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https://www.readbyqxmd.com/read/27900974/disseminated-mycobacteria-chelonae-infection-in-a-kidney-pancreas-transplant-recipient-a-case-report-and-review-of-the-literature
#1
Shafi Malik, Ananda Ghosh, Shahid Husain
A 40-year-old male with a long-standing history of type 1 diabetes with end-stage renal failure underwent combined kidney-pancreas (KP) transplant from a standard criteria donor. Post-operative course was uncomplicated with good primary function of both transplant grafts. Induction was with thymoglobulin and maintenance immunosuppression was with tacrolimus, mycophenolate mofetil and prednisolone. Nine weeks post-transplant, the patient developed dysfunction of both grafts. Panel reactive antibody testing revealed that the patient had developed a de novo donor-specific antibody and considering an antibody-mediated rejection the patient was treated with intravenous pulse methyl prednisone 500 mg ×3 doses, IV immunoglobulin 2 mg/kg in two divided doses, and ATG 7 mg/kg (total dose of 700 mg)...
November 2016: Saudi Journal of Kidney Diseases and Transplantation
https://www.readbyqxmd.com/read/27865549/anaemia-and-fever-in-kidney-transplant-the-role-of-human-parvovirus-b19
#2
Yanet Parodis López, Raquel Santana Estupiñán, Silvia Marrero Robayna, Roberto Gallego Samper, Fernando Henríquez Palop, José Carlos Rivero Vera, Rafael Camacho Galán, María José Pena López, Nery Sablón González, Fayna González Cabrera, Elena Oliva Dámaso, Nicanor Vega Díaz, José Carlos Rodríguez Pérez
Infections remain an issue of particular relevance in renal transplant patients, particularly viral infections. Human parvovirus B19 infection causes severe refractory anaemia, pancytopenia and thrombotic microangiopathy. Its presence is recognized by analysing blood polymerase chain reaction (PCR) and by the discovery of typical giant proerythroblasts in the bone marrow. We report the case of a 65 year-old man with a history of deceased donor renal transplant in September 2014. At 38 days after the transplant, the patient presented progressive anaemia that was resistant to erythropoiesis-stimulating agents...
November 16, 2016: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
https://www.readbyqxmd.com/read/27862562/management-of-pemphigus-disease-in-pregnancy
#3
REVIEW
Soheil Tavakolpour, Hajar Sadat Mirsafaei, Saeid Delshad
Pemphigus can cause complications during pregnancy and may cause serious harm to a fetus. For this study, a comprehensive review of common treatments of pemphigus and their adverse effects associated with pregnancy and male fertility was conducted. We concluded that a period of remission with minimal or no therapy before conception could significantly reduce the risk of the disease flaring up, at least in the first trimester. The period of remission causes a delay in the flare-up of the disease, which means lower cumulative doses and the prevention of possible congenital abnormalities caused by corticosteroid or immunosuppressant treatments...
November 8, 2016: American Journal of Reproductive Immunology: AJRI
https://www.readbyqxmd.com/read/27803135/childhood-arthritis-and-rheumatology-research-alliance-consensus-clinical-treatment-plans-for-juvenile-dermatomyositis-with-persistent-skin-rash
#4
Adam M Huber, Susan Kim, Ann M Reed, Ruy Carrasco, Brian M Feldman, Sandy D Hong, Philip Kahn, Homaira Rahimi, Angela Byun Robinson, Richard K Vehe, Jennifer E Weiss, Charles Spencer
OBJECTIVE: Juvenile dermatomyositis (JDM) is the most common form of idiopathic inflammatory myopathy in children. While outcomes are generally thought to be good, persistence of skin rash is a common problem. The goal of this study was to describe the development of clinical treatment plans (CTP) for children with JDM characterized by persistent skin rash despite complete resolution of muscle involvement. METHODS: The Childhood Arthritis and Rheumatology Research Alliance, a North American consortium of pediatric rheumatologists and other healthcare providers, used a combination of Delphi surveys and nominal group consensus meetings to develop CTP that reflected consensus on typical treatments for patients with JDM with persistent skin rash...
