scholarly journals Recent updates on the management of autoimmune hepatitis

2021 ◽  
Vol 27 (1) ◽  
pp. 58-69
Author(s):  
Atsumasa Komori
Keyword(s):  
Autoimmune Hepatitis ◽  
Clinical Manifestations ◽  
Serum Biochemistry ◽  
Acute Onset ◽  
Relative Increase ◽  
Treatment Withdrawal ◽  
First Line ◽  
Drug Induced ◽  
Smooth Muscle Antibody ◽  
First Line Therapy

Autoimmune hepatitis (AIH) is an immunoinflammatory chronic liver disease with dynamic and rather heterogeneous disease manifestations. A trend of increasing prevalence of AIH has been observed worldwide, along with a relative increase in the percentage of male patients. AIH is characterized and diagnosed based on serum biochemistry and liver histology: elevated aminotransferases and serum immunoglobulin G (IgG), the presence of serum anti-nuclear antibody or anti-smooth muscle antibody, and interface lympho-plasmacytic hepatitis. Clinical manifestations differ among disease subtypes with distinct time-frames, i.e., AIH with a chronic insidious onset, and acute-onset AIH (the diagnosis of which is often challenging due to the lack of typical serum findings). The absence of disease-specific biomarkers or histological findings may expand the disease phenotype into drug-induced AIH-like liver injury. Corticosteroids and azathioprine are recommended first-line treatments for AIH. The complete normalization of aminotransferases and serum IgG is an essential treatment response to ensure long-term overall survival. An incomplete response or intolerance to these drugs is considered an indication for second-line treatment, especially with mycophenolate mofetil. Life-long maintenance treatment is required for the majority of patients, but the few who achieve prolonged and stringent biochemical remission with lower alanine aminotransferase and IgG within the normal range may be able to discontinue the medications. In the future, the quality of life of AIH patients should be managed by personalized medicine, including the appropriate selection and dosing of first-line therapy and perhaps alternating with potential therapeutics, and the prediction of the success of treatment withdrawal.

scholarly journals Allopurinol-Induced Oral Lichenoid Drug Reaction with Complete Regression after Drug Withdrawal

2020 ◽  
Vol 7 (2) ◽  
pp. 18-25
Author(s):  
Alexandre Perez ◽  
Benjamin Lazzarotto ◽  
Jean-Pierre Carrel ◽  
Tommaso Lombardi
Keyword(s):  
Drug Reaction ◽  
Lichen Planus ◽  
Drug Withdrawal ◽  
Acute Onset ◽  
Complete Regression ◽  
Oral Manifestations ◽  
First Line ◽  
Drug Induced ◽  
Case Presentation ◽  
Oral Lichenoid Lesions

Background: Lichen planus is a chronic mucocutaneous inflammatory disease. Oral manifestations are common, and may remain exclusive to the oral mucosa without involvement of the skin or other mucosae. A differential diagnosis includes oral lichenoid drug reactions. Allopurinol, which is the first line hypo-uricemic treatment, is often quoted as being a possible offending drug, though oral reactions have rarely been reported. Case presentation: We describe a 59-year-old male gout patient, successfully treated with allopurinol, who developed acute onset of oral lichenoid lesions, involving bilaterally the buccal mucosa, the tongue and the labial mucosa. Histopathology was consistent with a lichen planus or a drug-induced lichenoid reaction. Improvement of the patient’s condition after withdrawal of allopurinol confirmed the lichenoid nature of the lesion. Remission was complete after a few weeks. Discussion: Although unusual, allopurinol may induce a lichenoid drug reaction. These reactions may mimic clinically and histopathologically idiopathic lichen planus. Improvement or complete regression of the lesions may be attempted to confirm the diagnosis. According to the latest WHO recommendations, these lesions have a potential for malignant transformation.

scholarly journals Budesonide as a first line therapy in autoimmune hepatitis: A systematic review

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Ibrahim Mahmoud Ajwah ◽  
Mohammed Abdullah Albalawi ◽  
Bashayer Jazza Alenazi ◽  
Saif Mohammed Alamri ◽  
Faris Essa Qubays ◽  
...  
Keyword(s):  
Systematic Review ◽  
Autoimmune Hepatitis ◽  
Hepatitis A ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

scholarly journals Pediatric eosinophilic esophagitis: a review for the clinician

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Simona Barni ◽  
Stefania Arasi ◽  
Carla Mastrorilli ◽  
Luca Pecoraro ◽  
Mattia Giovannini ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Multidisciplinary Approach ◽  
Unmet Needs ◽  
Clinical Manifestations ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Therapy Option ◽  
Esophageal Dysfunction ◽  
Histological Remission

AbstractEosinophilic esophagitis (EoE) is a chronic clinical-pathologic disease characterized by eosinophilic infiltration of the esophageal epithelium with esophageal dysfunction symptoms.EoE can occur at any age and has different clinical manifestations depending on the age onset.To date, esophago-gastroduodenal endoscopy (EGD) with biopsy is the gold-standard for EoE diagnosis.According to the recent consensus guidelines, proton pump inhibitors, corticosteroids and elimination diets could be a first-line therapy option. The aim of the treatment is clinical and histological remission for preventing long-lasting untreatable fibrosis.A multidisciplinary approach (allergist, gastroenterology, dietitian, and pathologist) is recommended for managing patients affected by EoE, given the complexity of its treatment.This review will provide a practical guide to assist pediatricians treating children with EoE.Moreover, it highlights the unmet needs in diagnosis and treatment that require urgent attention from the scientific community in the aim of improving the management of patients with EoE.

