first-line or rescue therapy for Helicobacter pylori infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725256203.793507305 ◽

2015 ◽

Author(s):

Steven Moss

Keyword(s):

Helicobacter Pylori ◽

Rescue Therapy ◽

Dual Therapy ◽

Helicobacter Pylori Infection ◽

High Dose ◽

First Line

Download Full-text

Acute Rejection Following Kidney Transplantation: State-of-the-Art and Future Perspectives

Current Pharmaceutical Design ◽

10.2174/1381612826666200610184433 ◽

2020 ◽

Vol 26 (28) ◽

pp. 3468-3496

Author(s):

Emilio Rodrigo ◽

Marcio F. Chedid ◽

David San Segundo ◽

Juan C.R. San Millán ◽

Marcos López-Hoyos

Keyword(s):

Kidney Transplantation ◽

Acute Rejection ◽

Rescue Therapy ◽

Standard Of Care ◽

Rejection Rate ◽

New Drugs ◽

High Dose ◽

Current Standard ◽

Antibody Mediated Rejection ◽

Cellular Rejection

: Although acute renal graft rejection rate has declined in the last years, and because an adequate therapy can improve graft outcome, its therapy remains as one of the most significant challenges for pharmacists and physicians taking care of transplant patients. Due to the lack of evidence highlighted by the available metaanalyses, we performed a narrative review focused on the basic mechanisms and current and future therapies of acute rejection in kidney transplantation. : According to Kidney Disease/Improving Global Outcomes (KDIGO) guidelines, both clinical and subclinical acute rejection episodes should be treated. Usually, high dose steroids and basal immunosuppression optimization are the first line of therapy in treating acute cellular rejection. Rabbit antithymocytic polyclonal globulins are used as rescue therapy for recurrent or steroid-resistant cellular rejection episodes. Current standard-of-care (SOC) therapy for acute antibody-mediated rejection (AbMR) is the combination of plasma exchange with intravenous immunoglobulin (IVIG). Since a significant rate of AbMR does not respond to SOC, different studies have analyzed the role of new drugs such as Rituximab, Bortezomib, Eculizumab and C1 inhibitors. Lack of randomized controlled trials and heterogenicity among performed studies limit obtaining definite conclusions. Data about new direct and indirect B cell and plasma cell depleting agents, proximal and terminal complement blockers, IL-6/IL-6R pathway inhibitors and antibody removal agents, among other promising drugs, are reviewed.

Download Full-text

CONVENTIONAL VERSUS THREE-DIMENSIONAL CONFORMAL EXTERNAL RADIOTHERAPY IN CANCER CERVIX: A COMPARATIVE STUDY FOR COMPLIANCE, RESPONSE AND TOXICITY

SRMS Journal of Medical Science ◽

10.21761/jms.v1i2.7127 ◽

2016 ◽

Vol 1 (2) ◽

Author(s):

Richa Gupta ◽

Piyush Kumar ◽

D. P. Singh ◽

Arvind Kumar Chauhan ◽

Kamal Sahni

Keyword(s):

