scholarly journals Pembrolizumab-induced myasthenia gravis-like disorder, ocular myositis, and hepatitis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Chia-Yi Tian ◽  
Yang-Hao Ou ◽  
Shih-Liang Chang ◽  
Chih-Ming Lin
Keyword(s):  
Myasthenia Gravis ◽  
Urothelial Carcinoma ◽  
Low Dose ◽  
Oral Steroid ◽  
High Grade ◽  
Bilateral Ptosis ◽  
Programmed Death ◽  
Number Of Patients ◽  
Oral Steroids ◽  
Dose Oral

Abstract Introduction Pembrolizumab and other immune checkpoint inhibitors are the emerging treatment for selected, high-grade malignancies. However, a small number of patients are unable to tolerate its adverse effects, leading to discontinuation of this potentially life-changing therapy. In this study, we present a case of high-grade urothelial carcinoma patient, who experienced neurocomplications during the first pembrolizumab administration. However, we were able to limit the adverse effect by concomitant use of low-dose oral steroids. Case presentation A 75-year-old Taiwanese female with high-grade urothelial carcinoma of the left ureter came to the neurology clinic with complaints of acute onset of bilateral ptosis 16 days after her first infusion of pembrolizumab. It was found that she developed complete bilateral ptosis and limited extraocular muscle movements. Myasthenia gravis-related antibodies and repetitive stimulation test were negative. We diagnosed her with pembrolizumab-induced myasthenia gravis-like disorder and myositis based on clinical symptoms and elevation of muscle enzymes. We commenced methylprednisolone pulse therapy followed by oral steroid therapy with gradual resolution of the symptoms. Three months later, the patient received a second cycle of pembrolizumab with low-dose oral steroids without any complications. Conclusion Pembrolizumab exerts its antitumor activity by interfering with the binding of programmed death 1 and its ligand, programmed death ligand 1. As a result, enhanced cytotoxic T cells can recognize tumor cells and induce cellular death. However, neurological complications may be severe and require prompt recognition and treatment. Our case demonstrated that concomitant use of low-dose steroids and pembrolizumab might prevent such complications.

Amelioration of flulike symptoms at the onset of interferon β- 1b therapy in multiple sclerosis by low-dose oral steroids is related to a decrease in interleukin-6 induction

1998 ◽  
Vol 44 (4) ◽  
pp. 682-685 ◽  
Author(s):  
E. M. MartíNez-CáCeres ◽  
J. Río ◽  
M. Barrau ◽  
I. Durán ◽  
C. Borrás ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Interleukin 6 ◽  
Low Dose ◽  
Interferon Β ◽  
Oral Steroids ◽  
Dose Oral

Dramatic effect of low-dose oral steroid on elephantiasic pretibial myxedema

2014 ◽  
Vol 41 (10) ◽  
pp. 941-942 ◽  
Author(s):  
Kohei Shirai ◽  
Tomonobu Ito ◽  
Yoshihiko Mitsuhashi ◽  
Ryoji Tsuboi
Keyword(s):  
Low Dose ◽  
Oral Steroid ◽  
Dramatic Effect ◽  
Dose Oral ◽  
Pretibial Myxedema

scholarly journals A Comparative Study To Evaluate The Role Of Inhaled Steroid Versus Low Dose oral Steroid In Patients Of COPD

2015 ◽  
pp. 1
Author(s):  
Arpita Singh ◽  
Surya Kant ◽  
Ajay Verma ◽  
Ankit Bhatia ◽  
Mohd Siddiqui ◽  
...  
Keyword(s):  
Comparative Study ◽  
Low Dose ◽  
Oral Steroid ◽  
Dose Oral

The Risk of Hemorrhage and the Frequency of Vitamin K Use in Asymptomatic Patients with Warfarin-Associated Coagulopathy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 527-527
Author(s):  
David A. Garcia ◽  
Mark A. Crowther ◽  
Elaine M. Hylek
Keyword(s):  
Vitamin K ◽  
Low Dose ◽  
Prosthetic Heart Valve ◽  
The United States ◽  
Oral Vitamin ◽  
Major Hemorrhage ◽  
Asymptomatic Patients ◽  
Number Of Patients ◽  
Dose Oral

