Discontinuation Of Prednisolone Research Articles

A case of AZOOR under immunomodulatory treatment.

To describe the clinical course and treatment response of a case of Acute Zonal Occult Outer Retinopathy (AZOOR). This is an observational case report. The examinations included ophthalmic examination, longitudinal multimodal imaging, visual field testing, electrophysiological recordings, serologic analyses and whole genome sequencing. In this report, the authors present the case of an otherwise healthy 33-year-old female with bilateral AZOOR manifestation. Other possible causes of the observed retinal lesions were ruled out by extensive diagnostic work-up. Treatment with oral prednisolone therapy led to temporal disease control but progression was observed after prednisolone discontinuation. A tapered oral prednisolone therapy in combination with adalimumab initiation prevented further progression for at least 21 months. Diagnosis of AZOOR is frequently complicated by the unspecific symptoms of the disease and significant number of differential diagnoses. Complete diagnostic work-up is important to rule out other etiologies. Due to the lack of randomized controlled trials, therapeutic decisions obligatorily rely on empiric treatment decisions in combination with frequent follow-up examinations.

The effect of prednisolone and a short-term prednisolone discontinuation for the diagnostic accuracy of FDG-PET/CT in polymyalgia rheumatica—a prospective study of 101 patients

Purpose2-[18F]Fluoro-2-deoxy-D-glucose (FDG)–positron emission tomography (PET)/computed tomography (CT) has been suggested as an imaging modality to diagnose polymyalgia rheumatica (PMR). However, the applicability of FDG-PET/CT remains unclear, especially following glucocorticoid administration. This study aimed to investigate the diagnostic accuracy of FDG-PET/CT before and during prednisolone treatment, as well as following short-term prednisolone discontinuation.MethodsTreatment naïve suspected PMR patients were clinically diagnosed at baseline and subsequently had an FDG-PET/CT performed. Patients diagnosed with PMR were administered prednisolone following the first FDG-PET/CT and had a second FDG-PET/CT performed after 8 weeks of treatment. Subsequently, prednisolone was tapered with short-term discontinuation at week 9 followed by a third FDG-PET/CT at week 10. An FDG-PET/CT classification of PMR/non-PMR was applied, utilizing both the validated Leuven score and a dichotomous PMR score. The final diagnosis was based on clinical follow-up after 1 year.ResultsA total of 68 and 27 patients received a final clinical diagnosis of PMR or non-PMR. A baseline FDG-PET/CT classified the patients as having PMR with a sensitivity/specificity of 86%/63% (Leuven score) and 82%/70% (dichotomous score). Comparing the subgroup of non-PMR with inflammatory diseases to the PMR group demonstrated a specificity of 39%/54% (Leuven/dichotomous score). After 8 weeks of prednisolone treatment, the sensitivity of FDG-PET/CT decreased to 36%/41% (Leuven/dichotomous score), while a short-term prednisolone discontinuation increased the sensitivity to 66%/60%.ConclusionFDG-PET/CT has limited diagnostic accuracy for differentiating PMR from other inflammatory diseases. If FDG-PET/CT is intended for diagnostic purposes, prednisolone should be discontinued to enhance diagnostic accuracy.Trial registrationClinicalTrials.gov (NCT04519580). Registered 17th of August 2020.

CD4 + and CD8 + T-lymphocyte number as predictive marker of relapse after rituximab treatment in childhood-onset refractory nephrotic syndrome.

