scholarly journals Paediatric anti-GABAB receptor encephalitis associated with SARS-CoV-2 (COVID-19) infection

2021 ◽  
Vol 8 (11) ◽  
pp. 1909
Author(s):  
Nidhi Shivanna Premakumari ◽  
Sudha Rudrappa ◽  
Pratibha Manjunath Patagar
Keyword(s):  
Gabab Receptor ◽  
Autoimmune Encephalitis ◽  
Female Child ◽  
High Dose ◽  
Csf Analysis ◽  
Autonomic Instability ◽  
Sudden Outburst ◽  
Initiation Of Therapy ◽  
Dose Corticosteroid ◽  
Second Wave

Though we are approaching the end of second wave of COVID pandemic, we are still unrevealing the various presentation this viral infection can result in. There are few cases reported to have anti NMDA autoimmune encephalitis associated with COVID-19 infection or MIS-C. Here we are reporting one of its variants that was anti-GABAB receptor encephalitis associated with COVID-19 infection. We are reporting a 9 years old female child who was a known case of seizure disorder and on regular medications presented on 4th day of RT-PCR positive status for COVID-19 with complains of convulsions which was managed with antiepileptics. On day 6 of hospitalization she had autonomic instability in the form of tachyarrhythmia, repitation of speech, sudden outburst of laughter and on day 7 child landed in status epilepticus. Autoimmune encephalitis suspected secondary to COVID-19 infection and the child was started on IVIG but not much of improvement seen with this. CSF analysis showed weakly positive anti GABAB antibodies and child had persistently elevated inflammatory markers hence started on high dose corticosteroid. MIS-C ruled out. Child showed drastic improvement both clinical and biochemical after high dose corticosteroids. Prompt treatment with IVIG/corticosteroids have shown a drastic improvement in our child just like in any other autoimmune encephalitis. Though further detailed study is required to prove its exact mechanism in COVID-19 infection, it should be thought of when appropriate and prompt early initiation of therapy will help us reduce morbidity and mortality associated with it.

scholarly journals Bilateral Meningo-Cortical Involvement in Anti-myelin Oligodendrocyte Glycoprotein-IgG Associated Disorders: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Guozhong Ma ◽  
Jinzhao He ◽  
Yan Li ◽  
Yan Xu ◽  
Yunxin Hu ◽  
...  
Keyword(s):  
Autoimmune Encephalitis ◽  
Immunoglobulin Therapy ◽  
Corticosteroid Treatment ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
High Dose ◽  
Cortical Lesions ◽  
Parietal Lobes ◽  
Mri Scans ◽  
Dose Corticosteroid ◽  
Cortical Involvement

Cortical T2-weighted fluid-attenuated inversion recovery (FLAIR)-hyperintense lesions in anti-myelin oligodendrocyte glycoprotein (MOG)-associated encephalitis with seizures (FLAMES) are mostly unilateral and rarely spread to the bilateral cortex and meninges. We describe a case of MOG-immunoglobulin G (IgG) associated disorder (MOGAD) in a 39-year-old male with bilateral meningo-cortical involvement. The patient was hospitalized for epilepsy, fever, and headache. The initial MRI revealed abnormalities in the sulci of the bilateral frontal, temporal, and parietal lobes. He was considered to have infectious encephalitis and given empiric antibiotic and antiviral therapy, which were ineffective. His condition rapidly improved after the patient was switched to high-dose immunoglobulin therapy. No tests supported the presence of central nervous system (CNS) infections or autoimmune encephalitis. The second and third MRI scans showed reduced but still clearly observable meningo-cortical lesions. The patient was discharged without a definite diagnosis, but reported severe left vision impairment 25 days later. A fourth MRI showed signs typical of demyelinating CNS disease in addition to the original meningo-cortical lesions. The patient's symptoms were initially relieved by low-dose corticosteroid therapy, but they eventually returned, and he was re-admitted. The original lesions were diminished on the fifth MRI scan, but new lesions had developed in the deep white matter. A positive cell-based assay for MOG-IgG in serum confirmed MOGAD. The patient received high-dose corticosteroid treatment followed by an oral methylprednisolone taper, and his visual acuity gradually improved. The sixth and final MRI showed substantial decreases in the original lesions without new lesion formation. This unique case presents the complete diagnosis and treatment process for MOGAD with bilateral meningo-cortical involvement and may provide a reference for prompt diagnosis.