Abstract Background: Warfarin, although highly effective in preventing thromboembolism, can cause hemorrhage. For warfarin-treated patients, the risk of bleeding increases as the International Normalized Ratio (INR) rises, particularly if the INR exceeds 4. Although low-dose oral vitamin K reliably decreases supratherapeutic INR values, previous surveys indicate that many providers choose not to administer vitamin K to asymptomatic patients who present with excessive INR prolongation. In effort to help guide the management of asymptomatic outpatients with elevated INRs, we assessed the rate of hemorrhage as well as the frequency of vitamin K use in an observational study. Methods: A prospective cohort of patients taking warfarin was assembled from 101 sites with personnel designated as warfarin managers across the United States during the period August 2000 to December 2001; 98 sites were community-based physician office practices. Enrolled practices participated in mandatory on-site study training and all patients provided written informed consent. Patients with a first observed episode of INR ≥5.0 were identified. For the two-week period following the index INR, provider-generated outpatient progress notes that pertained to anticoagulation (and were part of the medical record) were individually reviewed by one of the investigators. Outcomes included: site-specific management of elevated INR (recorded vitamin K use versus simple withholding of warfarin), and number of patients sustaining a major hemorrhage within the 2 weeks following the index INR value. Major hemorrhage was defined as fatal, necessitating hospitalization with transfusion of at least 2 units of packed red blood cells, or occurring at a critical site (e.g., intracranial, retroperitoneal). Results: During the study period, 6,792 patients were enrolled providing 5,961 person-years of follow-up. Of these, 979 had a first observed episode of an INR of more than 5. Thirty-nine % of these patients were receiving warfarin for atrial fibrillation and 29% had a prosthetic heart valve. Mean age was 69 years (range 20–94) and 50% were women. Ninety-six % (n=937) of the INRs were between 5 and 9. Ninety-eight % (n=963) were managed exclusively as outpatients; management could not be assessed in 16 patients who were hospitalized for unrelated reasons. Patients with an INR >9 were more likely to receive vitamin K compared to those with an INR of 5.0 to 9.0 (62% versus 7%). The mean INR for those patients known to have received vitamin K was 9.9 versus 6.2 among those for whom no vitamin K use was recorded. Of the 979 patients, 99.7% (n=976) had 14-day follow-up information. Nine patients sustained a major hemorrhage within the 2-week period (0.9%), mean INR 9.4, none were fatal. Conclusions: Among asymptomatic patients with warfarin-induced coagulopathy, an intervention known to reduce the INR (low-dose oral vitamin K) is used infrequently, particularly for patients whose INR value is 9 or less. For asymptomatic warfarin-treated individuals who are managed in the outpatient setting and whose INR is less than 9, the short-term risk of major bleeding appears to be low. Prospective, controlled trials are needed to determine the risks and benefits of administering vitamin K to this population.

scholarly journals Use of Oral Prednisolone and a 3-Phase Bone Scintigraphy in Patients with Complex Regional Pain Syndrome Type I

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 16
Author(s):  
Seunghun Park ◽  
Hyun-Jun Kim ◽  
Dong Kyu Kim ◽  
Tae Hee Kim
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Low Dose ◽  
Pain Syndrome ◽  
Oral Steroid ◽  
High Dose ◽  
Type I ◽  
Syndrome Type ◽  
Severity Scores ◽  
Dose Oral ◽  
Steroid Regimen

To compare the treatment effects of a high-dose and low-dose oral steroid regimen based on changes in the radioisotope uptake ratio (RUR) observed from three-phase bone scintigraphy (TPBS) in patients with complex regional pain syndrome type I (CRPS I), we retrospectively analyzed data of 34 patients with CRPS I from traumatic brain injury and stroke. Depending on the dose of steroid administered, patients were divided into high-dose (n = 14) and low-dose steroid groups (n = 20). We compared the severity scores, Kozin’s classification scores, and RUR observed from TPBS between the two groups. There were significant changes in the severity scores and Kozin’s classification between the baseline and 2 weeks from baseline (p < 0.05), however, there were no significant differences in terms of changes in the scores, classification, or the RUR observed from TPBS at 2 weeks from baseline (p > 0.05). There were no treatment-emergent adverse events (TEAEs) such as blood pressure elevation, impaired glycemic control, or gastrointestinal disturbances. Our results indicate that the efficacy profile of a low-dose oral steroid regimen is comparable to that of a high-dose regimen in alleviating symptoms in CRPS I patients. However, additional prospective, large-scale, multi-center studies are warranted to confirm our results.