November 1, 2016: Journal of Rheumatology
https://www.readbyqxmd.com/read/27796249/rituximab-related-late-onset-neutropenia-in-kidney-transplant-recipients-treated-for-antibody-mediated-acute-rejection
#5
Fatemeh Ahmadi, Simin Dashti-Khavidaki, Mohammad-Reza Khatami, Mahboob Lessan-Pezeshki, Hossein Khalili, Malihe Khosravi
OBJECTIVES: Kidney transplant is a new area for use of rituximab, which is being used to treat acute antibody-mediated rejection or as an induction agent in ABO- or HLA-incompatible grafts. We report on late-onset neutropenia in rituximab-treated kidney transplant recipients with antibody-mediated rejection. MATERIALS AND METHODS: This observational prospective study was performed on kidney transplant recipients with clinically suspicious or biopsy-proven antibody-mediated rejection treated with plasmapheresis plus intravenous immunoglobulin with (cases) or without (controls) rituximab...
October 31, 2016: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/27717323/outcome-of-low-dose-cyclophosphamide-for-induction-phase-treatment-of-lupus-nephritis-a-single-center-study
#6
Mahesh R Sigdel, Mukunda P Kafle, Dibya Singh Shah
BACKGROUND: The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months. METHODS: We carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed)...
October 7, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27717279/successful-renal-retransplantation-after-graft-loss-from-bk-polyomavirus-infection-in-a-human-immunodeficiency-virus-positive-patient
#7
Aurore Barthélemy, Nicolas Bouvier, Renaud Verdon, Valérie Chatelet, Bruno Hurault de Ligny
We report the case of a human immunodeficiency virus-seropositive patient whose initial kidney transplant failed because of BK polyomavirus-induced nephropathy, and who underwent a second transplantation 3 years later. BK viruria was detected 1 day after transplantation. After 1 month, BK viremia developed along with a donor-specific antibody. After decreasing tacrolimus and mycophenolic acid and 2 courses of intravenous immunoglobulins, BK viremia and donor-specific antibody permanently disappeared, with stable renal function...
September 26, 2016: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/27717107/management-of-patients-with-ocular-manifestations-in-vesiculobullous-disorders-affecting-the-mouth
#8
REVIEW
M S Hansen, O N Klefter, H O Julian, A M Lynge Pedersen, S Heegaard
Pemphigoid and pemphigus diseases as well as Stevens-Johnson syndrome present as vesiculobullous disorders of the skin and may additionally involve both the oral cavity and the ocular surface. Ocular involvement ranges from mild irritation and dry eye disease to chronic conjunctivitis, symblepharon, eyelid malposition, ocular surface scarring and severe visual loss. In addition to diagnostic assessments, ophthalmologists must treat the dry eye and meibomian gland dysfunction components of these diseases using a stepladder approach, including eyelid hygiene and lubricants...
October 7, 2016: Oral Diseases
https://www.readbyqxmd.com/read/27708963/impact-of-standard-of-care-treatments-and-disease-variables-on-outcomes-in-systemic-lupus-erythematosus-trials-analysis-from-the-lupus-foundation-of-america-collective-data-analysis-initiative
#9
Kenneth Carekin Kalunian, Mimi Kim, Xianhong Xie, Amrutha Baskaran, Rossi Paola Daly, Joan Tenenbaum Merrill
OBJECTIVE: Most clinical trials for systemic lupus erythematosus (SLE) study the efficacy and safety of investigational agents added to variable background immunosuppressants, which has resulted in high response rates in patients treated with placebo plus standard of care (SOC) plus rescue measures. This project compared the impact of different SOC treatments and disease variables on the outcomes of SLE trials. MATERIAL AND METHODS: Data were obtained from 981 patients receiving only SOC treatments in three nephritis and three general SLE trials to compare response and flare rates on the basis of the British Isles Lupus Assessment Group (BILAG) index, a measure common to all trials...
March 2016: European Journal of Rheumatology
https://www.readbyqxmd.com/read/27704496/myasthenia-gravis
#10
Daniel B Drachman
The basic abnormality in myasthenia gravis (MG) is a reduction in acetylcholine receptors (AChRs) at neuromuscular junctions due to the effects of autoantibodies that are directed against the AChRs in most patients, or against neighboring proteins involved in the clustering of AChRs (MuSK, LRP-4, or agrin). Clinically, MG is characterized by muscle weakness and fatigue, often in typical patterns. The diagnosis may be missed early, and depends on the recognition of clinical manifestations, the measurement of autoantibodies, and/or electrophysiological features...
