High Dose Of Intravenous Steroids Research Articles

Anti-Ma2 Antibody-Mediated Paraneoplastic Cerebellar Degeneration and Myeloneuropathy Secondary to Lymphoma.

A 61-year-old woman with a history of untreated low-grade B-cell lymphoma presented with blurry vision, unsteadiness, and worsening pain on touching skin of the upper trunk was enrolled. Blurry vision was attributed to oscillopsia from downbeat nystagmus, which later evolved into macrosaccadic oscillations. MRI brain and spine showed mild, longitudinally extensive T2 hyperintensity in the central gray matter of the spinal cord extending from the medulla to T11 level. Serum paraneoplastic panel was negative; however, she had very high titers of anti-Ma2 antibodies in cerebrospinal fluid. The diagnosis of paraneoplastic neurological syndrome was made. Empiric treatment with high dose of intravenous steroids followed by intravenous immunoglobulin infusions did not improve her symptoms. An extensive search for an underlying tumor commenced and was initially unrevealing. However, two-month follow-up positron emission tomography scan showed increased uptake in a right pulmonary nodule, which when biopsied confirmed diagnosis of extranodal marginal zone lymphoma. The final diagnosis was anti-Ma2 antibody-mediated paraneoplastic cerebellar degeneration and myeloneuropathy secondary to lymphoma.

A 50-Year-Old Male Patient with Toxic Epidermal Necrolysis (TEN) and Diabetes Mellitus Type 2: A Case Report

A 50-Year-Old Male Patient with Toxic Epidermal Necrolysis (TEN) and Diabetes Mellitus Type 2: A Case Report

Analysis of Corticosteroids in Immune Checkpoint Inhibitors (ICI) Induced Myocarditis- A Systematic Review of 352 Screened Articles

Introduction Immune Checkpoint Inhibitors (ICI) are used as a single agent or as a combination therapies for early or late-stage malignancies. The common malignancies that ICI targets include the following: melanoma, lung cancer, renal cell carcinoma, and hematological malignancies such as Hodgkin’s lymphoma. ICI use is associated with many immune-related adverse events, and ICI-induced myocarditis is one of the rare and most severe AE with a high mortality rate. There are no consensus evidence-based treatment guideline; the expert recommendation is to use high-dose steroids. We aim in this review to assess the effectiveness of steroids in treating ICI-induced myocarditis. Methods We searched the following database Pubmed, Scopus, Cinahl, and Google Scholar, using the following keywords: ICI-induced myocarditis, treatment, steroid. We included articles in the English language, case reports, case series, and published in the last five years. Results 352 articles were screened using PRISMA guidelines. After excluding the articles that were duplicate, irrelevant, and did not meet inclusion criteria, 35 articles with a total number of 50 patients were included. All patients treated with ICI either as a single or combination regimen. The onset of symptoms post initiation varied from one day to a year. 46 out of the 50 cases received high doses of Intravenous steroids as a loading dose followed by an oral or intravenous maintenance dose. Out of 50 patients 14 patients (28%) died but 34 (68%) patients survived, and 2 (4%) patients data were not available. The mean age of the patients was 66.31 ± 14.071 (range 23-88 years), 29 were male (58%), 21 were female (42%). Most of the cases were from the USA (42%), followed by Australia (20%), Japan (14%), Germany, France, and China (4%), Switzerland, Canada, and Spain (2%), and for (6%) cases. A total of 23 patients had cardiovascular comorbidities (46%), which were HTN (14 patients, 60.87%), hyperlipidemia (5 patients, 21.73%), and less than 1% of patients had myocardial ischemia, congestive heart failure, atrial fibrillation, and peripheral vascular disease. While 26 patients (52%) had normal basal cardiac status. Conclusion Our results showed that high doses of steroids were effective in controlling cardiac myocyte inflammation and mortality by 28%. Race was not included in the analysis as it was not reported. More in depth studies are needed to provide a broader representation of steroids in myocarditis.