scholarly journals Treatment of Myasthenia Gravis in Patients with Elderly Onset at Advanced Age

2015 ◽  
Vol 6 ◽  
pp. JCM.S29601 ◽  
Author(s):  
Noriko Nishikawa ◽  
Masahiro Nagai ◽  
Tomoaki Tsujii ◽  
Win T. Kyaw ◽  
Nachi Tanabe ◽  
...  
Keyword(s):  
Adverse Events ◽  
Myasthenia Gravis ◽  
Low Dose ◽  
Late Onset ◽  
Immunosuppressive Treatment ◽  
Advanced Age ◽  
Number Of Patients ◽  
Elderly Onset ◽  
Receptor Antibodies ◽  
Anti Acetylcholine

The number of patients with late-onset myasthenia gravis (MG) among patients ≥50 years has been increasing recently. We encountered three patients who developed elderly-onset MG at a particularly advanced age (≥80 years). All were female and positive for anti-acetylcholine receptor antibodies. About 4 years have passed since MG onset in all three patients and symptoms have been controlled without recurrence using a combination of oral low-dose prednisolone and tacrolimus. As many cases of elderly-onset MG do not require strong immunosuppression, we recommend minimum immunosuppressive treatment to avoid adverse events, particularly in patients at an advanced age of ≥80 years.

scholarly journals DISEASE COURSE IN EARLY RHEUMATOID ARTHRITIS: AN OBSERVATIONAL STUDY

2016 ◽  
Vol 25 (1) ◽  
pp. 14-19
Author(s):  
Teodora Serban ◽  
◽  
Iulia Satulu ◽  
Oana Vutcanu ◽  
Mihaela Milicescu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Low Dose ◽  
Mean Value ◽  
Early Arthritis ◽  
Classification Criteria ◽  
Interquartile Range ◽  
Number Of Patients ◽  
Significant Difference ◽  
Dose Oral ◽  
The Impact

Background. In rheumatoid arthritis (RA), prompt diagnosis and initiation of disease-modifying treatment during the first months after disease onset – a period called “window of opportunity” – is significantly superior to the delayed start of the same therapy. Clinical remission is more frequently obtained in patients with a disease duration no longer than 4 months and is the main aim of the treatment, therefore the “treat to target” (T2T) and “tight control” strategies were proposed. Objective. The aim of this study is to evaluate the therapy used for patients with early RA (ERA) and the impact of this medication on the clinical outcomes at 12 months after the first evaluation. Methods. Patients with early arthritis who were referred to the Early Arthritis Research Center of Dr. I. Cantacuzino Hospital between 2010-2014 and who fulfilled the 2010 EULAR/ACR Classification Criteria for RA (and who did not satisfy classification criteria for other inflammatory rheumatologic diseases) were enrolled. Only patients who received treatment with Methotrexate (MTX) associated or not with corticosteroids (CS) and patients who fulfilled the classification criteria for RA but did not received any DMARDs therapy were enrolled. Results. Forty-three patients were enrolled in the study, 62.8% females, mean age 55.47±13.71 years, median (interquartile range) DAS28 5.07 (4.31-5.60), SDAI 29.02 (20.92-34.61). At the first presentation, 40 patients (93.0%) received treatment with Methotrexate (MTX) in doses ranging from 5 mg/week to 20 mg/week, with a mean dose of 11.16±4.47 mg/week, the most frequently used doses ranging from 10 mg/week to 15 mg/week. 26 patients (60.5%) received corticosteroids (CS), either oral or intra-articular. During the study both the total number of patients receiving MTX and the mean dose of MTX increased, while the number of patients receiving CS decreased and at the end of the study only low-dose oral CS were still administered in 8 patients. At 12 months, median (interquartile range) DAS 28 was 1.77 (1.43-3.16), SDAI 3.58 (2.32-11.82). The evolution under treatment assessed by DAS28 and SDAI wasn’t significantly different between patients who received, at baseline, MTX in association with CS (mean value: ΔDAS28=-2.58±1.72, ΔSDAI=-20.44±16.49) and those who received MTX monotherapy (mean value: ΔDAS28=-2.91±1.17, ΔSDAI=-21.80±9.89) (p>0.05). There was no significant difference in change from baseline of DAS28 and SDAI at 12 months between patients who received low-dose oral CS and those who received intermittent intra-articular CS (p>0.05). Conclusions. Treatment with MTX and/or CS led to clinical and laboratory improved outcomes at 12 months of follow-up. There was no significant difference regarding long-term outcomes between patients who received low dose oral CS and those who received intra-articular CS. As this study was performed on a relatively small number of real-life patients with ERA, the results obtained should be validated on larger cohorts of patients.