October 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27687621/ofatumumab-in-two-pediatric-nephrotic-syndrome-patients-allergic-to-rituximab
#11
Marina Vivarelli, Manuela Colucci, Alice Bonanni, Martina Verzani, Jessica Serafinelli, Francesco Emma, Gianmarco Ghiggeri
BACKGROUND: Rituximab, a chimeric anti-CD20 monoclonal antibody, is an effective treatment in steroid-dependent nephrotic syndrome (SDNS). However, some patients develop adverse reactions. CASE-DIAGNOSIS/TREATMENT: Patient 1, a 14-year-old boy with SDNS since the age of 2, was treated with oral prednisone, cyclosporine A (CsA) and mycophenolate mofetil. A first infusion of rituximab at age 12 years was well tolerated, but this was followed by a prolonged relapse unresponsive to oral prednisone, mycophenolate mofetil and CsA...
September 29, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/27680225/a-case-of-intravenous-immunoglobulin-dependent-chronic-inflammatory-demyelinating-polyneuropathy-of-pure-motor-form-responsive-to-mycophenolate-mofetil-therapy
#12
Motomi Arai
This report concerns a case of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with frequent treatment-dependent relapses. A 75-year-old male presented with a 2-month history of progressive weakness of the limbs with no sensory symptoms. Neurological examination revealed normal cranial nerves, MRC grade 4 power in the proximal and distal muscles of the limbs, and generalized areflexia. However, the sensory examination results, serum immunoelectrophoresis, anti-HIV antibody, and vitamins B1 and B12 levels were normal...
October 28, 2016: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/27667489/-neuropsychiatric-systemic-lupus-erythematosus
#13
Yoshiya Tanaka
Central nervous system damage, a major organ manifestation of systemic lupus erythematosus (SLE), causes significant morbidity and mortality. Designating this condition as neuropsychiatric SLE (NPSLE), the American College of Rheumatology defines it as involving the central and peripheral nervous systems and being characterized by various manifestations including stroke, seizures, and psychosis. NPSLE treatment mainly seeks to reduce damage accrual. In patients with NPSLE, the use of high-dose corticosteroids is recommended in combination with immunosuppressants, such as mycophenolate mofetil and intravenous cyclophosphamide pulse therapy...
September 2016: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/27661067/combined-use-of-rituximab-and-intravenous-immunoglobulin-for-severe-autoimmune-cicatricial-conjunctivitis-an-interventional-case-series
#14
Bernhard Steger, Savitha Madhusudan, Stephen B Kaye, Amira Stylianides, Vito Romano, Sundas E Maqsood, Janice Harper, Sajjad Ahmad
PURPOSE: Despite the availability of systemic immunosuppressants, cicatricial conjunctivitis (CC) remains a potentially blinding ocular surface disease. We aim to describe the combined use of rituximab (RTX) and intravenous immunoglobulin (IVIg) for severe recalcitrant autoimmune CC. METHODS: In this single-center retrospective interventional case series with follow-up between 32 and 65 months, 3 cases with mucous membrane pemphigoid (patients 1-3) and 1 case with linear IgA disease (patient 4) were included...
September 21, 2016: Cornea
https://www.readbyqxmd.com/read/27623619/treatment-with-high-dose-recombinant-human-hyaluronidase-facilitated-subcutaneous-immune-globulins-in-patients-with-juvenile-dermatomyositis-who-are-intolerant-to-intravenous-immune-globulins-a-report-of-5-cases
#15
Fabian Speth, Johannes-Peter Haas, Claas H Hinze
BACKGROUND: High-dose intravenous immune globulins (IVIg) are frequently used in refractory juvenile dermatomyositis (JDM) but are often poorly tolerated. High-dose recombinant human hyaluronidase-facilitated subcutaneous immune globulins (fSCIg) allow the administration of much higher doses of immune globulins than conventional subcutaneous immune globulin therapy and may be an alternative to IVIg. The safety and efficacy of fSCIg therapy in JDM is unknown. CASE PRESENTATION: In this retrospective case series, five patients with steroid-refractory severe JDM were treated with high-dose fSCIg due to IVIg adverse effects (severe headaches, nausea, vomiting, difficult venous access)...