Clinical Response ◽

Three Dimensional ◽

Common Side Effect ◽

P Value ◽

High Dose ◽

Cancer Cervix ◽

Conventional Radiotherapy ◽

Radiation Fields ◽

Group A ◽

Group B

INTRODUCTION: Cervical cancer is the second most frequent cancer among Indian women. Radiotherapy is the cornerstone of treatment in all its stages. Three-dimensional conformal radiotherapy (3DCRT) combines multiple radiation fields to deliver precise dose of radiation to the affected area. Tailoring each of the radiation fields to focus on the tumor delivers a high dose of radiation to the tumor and avoids nearby healthy tissue. The present study is done to compare conventional radiotherapy versus 3DCRT in cancer cervix for compliance, clinical response and toxicity. MATERIAL AND METHODS: Fifty patients were enrolled and randomised into two radiotherapy plans with radical intent - Group A treated by conventional radiotherapy and group B treated by 3DCRT. Concurrent cisplatin was delivered on weekly (35mg/m2) or tri-weekly (75mg/m2) basis during external beam Radiotherapy and was followed by High Dose Radiotherapy Brachytherapy. Clinical response and complication assessment were evaluated.Collected data was analyzed using standard statistical methods and softwares to calculate level of significance using “p” value by chi square test. RESULTS: In this study mean age of the patients was 48 years (26-67 years). The anemia was the most common side effect seen in both groups (96% vs 88%, p=0.29). Neutropenia was more in group B (36% vs 44%, p= 0.56). Lower GI toxicity was seen only in patients in group A (20% vs 0%, p=0.018). In follow up there were no significant early rectal and bladder reactions in both groups and 2 patients in each group had late rectal reactions of grade I and II (p= 0.312). No significant skin, bladder and small intestinal toxicity were seen in both groups. CONCLUSION: Conventional radiotherapy gives equally efficacious response though accompanied by toxicities which were acceptable.

Download Full-text

Refractory constrictive pericarditis caused by an immune checkpoint inhibitor properly managed with infliximab: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab002 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Shohei Moriyama ◽

Mitsuhiro Fukata ◽

Ryoma Tatsumoto ◽

Mihoko Kono

Keyword(s):

Lung Cancer ◽

Constrictive Pericarditis ◽

Immune Checkpoint ◽

Checkpoint Inhibitors ◽

Rescue Therapy ◽

Treatment Strategies ◽

High Dose ◽

Acute Pericarditis ◽

Line Therapy ◽

Steroid Refractory

Abstract Background Immune checkpoint inhibitors (ICIs) can cause cardiac immune-related adverse events (irAEs), including pericarditis. Cardiovascular events related to pericardial irAE are less frequent, but fulminant forms can be fatal. However, the diagnosis and treatment strategies for pericardial irAE have not established. Case summary A 58-year-old man was diagnosed with advanced non-small-cell lung cancer and nivolumab was administered as 5th-line therapy. Eighteen months after the initiation of nivolumab, the patient developed limb oedema and increased body weight. Although a favourable response of the cancer was observed, pericardial thickening and effusion were newly detected. He was diagnosed with irAE pericarditis after excluding other causes of pericarditis. Nivolumab was suspended and a high-dose corticosteroid was initiated. However, right heart failure (RHF) symptoms were exacerbated during the tapering of corticosteroid because acute pericarditis developed to steroid-refractory constrictive pericarditis. To suppress sustained inflammation of the pericardium, infliximab, a tumour necrosis factor-alfa inhibitor, was initiated. After the initiation of infliximab, the corticosteroid dose was tapered without deterioration of RHF. Exacerbation of lung cancer by irAE treatment including infliximab was not observed. Discussion IrAE should be considered when pericarditis develops after the administration of ICI even after a long period from its initiation. Infliximab rescue therapy may be considered as a 2nd-line therapy for steroid-refractory irAE pericarditis even with constrictive physiology.

Download Full-text

Severe aquaporin 4-IgG-positive neuromyelitis optica with disseminated herpes zoster in a pregnant woman successfully treated with intravenous immunoglobulin

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217318758119 ◽

2018 ◽

Vol 4 (1) ◽

pp. 205521731875811

Author(s):

Yuki Matsumoto ◽

Mario Tsuchiya ◽

Shakespear Norshalena ◽

Chikako Kaneko ◽

Jin Kubo ◽

...

Keyword(s):

Herpes Zoster ◽

Pregnant Woman ◽

Intravenous Immunoglobulin ◽

Neuromyelitis Optica ◽

Rescue Therapy ◽

Transverse Myelitis ◽

Aquaporin 4 ◽

High Dose ◽

Healthy Baby ◽

Severe Infections

A 26-year-old, 17-week pregnant woman developed aquaporin-4-IgG-positive severe longitudinally extensive transverse myelitis during the course of disseminated herpes zoster and became quadriparetic. She was unresponsive to high-dose intravenous methylprednisolone but became able to walk without assistance after intravenous immunoglobulin. One and a half months later, left optic neuritis developed but her vision improved with intravenous immunoglobulin. The only sequela was left T5 girdle sensation, and she delivered a healthy baby. Intravenous immunoglobulin may be a rescue therapy in aquaporin-4-IgG-positive neuromyelitis optica attacks in pregnant women, especially those with severe infections.