scholarly journals Analysis of Steroid Effect in Patients with Olfactory Dysfunction

2021 ◽  
Vol 64 (4) ◽  
pp. 240-246
Author(s):  
Chang Bae Lee ◽  
Sangjun Kim
Keyword(s):  
Treatment Strategy ◽  
Medical Records ◽  
Olfactory Dysfunction ◽  
Oral Steroid ◽  
Steroid Dependent ◽  
Number Of Patients ◽  
Short Period ◽  
Olfactory Disorder ◽  
Oral Steroids ◽  
Ct Finding

Background and Objectives Olfaction plays an important role on sensing and discriminating smell and taste. The number of patients visiting outpatient department for treatment of olfactory dysfunction is increasing along with the change in patients’ perception about the importance of olfactory function.Subjects and Method Patients with olfactory dysfunction, who visited the hospital from 2010 to 2018, were included in this study. The medical records were reviewed focusing on the Korean Version of Sniffin’ Stick, the CT finding of olfactory cleft or signs of sinusitis, and the effect of oral steroids. Postviral olfactory disorder (PVOD) patients and chronic rhinosinusitis (CRS) patients were treated by oral steroid, starting on prednisolon (Solondo Tab<sup>®</sup>, YuHan Corp.; 40 mg per day) and tapered for 2 weeks.Results There were 13 cases where patients’ sense of smell was improved only for a short period of time after taking steroids but worsened thereafter. They showed improvement of olfactory function every time they took steroids. We defined this group as “steroid dependent olfactory dysfunction.”Conclusion It is necessary to understand the physiology and molecular biologic mechanisms behind the causes of olfactory dysfunction in order to establish the diagnostic criteria and treatment strategy. Steroid dependent olfactory dysfunction also needs more investigation.

scholarly journals Short-term Low-dose Oral Corticosteroid Therapy of Impingement Syndrome of the Shoulder: A Comparison of the Clinical Outcomes to Intra-articular Corticosteroid Injection

2014 ◽  
Vol 17 (2) ◽  
pp. 50-56
Author(s):  
Young Bok Kim ◽  
Young Chang Kim ◽  
Ji Wan Kim ◽  
Sang Jin Lee ◽  
Sang Won Lee ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Corticosteroid Therapy ◽  
Low Dose ◽  
Oral Corticosteroid ◽  
Impingement Syndrome ◽  
Oral Steroid ◽  
Short Term ◽  
Dose Oral ◽  
Ucla Score ◽  
Oral Corticosteroid Therapy

BACKGROUND: To assess the clinical outcomes of short-term oral corticosteroid therapy for impingement syndrome of the shoulder and determine whether it can be substituted as an alternative to the intra-articular injection.METHODS: The clinical outcomes of the 173 patients, the oral steroid group (n=88) and the injection group (n=85), were measured at 3 weeks, 2, 4, and 6 months postoperatively. The clinical outcomes were assessed by measuring the the University of California at Los Angeles (UCLA) score, visual analog scale (VAS) and range of motion (ROM) at every follow-up. Any complications and recurrence rate were noted. A relationship between the treatment outcomes and factors such as demographic factors, clinical symptoms and radiographic findings were determined.RESULTS: No difference was observed in VAS and UCLA scores between the two groups, but forward flexion and internal rotation of ROM were significantly improved in the injection group at the 2nd and 4th postoperative month (p < 0.05). At 6th postoperative month, recurrence rate of symptoms was 26% in the oral steroid group and 22% in the injection group. No major adverse effects were observed. When the clinical outcomes of the oral steroid group were compared to either demographic, clinical symptoms, or radiographic findings, UCLA score was found to be significantly low (p < 0.05) in patients with joint stiffness and UCLA score, whereas VAS score was significantly improved in patients with night pain (p < 0.05).CONCLUSIONS: Short-term low-dose oral corticosteroid therapy of impingement syndrome showed comparable clinical outcomes to intra-articular injection without any remarkable adverse effects. Low-dose oral steroids can be regarded as a partial alternative to intra-articular injection for the initial therapy of impingement syndrome of the shoulder.

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