Rituximab is a promising option for refractory idiopathic nephrotic syndrome. However, no simple predictive markers for relapse after rituximab have been established. To determine such markers, we investigated the relationship between CD4 + and CD8 + cell counts and relapse after rituximab administration. We retrospectively investigated patients with refractory nephrotic syndrome who received rituximab followed by immunosuppressive as maintenance therapy. Patients were divided into no relapse in 2years after rituximab treatment or relapse group. After rituximab treatment, CD4 + /CD8 + cell counts were measured monthly, at prednisolone discontinuation, and at B-lymphocyte recovery. To predict relapse, these cell counts were analyzed using receiver operating characteristic (ROC). Additionally, relapse-free survival was reevaluated based on the result of ROC analysis for 2years. Forty-eight patients (18 in the relapse group) were enrolled. At prednisolone discontinuation (52days after rituximab treatment), the relapse-free group showed significantly lower cell counts than the relapse group (median CD4 + cell count: 686 vs. 942 cells/µL, p = 0.006; CD8 + : 613 vs. 812 cells/µL, p = 0.005). In the ROC analysis, CD4 + cell count > 938 cell/µL and CD8 + cell count > 660 cells/µL could predict relapse in 2years (sensitivity, 56% and 83%; specificity, 87% and 70%). The patient group with both lower CD4 + and CD8 + cell counts showed significantly longer 50% relapse-free survival (1379 vs. 615days, p < 0.001 and 1379 vs. 640days, p < 0.001). Lower CD4 + and CD8 + cell counts in the early phase after rituximab administration may predict a lower risk of relapse.

A pediatric case of infliximab-resistant ulcerative colitis successfully treated using vedolizumab.

Pediatric ulcerative colitis is likely to be more severe than adult ulcerative colitis. Failure to thrive should be considered during therapy. A 10-year-old boy was diagnosed with ulcerative colitis based on his clinical presentation and colonoscopy and biopsy results. The administration of 5-aminosalicylic acid and prednisolone resulted in remission ; however, the symptoms reappeared after the discontinuation of prednisolone. Then, infliximab was administered ; however, the patient was resistant to it and appeared to be dependent on prednisolone. Vedolizumab, a monoclonal antibody against ?4?7 integrin, was administered, which resulted in rapid remission. A steady decrease in prednisolone followed, and remission was maintained even after prednisolone discontinuation. Vedolizumab may be effective in pediatric patients with moderate-to-severe refractory ulcerative colitis. Vedolizumab prevents lymphocytes from binding to MAdCAM-1, which is selectively expressed in the gastrointestinal submucosa, leading to the mitigation of the systemic side effects of immunosuppression, such as infections. In Japan, vedolizumab use is not yet approved for use in children, but its effectiveness and safety in children is expected to be investigated in the future. J. Med. Invest. 70 : 294-297, February, 2023.

Successful Treatment of Cardiac Tamponade with Systemic Lupus Erythematosus using Belimumab and Hydroxychloroquine

Cardiac tamponade with systemic lupus erythematosus (SLE) is a rare but fatal complication. Although cardiac tamponade is typically managed with pericardiocentesis and medication, there is no definitive treatment for this condition. Herein, we report a case of cardiac tamponade with SLE in a 15-year-old girl. The patient had fever, chest pain, and fatigue for 1 month. She was diagnosed with SLE, and hence, prednisolone treatment was initiated. Her symptoms had alleviated on the 4th day of treatment; however, the following day, she was admitted to our hospital with fever and vomiting. The patient did not show chest pain or dyspnea. She developed hypotension, chest pain, and dyspnea the day after admission. She was diagnosed with cardiac tamponade using echocardiography. After pericardiocentesis, she was administered belimumab and hydroxychloroquine following intravenous methylprednisolone pulses and was maintained with complete remission for 2 years after the discontinuation of prednisolone and mycophenolate mofetil. This case highlights the potential for successful treatment of lupus cardiac tamponade with intravenous methylprednisolone pulses followed by administration of belimumab and hydroxychloroquine.

Steroid-Sparing Effect of Tocilizumab and Methotrexate in Patients with Polymyalgia Rheumatica: A Retrospective Cohort Study.

Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by pain and stiffness in the shoulders, hips, and proximal limbs; it usually affects elderly patients. The effectiveness of methotrexate and tocilizumab in PMR treatment has not been extensively studied. Thus, we aimed to assess the steroid-sparing effect of tocilizumab and methotrexate in PMR in clinical practice. Consecutive patients with PMR in our hospitals, who were included in our retrospective cohort, were reviewed between 2005 and 2015 and divided into the following groups according to their treatments: prednisolone or none (prednisolone group), methotrexate ± prednisolone (methotrexate group), or tocilizumab ± prednisolone (tocilizumab group). The prednisolone dose at the last follow-up was compared. A total of 227 patients with an average age of 74 years were enrolled. No difference in baseline characteristics was found among the three groups. The prednisolone dose at the last follow-up was lower (0 vs. 3.0 vs. 3.5 mg/day, p < 0.001) and the prednisolone discontinuation rate was higher (80.0% vs. 28.3% vs. 18.8%, p < 0.0001) in the tocilizumab group than in the prednisolone and methotrexate groups. This study suggested that tocilizumab has a steroid-sparing effect in PMR. Tocilizumab can be an option in the management of PMR. Future studies are warranted to confirm our findings.

Can treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs at the window of opportunity with tight control strategy lead to long-term remission and medications free remission in real-world clinical practice? A cohort study.

The aim of this retrospective study is to compare the results of starting rheumatoid arthritis (RA) treatment with tight control strategy in the window of opportunity and later phases of the disease in real-world clinical practice. In this cohort, 609 RA patients were divided into three groups: (i) very early treatment (VET): ≤ 3months; (ii) early treatment (ET): 3-12months; and (iii) late treatment (LT) > 12months after the onset of the disease. Four levels of remission were defined: (i) sustained remission on treatment, (ii) sustained glucocorticoids free remission, (iii) sustained disease-modifying anti-rheumatic drugs (DMARDs) free remission, and (iv) long-term remission. Outcome was assessed based on the number of patients in sustained or long-term remission and patients with poor joint outcome and systemic involvement. There were no significant differences in the remission rate between the groups. Time to sustained remission in VET group was shorter than ET and LT groups. There were no significant differences in the rate and duration of prednisolone discontinuation in the studied groups. DMARDs were discontinued in VET, ET, and LT groups in 8.7%, 10.2%, and 7% of the patients, respectively. Poor joint outcome occurred in 33.2%, 50.5%, and 59.4% of the patients in the VET, ET, and LT groups, respectively. Remission induction in the first year of the treatment was associated with long-term remission in the VET, ET, and LT groups. Medications free remission in RA is rare, and although treatment with DMARDs within 3months of the onset of the disease can prevent joint damage, it cannot lead to long-term remission and discontinuation of medications. • Medications free remission in rheumatoid arthritis is rare. • Treatment with DMARDs within 3months of the onset of the disease can prevent joint damage, but it cannot lead to long-term remission and discontinuation of medications.

Efficacy of tight control strategy in the treatment of adult-onset Still disease.

Adult-onset Still's disease (AOSD) characterized by a high spiking fever, skin rash, arthritis, and leukocytosis. The aim of the present study was considering the long-term outcomes of patients with AOSD who were treated with tight control strategy with disease modifying anti-rheumatic drugs (DMARDs). Fifty-six patients with AOSD treated with tight control strategy were included. Four levels of remission were defined. Remission on-treatment was defined as the clinical remission, patient global assessment (PGA) ≤ 1, and prednisolone dose ≤ 5mg/day for at least 6months. Remission off-treatment was defined as the clinical remission and PGA ≤ 1 for at least 6months as well as discontinuation of prednisolone, DMARDs, and biologics. Sustained remission on-treatment was defined as the clinical remission, PGA ≤ 1, and prednisolone dose ≤ 5mg/day for ≥ 5years. Sustained remission off-treatment was defined as the clinical remission and PGA ≤ 1 for ≥ 5years as well as discontinuation of prednisolone, DMARDs, and biologics. Throughout a median follow-up of 47months, remission on-treatment and off-treatment were obtained in 94.6% and 44.6% of patients, respectively. Sustained remission on-treatment and off-treatment were obtained in 79.2 and 8.3% of patients, respectively. Glucocorticoids (GCs) and DMARDs were discontinued in 66.1% and 48.2% of the patients, respectively. Apart from the older age of the patients in the on-GCs group, no significant differences were observed between the groups. Our study showed that using DMARDs with tight control strategy at the presentation of AOSD may control disease activity successfully. Key Points • Using DMARDs with tight control strategy at the presentation of adult-onset Still's disease may control disease activity successfully.