VP-16 and cisplatin as first-line therapy for small-cell lung cancer.

1985 ◽  
Vol 3 (11) ◽  
pp. 1471-1477 ◽  
Author(s):  
W K Evans ◽  
F A Shepherd ◽  
R Feld ◽  
D Osoba ◽  
P Dang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Complete Response ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Drug Induced ◽  
First Line Therapy ◽  
Line Therapy

Thirty-one patients with small-cell lung cancer (SCLC) were treated with VP-16 and cisplatin as first-line therapy. In the majority of cases an Adriamycin (Adria Laboratories, Columbus, Ohio) containing regimen was contraindicated because of severe cardiac or hepatic disease. Eight patients who presented with cerebral metastases were also included in the series. Eleven patients had limited disease (LD), and 20 had extensive disease (ED). Of the 28 evaluable patients, 12 (43%) achieved a complete response (CR) and 12 (43%) had a partial response (PR). Four patients (14%) either had no response or progressed on treatment. The median duration of response for patients with LD was 39 weeks and for those with ED, 26 weeks. The median survival time (MST) for the whole group of responding (CR and PR) LD patients was 70 weeks (range, 28 to 181 + weeks), and for responding ED patients, it was 43 weeks (range, 17 to 68 weeks). Gastrointestinal toxicity was mild, but leukopenia and thrombocytopenia were common. There were four febrile episodes during periods of drug-induced neutropenia and this led to one treatment-related death. Nephrotoxicity occurred in 15 patients and required discontinuation of cisplatin in two. These results compare favorably with reports of standard induction chemotherapy regimens and provide further evidence of the activity of the VP-16 and cisplatin regimen in patients with SCLC.

Usefulness of corticosteroids as first-line therapy in patients with acute severe autoimmune hepatitis

2016 ◽  
Vol 65 (2) ◽  
pp. 444-446 ◽  
Author(s):  
Rémy Moenne-Loccoz ◽  
François Severac ◽  
Thomas F. Baumert ◽  
François Habersetzer
Keyword(s):  
Autoimmune Hepatitis ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

Clinicopathological Study of Autoimmune Hepatitis Cases That Were Difficult to Differentiate from Drug-Induced Liver Injury

2017 ◽  
Vol 35 (6) ◽  
pp. 506-514 ◽  
Author(s):  
Akemi Tsutsui ◽  
Kenichi Harada ◽  
Koichi Tsuneyama ◽  
Tomonori Senoh ◽  
Takuya Nagano ◽  
...  
Keyword(s):  
Liver Injury ◽  
Autoimmune Hepatitis ◽  
Scale Score ◽  
Plasma Cells ◽  
Final Diagnosis ◽  
Acute Onset ◽  
Pathological Findings ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Scale Scores

Aim: Acute-onset autoimmune hepatitis (AIH) histopathologically presents with features of acute hepatitis and lacks a specific diagnostic method. Also, AIH is often difficult to differentiate from drug-induced liver injury (DILI). We aimed to investigate the final clinical diagnosis of these cases, and compare the clinical, biochemical, and histological characteristics of AIH vs. DILI. Methods: We examined the Digestive Disease Week Japan 2004 (DDW-J) scale scores, AIH scores, clinical data, and pathological findings in 20 patients in whom it was difficult to differentiate autoimmune liver disease from DILI. Results: In cases with a DDW-J scale score of ≥5, there was a good correlation between the final diagnosis and DDW-J scale assessments, but in cases with a DDW-J scale score of ≦4 they did not correlate well. The scores for pathological findings, such as cobblestone hepatocellular change (p = 0.015), interface hepatitis (p = 0.012), and prominent plasma cells in portal areas (p = 0.011), were higher in the AIH group than in the DILI group. Conclusion: This study showed that DDW-J scale was useful for differentiating AIH from DILI in cases with a DDW-J scale score of ≧5. The histologic features of AIH were characterized by cobblestone hepatocellular change, interface hepatitis, and plasma cell infiltration of the portal region.

scholarly journals Successful Rechallenge with Osimertinib after Very Acute Onset of Drug-Induced Pneumonitis