High-Dose Corticosteroid Pulse Therapy Increases the Survival Rate in COVID-19 Patients at Risk of Cytokine Storm

2020 ◽  
Author(s):  
Miguel Ángel López-Zúñiga ◽  
Aida Moreno-Moral ◽  
Ana Ocaña-Granados ◽  
Francisco Padilla-Moreno ◽  
Alba María Castillo-Fernández ◽  
...  
Keyword(s):  
At Risk ◽  
Survival Rate ◽  
Pulse Therapy ◽  
High Dose ◽  
Cytokine Storm ◽  
High Dose Corticosteroid ◽  
Patients At Risk ◽  
Corticosteroid Pulse Therapy ◽  
Dose Corticosteroid

scholarly journals Severe acute myopathy following SARS-CoV-2 infection: a case report and review of recent literature

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Badrul Islam ◽  
Mohiuddin Ahmed ◽  
Zhahirul Islam ◽  
S. M. Begum
Keyword(s):  
High Serum ◽  
High Dose ◽  
Limb Weakness ◽  
Case Presentation ◽  
Skeletal Myopathy ◽  
Potential Marker ◽  
Ventilatory Failure ◽  
Muscle Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Dose Corticosteroid

Abstract Background SARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure. Case presentation We addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis. Conclusion We wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.

scholarly journals Assessment of Outcome Predictors after First Attack of Optic Neuritis

2011 ◽  
Vol 38 (6) ◽  
pp. 887-895 ◽  
Author(s):  
Mansoureh Mamarabadi ◽  
Hadie Razjouyan ◽  
Fatemeh Mohammadi ◽  
Mehdi Moghaddasi
Keyword(s):  
Risk Factors ◽  
Optic Neuritis ◽  
Corticosteroid Therapy ◽  
Cox Regression ◽  
Female Gender ◽  
Cumulative Probability ◽  
High Dose ◽  
Risk Of Progression ◽  
Dose Corticosteroid ◽  
Iranian Patients

Background:Optic Neuritis (ON) is one of the most common clinically isolated syndromes which develops into clinically diagnosed Multiple Sclerosis (CDMS) over time.Objective:To assess the conversion rate of Iranian patients presenting with idiopathic ON to CDMS as well as monitoring potential demographic and clinical risk factors.Methods:Atotal of 219 patients' medical records of idiopathic ON from March 2001 to May 2009 were reviewed. Demographic findings, ophthalmologic characteristics on admission and discharge, diagnostic approaches, type and dosage of therapy were retrospectively reviewed. A structured telephone interview was then conducted to identify patients who had subsequently been diagnosed with MS. Survival analysis was used to evaluate the cumulative probability of MS conversion and contributory risk factors.Results:From the 219 ON patients, 109 [age 11-51, female: 81%] were followed up. Among the male gender the mean age of patients developing MS was significantly lower (P=0.01). In cox regression model, female sex (p=0.07), bilateral ON (p=0.003), MRI abnormalities (p <0.001) and high dose (5g) corticosteroid therapy (p<0.001) were identified as risk factors for the development of MS. The two and five year cumulative probability of developing MS were 27% and 45%, respectively.Conclusions:Idiopathic ON in Iranian patients carries higher risk of progression to MS compared to other Asian countries. MRI lesions are the strongest independent risk factor of developing CDMS. Bilateral ON, female gender and high dose corticosteroid therapy are also important factors in predicting CDMS development.

scholarly journals Magnetic Resonance Imaging Evaluation in Patients with Linear Morphea Treated with Methotrexate and High-Dose Corticosteroid