The feasible maintenance dose of corticosteroid in Takayasu arteritis in the era of biologic therapy

Objective: Although biologic agents are used in Takayasu arteritis (TAK), corticosteroids are still the mainstay of treatment. This study aimed to investigate the feasible maintenance dose of prednisolone (PSL) in the biologic therapy era. Method: We enrolled 93 patients with TAK who satisfied the criteria of the American College of Rheumatology and visited our department from 2008 to 2018. The clinical characteristics and PSL dose of the patients were retrospectively evaluated. Results: The mean ± sd maintenance dose of PSL was 5.0 ± 3.0 mg/day. In patients having TAK for > 20 years, PSL discontinuation and drug-free status were achieved in 27.2% and 18%, respectively. Although tapering the PSL dose to 10 mg/day was achieved within 12 months, tapering to 5 mg/day required 10 years. Relapse significantly interfered with the PSL dose reduction. The clinical characteristics of patients with relapse included a lower rate of combination therapy using immunosuppressants. Moreover, biologics were used in > 60% of patients with relapse. Tapering of PSL was significantly possible in patients receiving biologics and additional relapse was observed in 6.3% and 50% of patients with and without biologics, respectively. Such PSL-sparing effect enabled the reduction of the median PSL dose from 10 to 5 mg/day. Steroid discontinuation was achieved in some patients. Conclusions: The use of biologics significantly reduced the PSL dose in relapsed patients. A PSL dose of ≤ 5 mg/day is a feasible target for TAK, especially when biologic agents are used. Nevertheless, corticosteroid discontinuation may also be the target in some patients.

Investigations on the expression and relevance of nerve growth factor in dogs with atopic dermatitis

Introduction: Human atopic dermatitis (AD) keratinocytes overexpress nerve growth factor (NGF). Its inhibition, or that of its receptor, reduces itch in a mouse model of AD. In this study, we evaluated the expression of NGF in canine AD and assessed the effect of a caninized anti-NGF monoclonal antibody to delay flares of itch in dogs with natural AD. Methods: We used archived frozen skin biopsies from 6 house dust mite–sensitized atopic dogs after allergen challenge, 4 dogs with spontaneous AD and 1 dog with normal skin. The expression of NGF was evaluated by immunofluorescence. We also conducted a pilot crossover trial with 8 dogs with glucocorticoid-responsive AD. In both phases, the dogs were first treated for 28 days with oral prednisolone at 0.5 mg/kg/d. On the first day of the first phase, they received a saline subcutaneous injection, while on that of the second phase, they were injected with 0.2 mg/kg once of the caninized anti-dog NGF ranevetmab. The primary outcome measure was the time-to-flare, defined as the number of days between that of the last prednisolone administration and the day when the pruritus reached a score of at least 5.5/10, or 8 weeks, whichever came first. Results: In normal canine skin, the highest intensity of NGF staining was in stratum granulosum keratinocytes. After allergen challenge and in atopic canine skin, the NGF expression also extended downward to the upper stratum spinosum. In the pilot trial, the time-to-flare after prednisolone cessation was not significantly different between saline and ranevetmab-treated dogs. Discussion: While NGF is overexpressed in the atopic canine epidermis and after allergen challenge in sensitized dogs, the anti-NGF antibody ranevetmab did not delay pruritus flares after the discontinuation of prednisolone. Further studies are needed to assess if NGF is a relevant contributor for canine atopic itch.

Acute fibrinous and organising pneumonia

Acute fibrinous and organising pneumonia (AFOP) is a rare histological pattern of interstitial lung disease. The authors describe a 60-year-old woman admitted to the hospital for sustained fever, presenting with...

