Macrophage activation syndrome triggered by systemic lupus erythematosus flare: successful treatment with a combination of dexamethasone sodium phosphate, intravenous immunoglobulin, and cyclosporine: a case report

Background Macrophage activation syndrome is classified as a secondary form of hemophagocytic lymphohistiocytosis. It is a hyperinflammatory complication observed to be comorbid with a variety of autoimmune diseases, including adult-onset Still’s disease and systemic juvenile idiopathic arthritis. Macrophage activation syndrome is less commonly detected in adult patients with systemic lupus erythematosus, which, if untreated, can be fatal, though determining the optimum treatment strategy is still a challenge. Case presentation Herein, we report a case of macrophage activation syndrome in a 33-year-old Egyptian female as an unusual complication of a systemic lupus erythematosus flare in adult patients. Our patient was initially treated with a combination of intravenous methylprednisolone pulse therapy and intravenous immunoglobulin therapy, which was followed by a course of oral prednisolone and oral cyclosporine with little response. Switching from oral prednisone to intravenous dexamethasone sodium phosphate showed a more favorable clinical and biochemical response. Conclusion Macrophage activation syndrome is less commonly detected in adult patients with systemic lupus erythematosus. Our case demonstrates that dexamethasone sodium phosphate can be a successful alternative treatment for patients with systemic lupus erythematosus complicated by macrophage activation syndrome in whom the response to pulse methylprednisolone was inadequate to manage their illness, proving to be remarkably effective in a relatively short time frame.

Histological alterations in Rabbit liver after treatment with dexamethasone

Background One of the most potent glucocorticoids is known as Dexamethasone. Many metabolic side effect shave been reported on almost every organ after dexamethasone treatment specially its effect on liver. Aim: To investigate harmful side effects of dexamethasone sodium phosphate on rabbit’s liver that serve as human liver model via using light microscope, by administration of two doses (extreme) and two durations in order to depict the duration as well as dosage dependency. Methods: Liver samples were taken via rabbits who were administered dexamethasone sodium phosphate. Then two Stratas were made namely, 1 and 2. The fixations of liver samples were carried out and underwent into evaluation in order to observe any histochemical and histological alterations. Study duration is from February to May 2021 Rabbits were brought from Veterinary Research Institute, Lahore. These Rabbits were kept in cages in the animal house of PGMI, Bird wood road Lahore. Results: The ballooning and vacuolation of hepatic cells were seen in the liver in case of Stratas that were treated along with the degenerative alterations of these cells, congestion and dilatation of central hepatic vein with sinusoidal capillaries, positive periodic acid schiff's stain (PAS) reactions. The severity of all these alterations was dependent upon duration and dosage. Conclusion: Morphological variations induced in the liver by dexamethasone sodium phosphate could be accepted as side effects of these drugs. Keywords: Liver, dexamethasone, histology, glycogen.