Traumatic optic neuropathy-associated progressive thinning of the retinal nerve fiber layer and ganglion cell complex: two case reports

BackgroundTraumatic optic neuropathy (TON) is a form of optic nerve injury that occurs secondary to trauma and is etiologically associated with acute axonal loss with severe vision loss. Here, we reported longitudinal changes in the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) using wide-field swept source optical coherence tomography (SS-OCT) in two cases of TON and identified the source of the damage.Case presentation(Case 1) A 65-year-old man was admitted to the hospital due to an injury in the right eye (OD) and was subsequently diagnosed with indirect TON. He was then treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 day, 2 days, 1 week, 1 month, and 4 months. The wide-field deviation map detected thinning earlier in the macular GCC than in the peripapillary RNFL. (Case 2) A 63-year-old man was admitted to the hospital with a fractured left maxilla-zygomatic complex attributed to blunt-force trauma to the head and loss of vision in his left eye (OS). He was diagnosed with indirect TON and treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 week, 2 weeks, 2 months 5 months, and 7 months. The wide-field deviation map detected thinning earlier in the peripapillary RNFL than in the macular GCC.ConclusionsWide-field SS-OCT facilitated the identification of various sequential progression patterns in patients with TON. Furthermore, the area in which the structural damage was first detected was seen differently in the peripapillary and macular deviation maps for each case. Thus, wide-field imaging, which includes the macular and peripapillary areas, are useful in monitoring TON.

Hydrocodone Snorting Leading to Hypersensitivity Pneumonitis

We present a case of hypersensitivity pneumonitis caused by intranasal abuse of the prescription narcotic hydrocodone. The patient's clinical course was complicated by acute respiratory failure. A chest radiograph showed diffuse bilateral opacities. The patient was treated with noninvasive ventilation, a high dose of intravenous steroids, and bronchodilators, resulting in improvement of symptoms and radiographic appearance.

POSTERIOR REVERSIBLE LEUKOENCEPHALOPATHY SYNDROME IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Posterior reversible leukoencephalopathy syndrome (PRES) is associated with severe neurological symptoms (headache, altered mental status, cortical blindness, focal neurological deficits, vomiting) and reversible changes on neuroimaging due to cerebral edema. Posterior reversible encephalopathy syndrome is mainly associated with hypertension, eclampsia, renal failure and/or use of immunosuppressive drugs. We present a literature review and a case report of PRES in a patients with systemic lupus erythematosus (SLE). The clinical symptoms and neuroimaging features were not specific. The peculiar role of SLE in the PRES development is not clear, since hypertension, renal diseases, immunosuppressive therapy and|or early management with high doses of intravenous steroids may facilitate PRES occurrence.

Traumatic optic neuropathy: To treat or not to treat? Report of two cases

Case reportsWe present two cases of blunt ocular trauma with clinical findings and complementary tests compatible with traumatic optic neuropathy (TON), and progression to sectorial optic atrophy. DiscussionTON has an essentially clinical diagnosis, and in the last few years has been treated with high doses of intravenous steroids, based on weak evidence of the benefit of the steroids in cases of medular trauma. Nevertheless, subsequent studies have concluded that there is a relatively high proportion of cases in all series with spontaneous visual recovery, and there was no convincing evidence of a benefit of steroids compared to observation only.

Neuropatía óptica traumática: ¿tratar o no tratar? A propósito de dos casos

Case reportsWe present two cases of blunt ocular trauma with clinical findings and complementary tests compatible with traumatic optic neuropathy (TON), and progression to sectorial optic atrophy. DiscussionTON have an essentially clinical diagnosis, and in the last few years has been treated with high doses of intravenous steroids, based on weak evidence of the benefit of the steroids in cases of medular trauma. Nevertheless, subsequent studies have concluded that there is a relatively high proportion of cases in all series with spontaneous visual recovery, and there was no convincing evidence of a benefit of steroids compared to observation only.

Blindness caused by retrobulbar hemorrhage (orbital compartment syndrome)

In the author's department, 5 patients developed retrobulbar hemorrhage from the 199 patients with midface fractures, between August 2007 and March 2010 (2.5%). 4 of these patients became irreversibly blind on the affected eye. With timely treatment, one patient avoided blindness. The author presents a retrospective analysis of the patients from different departments with midface/orbital fractures and blindness. Bleeding and oedema behind the eyeball due to midface/orbital fractures in the relatively non-expandable orbit results a quick elevation of orbital pressure and consequently diminished circulation, ischemia, and later necrosis of the optic nerve (orbital compartment syndrome) with irreversible blindness. Immediate medical (high dose of intravenous steroids, mannitol, acetazolamide) and surgical intervention (lateral canthotomy, cantholysis, orbitotomy) on noticing the signs (proptosis, ecchymosis, ophthalmoplegia, mydriasis) and symptoms (pain, diplopia, decreased visual acuity, blindness), of a retrobulbar hemorrhage could theoretically give a chance to save the affected eye. Treatment started beyond 20 minutes of onset of blindness, might not revert the vision. Unfortunately, the description and treatment of the retrobulbar hemorrhage and the orbital compartment syndrome is not within the curriculum of the medical university, thus young colleagues could have vague idea about the diagnosis, the urgency and the treatment - as shown in these cases. With the introduction of these cases the author would like to highlight the signs, symptoms and necessary treatment. Knowledge of the disease could also increase the detected number of retrobulbar hemorrhages, which might be less rare than we think. Including the disease into the medical curriculum and postgraduate trainings could help to reduce the number of sad cases in the future.