Acute interstitial nephritis after sequential ipilumumab - nivolumab therapy of metastatic melanoma

BackgroundThe anti-Programmed Death receptor 1 (anti-PD-1) antibodies nivolumab and pembrolizumab are new treatments in metastatic melanoma. Immunotherapies are best known to be responsible for thrombotic microangiopathy. However, immune interstitial nephritis has been described in a patient treated by nivolumab and ipilimumab concomitantly, and three cases of granulomatous interstitial nephritis have been reported with ipilimumab monotherapy. We report herein a case of acute interstitial immune nephritis in a patient treated with nivolumab after ipilimumab for pulmonary metastatic melanoma.Case presentationInterstitial nephritis was diagnosed after acute kidney injury following three cycles and was confirmed by kidney biopsy. Kidney injury responded rapidly to prednisolone, which was then gradually reduced. As a follow-up computed tomography scan indicated mixed response, with minimal size progression of a pulmonary nodule, but a significant reduction in the size of the other nodules, nivolumab was reintroduced after renal function improvement. Low-dose corticosteroids were first maintained during nivolumab treatment and subsequently discontinued. Only one month after prednisolone discontinuation, creatinine levels increased. A second kidney biopsy confirmed relapse of acute interstitial nephritis.ConclusionsTo our knowledge, this is the first case of nivolumab-induced acute interstitial immune nephritis. This case highlights that anti-PD-1 immunotherapy may be continued when renal function is adequate, and this requires close interaction between dermatologists and nephrologists. This adverse effect should be made known to prescribers as nivolumab is associated with significant improvement of survival in metastatic melanoma and may be used in many different types of cancer.

Outcome in advanced non-small cell lung cancer patients with successful rechallenge after recovery from epidermal growth factor receptor tyrosine kinase inhibitor-induced interstitial lung disease.

Several non-small cell lung cancer (NSCLC) cases of successful rechallenge with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) after recovery from gefitinib or erlotinib-induced interstitial lung disease (ILD) have been reported, but it is not clear whether the rechallenge affects the outcome. We retrospectively evaluated the difference in the outcome between advanced NCLC patients with active EGFR mutations who received EGFR-TKI rechallenge after recovery from EGFR-TKI-induced ILD and those who did not. EGFR-TKI-induced ILD occurred in 11 (10%) of 110 patients receiving gefitinib, five (7%) of 73 patients receiving erlotinib and one (8%) of 13 patients receiving afatinib. Diffuse alveolar damage pattern ILD was observed in six cases, four of which had chemotherapy-related death. Five of 13 patients who had recovered from ILD received EGFR-TKI rechallenge with concurrent oral administration of prednisolone 0.5mg/kg after the strict informed consent of the risk for the recurrence of severe ILD. All of the five patients achieved a partial response. The median overall survival from the occurrence of EGFR-TKI-induced ILD was longer in patients with EGFR-TKI rechallenge than that in patients without (15.5 vs. 3.5months, p = 0.029). The adverse events of EGFR-TKI rechallenge were tolerable, but one case receiving EGFR-TKI rechallenge with the suspected drug exhibited the recurrence of grade 3 ILD after the discontinuation of prednisolone. EGFR-TKI rechallenge with concurrent prednisolone therapy might be salvage therapy in advanced NSCLC patients with active EGFR mutations after recovery from EGFR-TKI-induced ILD.

A Rare Case of Adult Autoimmune Neutropenia Successfully Treated with Prednisolone

Autoimmune neutropenia (AIN) is a rare disorder that may cause life-threatening infections. In adults, most cases are secondary to other pathological conditions, and primary AIN is extremely rare. We herein report a case involving a 57-year-old woman diagnosed with AIN. A granulocyte immunofluorescence test detected autoantibodies against human neutrophil antigens in her serum, while various examinations revealed no other causes of neutropenia, suggesting her AIN was primary. She was refractory to granulocyte-colony-stimulating factor but responded to prednisolone. Her neutrophil count remained normal after gradual discontinuation of prednisolone. Diagnostic procedures and optimal treatments for this disorder need to be established.

T Lymphocyte Activation Markers as Predictors of Responsiveness to Rituximab among Patients with FSGS.