Download Full-text

Burn Resuscitation

10.2310/7ccsp.8190 ◽

2018 ◽

Author(s):

Nicole Gibran ◽

Samuel P Mandell ◽

Theresa L. Chin

Keyword(s):

Wound Care ◽

Rescue Therapy ◽

Initial Period ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Accurate Estimation ◽

High Dose ◽

Post Injury ◽

Secondary Survey ◽

Burn Resuscitation

Resuscitation of adult patients with burn size greater than 20% total body surface area (TBSA) and pediatric patients with burn size greater than 15% TBSA is essential for early survival due to the fluid shifts that occur after injury. After the primary and secondary survey, burn resuscitation is different from resuscitation from other types of shock because it is based on continuous fluid administration. Judicious use of fluids reduces fluid creep and complications of over-resuscitation. Accurate estimation of TBSA will improve the use of crystalloids. Furthermore, inhalation injury, chemical injury, electrical injury, and preexisting comorbidities can complicate resuscitation of these patients. Although crystalloids are the mainstay of therapy, adjuncts to resuscitation such as colloids, plasma exchange, and high-dose vitamin C have been considered to reduce complications of over-resuscitation or support patients who are refractory to typical resuscitation strategies in the initial period post injury. Wound care should never precede the primary and secondary survey and most often can wait until definitive care at a burn center. This review contains 5 figures, 6 tables and 54 references Key Words: burn, colloid, crystalloid, failing resuscitation, rescue therapy, resuscitation

Download Full-text

Therapeutic Effect of Superficial Cryotherapy versus Intralesional Corticosteroids injection in Alopecia Areata

QJM ◽

10.1093/qjmed/hcab093.035 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nour El-dissouki Ibrahim ◽

Mahira Hamdy Elsayed ◽

Ahmed Abdel-Fattah Afify

Keyword(s):

Side Effects ◽

Alopecia Areata ◽

Response To Treatment ◽

High Dose ◽

Efficacy And Safety ◽

Steroid Injections ◽

Intralesional Steroid ◽

Males And Females ◽

Intravenous Steroids ◽

Effects Assessment

Abstract Alopecia areata, one or more round bald patches appear suddenly, most often on the scalp. It can affect males and females at any age. It starts in childhood in about 50%, and before the age of 40 years in 80%. The exact mechanism is not yet understood. There is not yet any reliable cure for alopecia areata. Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people. Their role and efficacy are unknown. Injections of triamcinolone acetonide 2.5–10 mg/ml into patchy scalp, its efficacy is temporary. Oral and pulse intravenous steroids in high dose can lead to temporary regrowth of hair. The sensitisers diphenylcyclopropenone provoke hair growth in treated areas Now, superficial cryotheray is introduced as a possible treatment for Alopecia Areata. With minimial side effects and being less painful. So, this study clarifies the therapeutic efficacy and safety of superficial cryotherapy for treatment of patchy Alopecia areata. Aim of the study The aim of the study is to evaluate and compare the efficacy and safety of Superficial Cryotherapy and Intralesional corticosteroids in the treatment of patchy Alopecia Areata. Patients and methods study included 20 patients complaining of Alopecia Areata. 3 patches of scalp alopecia areata will be randomly subjected to either superficial cryotherapy twice monthly for 3 months (3 cycles, 2-3 seconds) or intralesional steroid injections once monthly for 3 months (triaminoclone acetonide 1:7, 1ml) or intralesional saline (1 ml). Assessment for the response to treatment will be done at one month and three month following treatment by digital photography and by phototrichogram by comparing number of Terminal, and vellus and hair thickness, Also assessment for side effects of therapy will be done. Results Patients treated with TCA showed statistically significant high response compared to patients treated with cryotherapy. Also, side effects assessment showed minimal side effects with treatment with TCA compared to cryotherapy. Conclusion TCA treatment of alopecia areata is much tolerable than treatment with cryotherapy with also better response rates.

Download Full-text