Oral Steroid Therapy Research Articles

Reappraisal of Oral Steroid Therapy for Myasthenia Gravis.

Treatment with oral corticosteroids at high doses with an escalation and de-escalation schedule is effective against myasthena gravis (MG). In fact, the use of corticosteroids has led to a reduction in mortality to below 10% after the 1960s. However, long-term use of oral steroids above a certain dosage level is known to cause a number of problems. In 2014, the Japanese clinical guidelines for MG proposed that the first goal in MG treatment (treatment target) should be set at minimal manifestations (MM) with oral prednisolone (PSL) 5 mg/day or below, and that treatment strategies should strive to attain this level as rapidly as possible. In 2015, a multicenter, cross-sectional study revealed that higher PSL dose and longer PSL treatment do not ensure better outcome. In the absence of good response, the PSL dose should be decreased by combining with modalities such as plasma exchange/plasmapheresis and intravenous immunoglobulin (fast-acting treatments). In 2018, we conducted a multicenter, cross-sectional study in a large population of Japanese patients with generalized MG, aiming to elucidate the correlation between oral PSL regimens and achievement of treatment goals. The ORs for low vs. high dose to achieve treatment goals at 1, 2, and 3 years were 10.4, 2.75, and 1.86, respectively, whereas the corresponding ORs for low vs. medium dose were 13.4, 3.99, and 4.92. Early combination with fast-acting therapy (OR 2.19 at 2 years, 2.11 at 3 years) or combination with calcineurin inhibitors (OR 2.09 at 2 years, 2.36 at 3 years) were also positively associated with achieving treatment goals. These results indicate that early combination of low-dose PSL regimens with other therapies is the key for early achievement of treatment goals in generalized MG. However, even with this regimen, ~35% of patients did not achieve the treatment target after 3 years. These results suggest the limitation of the current oral corticosteroid therapy. We need to develop new treatment options to increase the rate of satisfactory outcome.

Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma.Case presentationHere, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced.ConclusionOur case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.

Intradural extramedullary tuberculoma of the spinal cord in patient of tubercular meningitis - an uncommon scenario

Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare and unanticipated manifestation of CNS tuberculosis. A 28 years old female diagnosed case of tubercular meningitis (TBM), already on antitubercular therapy (ATT) for last nine months, developed sensory and motor weakness in lower limbs along with saddle anaesthesia. Magnetic resonance imaging (MRI) with contrast of the spine revealed the presence of multiple space occupying lesions in dorsal spinal cord. She received oral steroid therapy for six weeks with escalation of ATT after which neurological functions improved remarkably.

The dreaded osteonecrosis of femur following chronic steroid therapy: a case series from a dermatologist’s eye

<p>Corticosteroids, undoubtedly, is the saving grace of many patients ailing from a variety of inflammatory and autoimmune dermatoses. But it is not free of side effects, some being crippling enough to subject the patient to huge amounts of morbidity. Here we report a series of cases – Vesiculobullous diseases and Lupus Erythematosus - with prolonged oral steroid therapy that lead to osteopenia and osteonecrosis of the femur.</p>

Unexpected effects of systemic steroids on the CRSwNP proteome: is protein upregulation more important than inhibition?

Oral steroids, traditionally thought of as immunosuppressive agents that are broad in their immunomodulatory effects, are a mainstay of treatment to reduce disease burden in chronic rhinosinusitis with nasal polyps (CRSwNP). The purpose of this study was to determine how differentially expressed proteins in CRSwNP are affected by oral steroid therapy. Matched exosomal proteomic arrays were quantified using aptamer-based methods in systemic steroid-naive CRSwNP patients before and after a standardized oral prednisone course (n = 12). Previously identified differentially expressed proteins in CRSwNP patients were compared to determine the effect of steroids on expression. Fisher's exact test and t test were applied to normalized protein expression profiles to determine significance. Of 18 proteins previously identified to be highly underexpressed in CRSwNP, 16 (89%) had an average increase after systemic steroid treatment (p < 0.05). Lactoperoxidase, initially present at 9-fold lower concentrations in CRSwNP subjects, increased by 209% after steroid treatment. A similar trend was observed with other proteins of interest, including platelet factor 4 and C-C motif ligand 28. The converse of this steroid effect was not true; of the 53 proteins that are highly overexpressed in CRSwNP, only 22 (42%) decreased in quantity with steroid use. Proteomic analysis of differentially expressed proteins in CRSwNP demonstrates that systemic steroids cause almost uniform upregulation of transcriptionally decreased proteins, whereas the effects of steroids on transcriptionally increased proteins are more heterogeneous. Thus, proteomic analysis may be an effective tool to understand specific therapeutic benefits of steroid use in polyp disease and to create more targeted treatments.