Rituximab is used with variable success in difficult FSGS. Because B cell depletion significantly affects T cell function, we characterized T cell subsets in patients with FSGS to determine if an immunologic signature predictive of favorable response to rituximab could be identified. Twenty-two consecutive patients with FSGS (median age =14.4 years old; range =6.2-25.0 years old) and age of onset of nephrotic syndrome 1-18 years old receiving rituximab for clinical indications between October of 2009 and February of 2014 were studied. Indications for rituximab were lack of sustained remission despite calcineurin inhibitors (CNIs) and mycophenolate in steroid-resistant patients and lack of steroid-sparing effect with cyclophosphamide and CNI or CNI toxicity in steroid-dependent patients. Exclusion criteria were infantile onset, known genetic mutations, and secondary causes. Rituximab (375 mg/m(2)) was given fortnightly up to a maximum of four doses. Immunologic subset monitoring was performed at baseline and regular intervals until relapse. Median follow-up duration postrituximab was 26.7 months (range =6.5-66.5 months). Baseline immunologic subsets were examined for association with rituximab response defined as resolution of proteinuria with discontinuation of prednisolone and CNI 3 months postrituximab. Twelve patients (54.5%) responded to rituximab. Mitogen-stimulated CD154(+)CD4(+)CD3(+) subset before rituximab was significantly lower in FSGS responders compared with nonresponders (54.9%±28.1% versus 78.9%±16.4%; P=0.03). IFN-γ(+)CD3(+) and IL-2(+)CD3(+) were similarly decreased in responders compared with nonresponders (0.6%±0.8% versus 7.5%±6.1%; P=0.003 and 0.2%±0.5% versus 4.0%±4.7%; P<0.01, respectively). Recovery of all three activation subsets occurred 6 months postrituximab treatment (CD154(+)CD4(+)CD3(+), 74.8%±17.2%; IFN-γ(+)CD3(+), 7.1%±7.7%; and IL-2(+)CD3(+), 7.9%±10.9%; P<0.01). Receiver-operating characteristic analysis using optimal cutoff values showed that activated CD154(+)CD4(+)CD3(+) <83.3% (area under the curve [AUC], 0.81; 95% confidence interval [95% CI], 0.61 to 1.00), IFN-γ(+)CD3(+)<2.5% (AUC, 0.90; 95% CI, 0.75 to 1.00), and IL-2(+)CD3(+)<0.3% (AUC, 0.78; 95% CI, 0.57 to 0.98) were good predictors of rituximab response. We have identified prognostic markers that define a subset of patients with FSGS bearing an immunologic signature representing hyporesponsiveness to T cell stimulation and therefore, who respond better to rituximab.

Effect of Discontinuation of Prednisolone Therapy on Risk of Cardiac Mortality Associated With Worsening Left Ventricular Dysfunction in Cardiac Sarcoidosis

Prednisolone (PSL) therapy is the gold standard treatment in patients with cardiac sarcoidosis (CS). However, clinicians often have difficulty in deciding whether to discontinue PSL therapy in long-term management. Sixty-one consecutive patients with CS were divided into 2 groups based on the discontinuation of PSL during the median follow-up period of 9.9 years. PSL was discontinued in 12 patients because of improvement of clinical findings. There were no significant differences between the 2 groups in age, gender, left ventricular ejection fraction (LVEF), findings of imaging techniques, incidence of fatal arrhythmias and heart failure, and dose of PSL. After discontinuation of PSL, 5 patients had cardiac death, and discontinuation of PSL was significantly associated with higher cardiac mortality compared with continuation (p = 0.035). Although patients with discontinuation had improvement of LVEF after PSL treatment, LVEF decreased after discontinuation of PSL. Furthermore, discontinuation of PSL was associated with greater percent decrease in LVEF compared with continuation (p = 0.037) during the follow-up period. In conclusion, in the long-term management of patients with CS, discontinuation of PSL was associated with poor clinical outcomes and decreased LVEF, suggesting the importance of PSL maintenance therapy.