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammad Shahidi-Dadras ◽  
Fahimeh Abdollahimajd ◽  
Razieh Jahangard ◽  
Ali Javinani ◽  
Amir Ashraf-Ganjouei ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Dose ◽  
Skin Thickness ◽  
Resonance Imaging ◽  
High Dose Corticosteroid ◽  
Before And After ◽  
Lesion Extension ◽  
Dose Corticosteroid ◽  
Mri Changes

Background. Morphea is an inflammatory disease of the connective tissue that may lead to thickening and hardening of the skin due to fibrosis. The aim of this study was to document magnetic resonance imaging (MRI) changes in patients with linear morphea who were treated with methotrexate (MTX) and high-dose corticosteroid. Methods. This study was conducted on 33 patients from the outpatient’s dermatology clinic of our institute, who fulfilled the inclusion criteria. Patients received 15 mg/week of MTX and monthly pulses of methylprednisolone for three days in six months. The effectiveness of the treatment was evaluated by MRI, modified LS skin severity index (mLoSSI), and localized scleroderma damage index (LoSDI). Results. All parameters of mLoSSI and LoSDI including erythema, skin thickness, new lesion/lesion extension, dermal atrophy, subcutaneous atrophy, and dyspigmentation were also noticeably improved after treatment. Subcutaneous fat enhancement was the most common finding in MRI. MRI scores were significantly associated with clinical markers both before and after the treatment with the exception of skin thickness and new lesion/lesion extension which were not associated with MRI scores before and after the treatment, respectively. Limitations. The lack of correlative laboratory disease activity markers, control group, and clearly defined criteria to judge the MRI changes. Conclusion. MRI could be a promising tool for the assessment of musculoskeletal and dermal involvement and also monitoring treatment response in patients with morphea.

Indications for Tonsillectomy in Infectious Mononucleosis

PEDIATRICS ◽  
1971 ◽  
Vol 48 (2) ◽  
pp. 338-339
Author(s):  
Edward J. Feroli ◽  
Gordon W. Mella ◽  
Frank A. Pedreira ◽  
Regis T. Storch ◽  
Howard P. Gutgesell
Keyword(s):  
Case Report ◽  
Infectious Mononucleosis ◽  
Community Hospital ◽  
Nasotracheal Intubation ◽  
Benign Disease ◽  
Therapeutic Modality ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Acute Airway Obstruction ◽  
Dose Corticosteroid

We read with interest the recent report, "Acute Airway Obstruction in Infectious Mononucleosis."1 Dr. Gutgesell appropriately has called attention to a serious complication of a usually benign disease. He mentions brief, high-dose corticosteroid therapy, tracheotomy, nasotracheal intubation, and IPPB as potential modes of therapy. The following case report suggests an additional therapeutic modality in the management of these patients. A 4-year-old girl was admitted to a community hospital in acute respiratory distress associated with suspected infectious mononucleosis.

Sustained hemostatic abnormality in patients with steroid-induced osteonecrosis in the early period after high-dose corticosteroid therapy

2000 ◽  
Vol 5 (4) ◽  
pp. 374-379 ◽  
Author(s):  
Kazuhiro Oinuma ◽  
Yoshitada Harada ◽  
Yasushi Nawata ◽  
Katsuhiko Takabayashi ◽  
Isao Abe ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Early Period ◽  
High Dose ◽  
High Dose Corticosteroid ◽  
Dose Corticosteroid

scholarly journals Imatinib mesylate treatment for platelet-derived growth factor receptor alfa-positive choroid plexus carcinoma

2012 ◽  
Vol 2 (2) ◽  
pp. 49 ◽  
Author(s):  
Chihiro Kawakami ◽  
Akiko Inoue ◽  
Kimitaka Takitani ◽  
Motomu Tsuji ◽  
Kimiko Wakai ◽  
...  
Keyword(s):  
Growth Factor ◽  
Choroid Plexus ◽  
Standard Dose ◽  
Growth Factor Receptor ◽  
Female Child ◽  
Disease Recurrence ◽  
Choroid Plexus Carcinoma ◽  
High Dose ◽  
Imatinib Treatment ◽  
Stem Cell Rescue