Frequency of Pulmonary Tuberculosis in Patients with Cutaneous Diseases taking Oral Steroid Therapy

Objective: to investigate the frequency of pulmonary tuberculosis in patients of cutaneous diseases requiring high dose steroids therapy. Study Design: Cross sectional study Place and duration: Dermatology department of Nishtar Hospital Multan in one year duration from 2nd March 2018 to 2nd March 2019. Methodology: Sixty patients currently diagnosed with skin manifestations and taking high dose steroids were screened for pulmonary tuberculosis. Patients were screened at 6 weeks, 3 months and 6 months. Chest radiograph, sputum smear for acid fast bacilli and sputum culture were performed at every visit. SPSS version 23 was used for analysis of data and test of significance. Results: Sputum smear at 6 weeks, 3 months and 6 months was observed as 1.6%, 3.3% and 6.6%, respectively. Sputum culture at 6 weeks, 3 months and 6 months was observed as 11.6%, 13.3% and 10%, respectively. X-Ray at 6 weeks, 3 months and 6 months was observed as 1.6%, 0% and 0%, respectively. Conclusion: Patients with cutaneous diseases taking systemic steroids should screen for pulmonary diseases at intervals because they can develop pulmonary tuberculosis.

Safety and efficacy of one week oral steroid therapy in the treatment of common eczemas with emphasis on its effect on hypothalamic pituitary adrenal axis: An open label randomized controlled pilot study

Introduction: Oral steroids are not commonly used because of fear of side effects. A study was conducted to find out if a short course of 1 week of oral steroid without tapering is effective and safe for the treatment of common eczemas. Materials and Methods: Patients with common eczemas were included in the study. There were five groups. One group each received tablet prednisolone 15 mg morning and 10 mg after dinner for 7 days, tablet methylprednisolone 16 mg morning and 8 mg night for 7 days, and tablet betamethasone 2 mg morning and 1 mg night for 7 days. One group received tablet betamethasone 3 mg once a day as a single morning dose for 7 days and the last group received tablet deflazacort 18 mg morning and 12 mg night for 7 days only. All the patients also received topical clobetasol propionate cream for 1 month. However, the maximum permissible amount of topical clobetasol propionate was 30 g in a month. Basal serum cortisol at 8 am along with ACTH stimulation test was carried out in all the patients on day 10th. The tests were repeated on 30th day if negative on day 10th. Results: In all groups, rapid improvement was seen at visit 2, which further continued at visit 3. No suppressive effect on hypothalamic–pituitary–adrenal (HPA) axis was seen. Conclusion: A short course of oral steroid of 25 mg of prednisolone equivalent for a period of 7 days was found to be effective and safe, and 7 days of oral steroids do not need tapering.

Pharmacoresistant Atypical Benign Partial Epilepsy of Childhood: Early Introduction of Specific Therapies to Prevent Cognitive Decline

AbstractAtypical benign partial epilepsy (ABPE) of childhood is a special type of epileptic syndrome characterized by the combination of epileptic negative myoclonus, atypical absence seizures, focal motor seizures, and a continuous spike–wave during slow sleep (CSWS). Although the seizures are resistant to antiseizure drugs (ASDs) effective for focal epilepsy, they are markedly responsive to ethosuximide (ESM). An incorrect ASD choice may aggravate the seizures and CSWS, resulting in a pseudo-catastrophic state or nonconvulsive status epilepticus. In this study, we retrospectively investigated the effectiveness of steroid and ketogenic diet (KD) therapies for children with ABPE resistant to ASDs, including ESM. Adrenocorticotropic hormone (ACTH) therapy (n = 4), KD therapy (n = 4), and an oral steroid (n = 2) were tried for eight patients (two patients tried two therapies). An excellent response (seizure-free period &gt; 1 year) was achieved by four out of four patients undergoing ACTH therapy, two out of four undergoing KD therapy, and one out of two receiving oral steroid therapy. In conclusion, steroid and KD therapies are reasonable treatment options early in the course of treatment of children with pharmacoresistant ABPE to prevent a decline in cognitive function due to the persistence of epileptic encephalopathy. The majority of patients in our case series had an excellent response, though further studies are warranted to confirm their efficacy and safety.

Pulsed intravenous methylprednisolone combined with oral steroids as a treatment for poorly responsive type 2 amiodarone-induced thyrotoxicosis.

Amiodarone-induced thyrotoxicosis (AIT) affects up to 3% of treated patients. Type 2 AIT (AIT2) is a destructive thyroiditis and is usually treated with medium-high oral doses of prednisone. As AIT may worsen the underlying heart disease, a rapid control of thyroid function is desirable. We aimed to determine whether a combined intravenous methylprednisolone (IVMP) pulses therapy associated to prednisone in the interpulse period can represent an efficient and safe alternative to urgent total thyroidectomy in patients with AIT2 not responsive to prednisone alone. Patients presenting with a severe AIT2 studied in a tertiary referral Center from August 2018 to April 2019. We included four patients requiring a rapid improvement of thyroid function for their underlying cardiac disorders. The baseline doses of oral prednisone (range: 5-12.5 mg/day) and IVMP (range: 250-500 twice a week) were determined according to the severity of the thyrotoxicosis and were titrated based on clinical response. Combined treatment was effective in all patients in the prompt restoration of euthyroidism and no major adverse events were reported during the follow-up. In all cases, FT4 and FT3 levels normalized at 3-5 weeks of treatment. A permanent hypothyroidism was observed in one patient, 3 months after the discontinuation of treatment. We report for the first time that the combined intravenous and oral steroid therapy is effective in patients with AIT2. The treatment is well tolerated and leads to a rapid improvement of thyroid function, avoiding urgent total thyroidectomy and favoring a quick functional recovery and rehabilitation of cardiac patients.