2021 ◽  
pp. 733-738
Author(s):  
Turab Mohammed ◽  
Shaunak Mangeshkar ◽  
Joerg Rathmann
Keyword(s):  
Kinase Inhibitor ◽  
Clinical Symptoms ◽  
Radiological Finding ◽  
Growth Factor Receptor ◽  
Pulmonary Involvement ◽  
Acute Onset ◽  
Treatment Withdrawal ◽  
High Dose ◽  
Drug Induced ◽  
Radiographic Findings

Drug-induced interstitial lung disease (DI-ILD) is a rare, yet life-threatening complication associated with tyrosine-kinase inhibitor (TKI) therapy. Third-generation epidermal growth factor receptor-TKI, osimertinib use can be associated with a benign radiological finding called transient asymptomatic pulmonary opacities that can be confused with an infectious pulmonary process resulting in overtreatment with antibiotics or premature treatment withdrawal or severe DI-ILD. In this case, our patient with newly diagnosed metastatic non-small cell lung cancer on treatment with osimertinib developed very early onset severe DI-ILD (grade-IV) with a unique pattern of pulmonary involvement and was treated with high-dose corticosteroids with a response. She was later successfully rechallenged with osimertinib and responded well to the treatment. Our case highlights the importance of being cognizant of the possibility that DI-ILD can rarely occur within a week of treatment initiation with osimertinib and safe reintroduction of the drug is possible in select patients following complete resolution of pulmonary radiographic findings and clinical symptoms even with high-grade adverse events.

scholarly journals Clinical and treatment patterns in neuromyelitis optica: a retrospective study from a single centre

2019 ◽  
Vol 6 (4) ◽  
pp. 1277
Author(s):  
Kamlesh A. Jagiasi ◽  
Shashank Nagendra ◽  
Afroz Ansari ◽  
Prachi Barvalia ◽  
Vikram Aglave
Keyword(s):  
Neuromyelitis Optica ◽  
Oral Therapy ◽  
Clinical Manifestations ◽  
Tertiary Hospital ◽  
Treatment Patterns ◽  
Published Data ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Oral Agents

Background: The aim of the study was to study the different presentations, treatment patterns and relapses on therapy in patients of neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorder (NMOSD).Methods: This is a retrospective, observational study in a tertiary hospital where Demographics, clinical manifestations at onset and at follow up and relapses, serum anti Aquaporin 4 antibody status, first line immunomodulatory therapy which was initiated and Relapses on first line therapy were noted.Results: Demographics and clinical presentation was largely similar to published data. 80% patients presented with LETM/ON at onset. Ten patients relapsed on oral therapy and trend was to shift from oral therapy to RTX after relapse on oral agent. No relapses were noted on RTX.Conclusions: Unaffordability and apprehension towards injections and cost were the factors affecting IMT decision, so majority received oral agents Aza/ MMF as first line therapy while remaining patients on oral therapy remained relapse free.

scholarly journals A patient with severe autoimmune hepatitis of acute onset negative for Anti-nuclear antibody but positive for anti-smooth muscle antibody.

Kanzo ◽  
1998 ◽  
Vol 39 (4) ◽  
pp. 251-254
Author(s):  
Satsuki Oe ◽  
Shuzo Noda ◽  
Kayoko Fujimi ◽  
Takatoshi Kitada ◽  
Shigeru Sakuta ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Autoimmune Hepatitis ◽  
Acute Onset ◽  
Smooth Muscle Antibody

TSH-secreting pituitary adenoma: late diagnosis and effectiveness of therapy

2017 ◽  
Vol 63 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Galina G. Petrik ◽  
Elena D. Kosmacheva ◽  
Ulya I. Polyakova ◽  
Svetlana V. Butaeva ◽  
Ludmila Ya. Rozhinskaya ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Manifestations ◽  
Thyroid Status ◽  
First Line ◽  
Free T4 ◽  
Adequate Treatment ◽  
First Line Therapy ◽  
Thyroid Hormone Resistance Syndrome ◽  
Rule Out

The modern therapeutic and diagnostic algorithms allow timely detection of pituitary disorder to prescribe adequate treatment. Meanwhile, when interpreting the thyroid status, physicians need to take into account the extremely rare but the actually existing possibility of central thyrotoxicosis. The worldwide practice shows that diagnosis of this condition is rather challenging. We report a clinical case of a TSH-secreting pituitary adenoma in a 47-year-old female who received a long-term thyrostatic therapy for thyrotoxicosis. The patient was diagnosed with Graves’ disease; however, thyrotoxicosis was actually caused by TSH-oma. The key laboratory signs of central thyrotoxicosis included the combination of episodes of normal or elevated TSH level with the high or normal free T4 level. MRI showed a pituitary macroadenoma. The clinical manifestations of thyrotoxicosis made it possible to rule out the thyroid hormone resistance syndrome. The attempted therapy with octreotide eliminated the clinical and laboratory signs of thyrotoxicosis, so the conservative method was selected as first-line therapy. The features of clinical and laboratory signs, as well as the principles of differential diagnosis and modern methods for treating TSH-secreting pituitary adenomas are discussed.

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