We herein report a female child with choroid plexus carcinoma treated with standard dose of imatinib at disease recurrence. This patient failed initial twice-surgical resections, central nervous system (CNS) irradiation, and adjuvant chemotherapies and high-dose thiotepa and melphalan with auto peripheral blood stem cell rescue. Finally, imatinib treatment was undergone as a palliative setting, however the tumor did not reduce and the patient died of tumor bleedings. We consider that the reasons for the failure are as follows: i) adequate CNS level of imatinib were not obtained because of the blood brain barrier, ii) the lack of plateletderived growth factor receptor beta expression in our case may have a crucial role.

scholarly journals Coronavirus disease 2019 in kidney transplant recipients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
QY Ho ◽  
R Sultana ◽  
TL Lee ◽  
S Thangaraju ◽  
T Kee ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Kidney Injury ◽  
High Dose ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Presenting Symptoms ◽  
Effect Of Treatment ◽  
Dose Corticosteroid

Introduction: The clinical presentation and outcomes of coronavirus disease 2019 (COVID-19) in kidney transplant recipients (KTRs) have not been well studied. Methods: We performed a meta-analysis to examine the presenting features, outcomes and the effect of treatment on outcomes of KTRs with COVID-19. Database search was performed up to 5 September 2020 through PubMed, EMBASE, Web of Science, SCOPUS, and CENTRAL. Results: Overall, 23 studies (1373 patients) were included in the review and meta-analysis. The most common presenting symptoms included fever (74.0%, 95% confidence interval [CI] 65.3–81.1), cough (63.3% 95% CI 56.5–69.6) and dyspnoea (47.5%, 95% CI 39.6–55.6). Pooled rates of mortality and critical illness were 21.1% (95% CI 15.3-28.4) and 27.7% (95% CI 21.5–34.8) respectively. Acute kidney injury occurred in 38.9% (95% CI 30.6–48.1) and dialysis was required in 12.4% (95% CI 8.3–18.0) of the cases. Discussion: KTRs with COVID-19 have a similar clinical presentation as the general population but have higher morbidity and mortality. It is uncertain whether high dose corticosteroid or hydroxychloroquine reduces the risks of mortality in KTRs with COVID-19.

Encephalopathy With Alternating Hemispheric MRI Abnormalities

2021 ◽  
pp. 181-183
Author(s):  
Andrew McKeon
Keyword(s):  
Genetic Testing ◽  
Oral Prednisone ◽  
Autoimmune Encephalitis ◽  
High Dose ◽  
Temporal Region ◽  
Sharp Waves ◽  
Signal Abnormality ◽  
History Of ◽  
Fluctuating Course ◽  
Short Time

A 21-year-old woman with a long-standing history of migraine sought care at her local provider for a 1-week history of confusion and mixing up her words. She then had a witnessed seizure, with dyscognitive features and secondary generalization. On hospitalization, electroencephalography demonstrated left temporal theta slowing and sharp waves. Magnetic resonance imaging showed patchy T2-signal abnormality, nonenhancing, in the left temporal region (only a report was available). Thyroid peroxidase antibodies were increased at 271 IU/mL. A diagnosis of an autoimmune encephalopathy was made, and the patient was treated with phenytoin, levetiracetam, and high-dose corticosteroids, followed by a slow oral prednisone taper. The patient improved cognitively but had considerable emotional lability and an increase in headache frequency and severity and, thus, sought a second opinion. Blood was drawn for genetic testing. The patient died in her sleep a short time later, most likely in the context of sudden unexplained death in epilepsy. Her genetic testing results became available 1 month later, which showed findings consistent with MELAS syndrome: heteroplasmic sequence variation m.3243A>G (tRNA Leu) and homoplasmic rare variant m.2294A>G (16S rRNA). Encephalopathy or encephalitis of subacute onset with fluctuating course is not unique to autoimmune encephalitis. Common acquired metabolic disorders must be considered and excluded in all cases, such as deficiencies of vitamin B12 and folate, hypothyroidism, sepsis, and central nervous system–active medications.

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