Bromoderma caused by over‐the‐counter analgesic mimicking pyoderma gangrenosum

A 41-year-old Japanese woman was admitted to the emergency department of our hospital due to a seizure. She had been diagnosed with pyoderma gangrenosum 11 years ago without bone marrow disease, rheumatoid arthritis, or inflammatory bowel disease. Pyoderma with painful ulcers had repeatedly appeared on the arms, legs, face, and pubic arch despite treatment with systemic prednisolone and cyclosporine. She also had frequently complained about syncopal episodes, however, there was no evidence of neurological diseases, including epilepsy and endocrine diseases. On admission, the blood test revealed a negative anion gap, hyperchloremia, and neutrophilic leukocytosis. Since one of the major causes of negative anion gaps with hyperchloremia is bromide intoxication, we measured the serum bromide level and found that it was significantly high at 21 mg/dl. Bromide is not normaly detectable in healthy indivisuals. Furthermore, 296 empty sheets of over-the-counter(O-T-C) analgesic tablets containing bromide (Naronace: O-T-C analgesic in Japan, contain bromovalerylurea 100 mg/ tablet) were found in her house, suggesting that she had bromide intoxication. Repeated syncopal episodes may have been due to this intoxication. These findings forced us to reconsider the diagnosis of pyoderma gangrenosum in this case, because bromide causes the same clinical symptoms as pyoderma. In addition, we realized neutrophilic leukocytosis and hyperchloremia had been associated with exacerbation of the clinical symptoms for 11 years. Therefore, we examined the bromide level of the serum samples collected from the past 10 years and found that the bromide level had been as high as 112.7 mg/dl. In conclusion, we diagnosed this case with bromoderma caused by O-T-C analgesic mimicking pyoderma gangrenosum. After the patient stop taking the analgesic, the pyoderma rapidly disappeared, and the white blood cell count and the serum chloride level returned to normal levels, with no recurrence, even after the discontinuation of prednisolone and cyclosporine.

Prednisolone-Free Renal Transplants With Protocol Biopsies and Long Term Follow Up.

A total of 741 patients, who underwent kidney transplantation since July 2005 till October 2013 were studied. Injection thymoglobulin was used for induction at a dose of 1.5 mg/kg 3 doses in the first 5 days. Injection rituximab 500 mg Intravenous (IV) was given pre-operatively to re-transplants and 200 mg to other high risk recipients. Maintenance immunosuppression was tacrolimus and mycophenolate mofetil (MMF). Steroid was discontinued by day 5. We compared the results in recipients of the prednisolone-free protocol with those of a historical cohort of 139 patients who received a maintenance dose of prednisolone 5 mg once in a day in addition to MMF and tacrolimus. This cohort was transplanted between June 2003 and March 2005. 28% were pre-transplant diabetics. The patients underwent protocol biopsies at 3 months, 1 year and 5 years. Indicated biopsies were done whenever required. The total number of biopsies was 2330. The normal histology was seen in 76.8% patients. Subclinical rejection was seen in 3.1% patients. 14.5% patients experienced acute rejection. The mean serum creatinine at 1, 5 and 8 year in steroid-free patients were 1.2 mg/dl, 1.3 mg/dl and 1.6 mg/dl, respectively. 42 patients died in this period and 27 patients lost the graft. Prednisolone free treatment was continued in 77.7% at 8 years. BK virus was seen in 8 patients (1%). The total death rate was 5.6% for the entire observational period. The actuarial graft and patient survival are shown in following [figure 1] and [figure 2] Rapid discontinuation of prednisolone does not increase acute rejection rate as it was 13.5% in our historical cohort. Prednisolone withdrawal drastically reduced NODAT as it was seen in only 5.7% of patients in comparison to 43% at 2 weeks and 23% thereafter in historical cohort.Figure: No Caption available.

Maintenance of complete remission after allogeneic stem cell transplantation in leukemia patients treated with Wilms tumor 1 peptide vaccine

Maintenance of complete remission after allogeneic stem cell transplantation in leukemia patients treated with Wilms tumor 1 peptide vaccine

AB0592 Decrease of tocilizumab by monitoring serum IL-6 with sustained triple remission in rheumatoid arthritis: 6-star

BackgroundA lower dose of tocilizumab (TCZ) (e.g., 4 mg/kg/month) than the standard 8 mg/kg/month has been shown to be effective for treating rheumatoid arthritis (RA), but not all patients obtain...