Surgical management of sialorrhoea: A review and outcome report from Red Cross Hospital, Cape Town

Aim. To review the surgical management of sialorrhoea (submandibular duct transposition with or without bilateral excision of the sublingual salivary glands: the ‘drooling procedure\', DP) at Red Cross War Memorial Children\'s Hospital, Cape Town. Patients and methods. A retrospective review of the medical records of patients who had undergone a DP between 1996 and 2003, to ascertain the results of the procedure and complications. Subsequently a questionnaire was sent to all patients with a recognisable postal address to ascertain long-term satisfaction with the procedure. Results. Forty-six patients had had a DP, and 32 of the medical records were available for analysis. In 23 cases a comment had been recorded on the result of the procedure; 18 (78%) had shown ‘marked\' improvement and 5 (22%) ‘a little\' improvement. The medical records indicated that 2 patients had had immediate postoperative problems: one patient was slow to commence oral feeding and another required a single high dose of intravenous steroids to resolve marked oedema of the floor of the mouth. In the longer term, one patient developed a ranula (a mucus inclusion cyst). Ten postal questionnaires, were returned; of these 8 reported an improvement in the symptoms. Discussion. Short-term improvement was recorded in 78% of patients, and although only 10 questionnaires were returned, 8 of these indicated satisfaction with the procedure. It is impossible to draw conclusions, however, as the large number of patients (36 of the original 46) lost to follow-up could have had a poor outcome. There is need for prospective studies on the long-term outcome of the DP. South African Journal of Child Health Vol. 2 (2) 2008: pp. 46-49

An autopsy case of acute multiple sclerosis (Marburg's type) during pregnancy

We report a case of a 9-month pregnant woman who presented acute psychiatric and neurological symptoms with extensive involvement of the white matter on MRI and no oligoclonal bands on CSF examination. Despite high doses of intravenous steroids, plasmapheresis and immunosuppressive drugs, a fatal outcome (coma) was noted 8 months later. Neuropathological examination confirmed the diagnosis of Marburg's type of multiple sclerosis showing sharp-edged lesions of demyelination, giant astrocytes, numerous macrophages and little perivascular inflammation. We discuss the definition and limits of the Marburg entity with reference to acute disseminated encephalomyelitis, impact of pregnancy, unusual MRI features, neuropathology and treatment.

METHANOL‐INDUCED OPTIC NEUROPATHY: TREATMENT WITH INTRAVENOUS HIGH DOSE STEROIDS

SUMMARYThe aim of this study was to find the potential benefit of intravenous high dose steroids in the treatment of patients with methanol optic neuropathy. Four patients complaining of diminution of vision after taking methylated spirit presented to us within a variable period of its consumption. The systemic features of methanol poisoning were absent in these patients. Raised blood levels of methanol confirmed the diagnosis of methanol optic neuropathy. All these patients received high doses of intravenous steroids for three days, followed by oral steroids, 1 mg/kg body weight, for 11 days. The administration of high doses of intravenous steroids led to an improvement of visual status in all four patients. Intravenous high dose steroids benefit the visual status of patients with methanol‐induced optic neuropathy, provided the interval between the consumption of methanol and starting treatment is short. Further studies should be undertaken to document the role of intravenous steroids in this context.

Systemic lupus erythematosus: A cause of “medical peritonitis”

In two patients with systemic lupus erythematosus, an acute lupus crisis developed with multisystem involvement that included peritonitis. Paracentesis was performed and the fluid obtained was sterile and serous. In one patient the antinuclear antibody test performed on the paracentesis fluid showed 4+ peripheral staining. The clinical impression that these episodes represented lupus activity was supported by the results of paracenteses. Laparotomy was not performed and the patients were treated with high doses of intravenous steroids and antibiotics with a favorable response. Frequent abdominal examinations and follow-up gastrointestinal series did not disclose ulceration and/or perforation which may have been masked by the steroids. Paracentesis is recommended as a useful method of distinguishing perforation from peritonitis in patients with systemic lupus erythematosus presenting with an acute abdomen.