2016: Pediatric Rheumatology Online Journal
https://www.readbyqxmd.com/read/27591329/moderator-s-view-the-use-of-calcineurin-inhibitors-in-the-treatment-of-lupus-nephritis
#16
Andreas Kronbichler, Irmgard Neumann, Gert Mayer
Lupus nephritis (LN) is one of the most severe manifestations of systemic lupus erythematosus (SLE), affecting ∼50% of patients, and both renal disease and treatment-related toxicity contribute to significant morbidity and mortality. Although our understanding of the aetiopathogenesis of LN is improving, treatment still remains a challenge, with the achievement of complete remission at 1 year in <50% of patients treated with current standard of care immunosuppressive therapy; this is associated with considerable short- and long-term side effects, some of which further contribute to non-adherence...
October 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27591327/pro-the-use-of-calcineurin-inhibitors-in-the-treatment-of-lupus-nephritis
#17
Chi Chiu Mok
Renal disease in systemic lupus erythematosus (SLE) carries significant morbidity and mortality. Cyclophosphamide (CYC)- and mycophenolate mofetil (MMF)-based induction regimens are not ideal in terms of efficacy and toxicity. The adverse effects of CYC, such as infection risk, infertility, urotoxicity and oncogenicity, limit its use in lupus nephritis. Although MMF is non-inferior to CYC as induction therapy and has reduced gonadal toxicity and oncogenic potential, meta-analyses of clinical trials do not show a lower rate of infective and gastrointestinal complications...
October 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27576953/cerebral-toxoplasmosis-in-a-patient-with-myasthenia-gravis-and-thymoma-with-immunodeficiency-good-s-syndrome-a-case-report
#18
Sarah C Sasson, Sarah Davies, Raymond Chan, Leo Davies, Roger Garsia
BACKGROUND: Patients with thymoma with immunodeficiency (TWI)/Good's syndrome characteristically have evidence of combined immunodeficiency including low or absent B-cells, hypogammaglobulinemia and defects in T-cell mediated immunity. These patients can present with common or opportunistic infections. CASE PRESENTATION: A 54-year-old female was diagnosed with cerebral toxoplasmosis. This occurred on a background of metastatic thymoma previously treated with chemotherapy and myasthenia gravis (MG) treated with mycophenolate mofetil, monthly intravenous immunoglobulin (IVIG) and pyridostigmine...
2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27554644/successful-anti-hcv-therapy-of-a-former-intravenous-drug-user-with-sofosbuvir-and-daclatasvir-in-a-peritranspant-setting-a-case-report
#19
Leon Louis Seifert, Hauke Heinzow, Iyad Kabar, Stefan Christensen, Anna Hüsing, Hartmut H-J Schmidt
BACKGROUND Direct-acting antivirals (DAAs) represent a new hallmark in antiviral therapy of hepatitis C virus (HCV). DAAs have been shown to be safe and effective after liver transplantation (LT), but there is little information about their use in peritransplant settings. Former intravenous drug users represent an increasing group seeking HCV treatment. This case report demonstrates the successful peritransplant antiviral treatment of a former intravenous drug user who had been treated in a methadone maintenance program...
August 24, 2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27536670/lupus-nephritis-in-asia-clinical-features-and-management
#20
REVIEW
Desmond Y H Yap, Tak Mao Chan
BACKGROUND: Lupus nephritis (LN) is a common and severe organ involvement manifesting itself in systemic lupus erythematosus (SLE). There is a considerable difference in prevalence, severity, treatment response and outcomes between Asian LN patients and LN patients from other racial backgrounds. SUMMARY: Asian SLE patients have a higher prevalence of LN than Caucasian SLE patients and often present with a more severe disease. Increasing data from genetic studies, accompanied by progress in high-throughput genotyping, have advanced our knowledge about genetic predispositions that might partly contribute to the clinical variations observed...
September 2015: Kidney Diseases
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