Budd-Chiari Syndrome Associated With Hypereosinophilic Syndrome Treated by Deceased-Donor Liver Transplantation: A Case Report

IntroductionBudd-Chiari syndrome (BCS) associated with hypereosinophilic syndrome (HES) is very rare, and only a few reports have described its treatment. Furthermore, no report to date has described the performance of liver transplantation for the treatment of BCS associated with HES. We herein describe a 54-year-old man who underwent deceased-donor liver transplantation (DDLT) for treatment of BCS associated with HES. CaseA 54-year-old man was found to have an increased eosinophil count during a medical check-up. After exclusion of hematopoietic neoplastic diseases and secondary eosinophilia, idiopathic hypereosinophilia was diagnosed. Oral prednisolone was administered to the patient, and his eosinophil count immediately decreased to a normal level. He had an uneventful course without complications for 11 months but then presented with bloating and malaise. Imaging studies including ultrasonography, enhanced computed tomography, and angiography revealed BCS associated with HES. Transjugular intrahepatic portosystemic shunt failed because of complete obstruction of the hepatic veins. Therefore, the patient was introduced to our hospital for liver transplantation. DDLT was performed with venovenous bypass 1 month after the patient was placed on the DDLT waiting list. The explanted hepatic veins were completely occluded and organized. The patient’s eosinophil count was maintained at a normal level with prednisolone treatment after DDLT. ConclusionsLiver transplantation can be a treatment option for BCS associated with HES if neoplastic diseases and secondary eosinophilia have been excluded. Life-long oral steroid therapy is required to control HES even after liver transplantation.

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34. An unusual presentation of a cervical mass

Effect of Intratympanic Dexamethasone in Idiopathic Sudden Sensorineural Hearing Loss

Introduction&#x0D; Oral steroids currently represent the standard treatment for idiopathic sudden sensorineural hearing loss The aim of this study is to assess the effectiveness of intratympanic dexamethasone injection for treating ‘Idiopathic sudden sensori-neural hearing loss’ (ISSNHL) not improved with conventional oral steroid.&#x0D; Materials and Methods&#x0D; A prospective study was conducted on 30 patients refractory to oral steroid therapy between June 2017 to May 2018. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment.&#x0D; Results&#x0D; Hearing improvement was found in 19 out of the 30 cases (63.3%).&#x0D; &#x0D; Conclusions&#x0D; Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment.

MON-028 PATHOLOGICALLY PROVEN COMPLETE CURE OF IDIOPATHIC MEMBRANOUS GLOMERULONEPHRITIS BY METHYLPREDNISOLONE PULSE THERAPY

MGN is the second most common cause of nephrotic syndrome in adults, with FSGS recently becoming the most common, however there is no cure for idiopathic MGN and treatment focus on conservative methods such as salt restriction, blood thinning agents, ARB etc. Sometimes corticosteroids, cyclophosphamide, chlorambucil, cyclosporine-A, tacrolimus, MMF, Rituximab etc are tried with mixed results. Recently we have tried methylprednisolone pulse therapy in 7 cases and follow up renal biopsy were performed after 1 year of therapy. Age distribution from 1 to 61 (mean37) year old. Methylprednisolone pulse were tried by Cho’s method (Andreucci; New Therap Strat Nephrol, Kluwer Acad.Pub 1990). One cycle of MP pulse consist of methylprednisolone 20-30mg/kg (max1,000mg)/day mixed at 250ml amino acids solution for 3 consecutive days at 2 weeks interval. We tried 10 cycles. Between pulse therapy we tried deflazacort 0.5mg/kg/day and ARB were given every day. All 7 cases showed complete response clinically and complete dissolution of subepithelial deposits although sclerotic lesions were persisted pathologically. Two pediatric cases ages 1 and 7 showed completely cured clinically and pathologically. No major side effects were noted except one case developed cataract although minor side effects such as moon face, mild abdominal striae were noted. No relapses during 3 years follow up. In conclusion, further studies are needed. However methylprednisolone pulse therapy might be a promising initial treatment method in idiopathic MGN without noticeable side effects before considering secondary drugs such as alkylating agents, calcineurin inhibitors, Rituximab etc. Follow up renal biopsy is mandatory when deciding to stop oral steroid therapy.

A retrospective longitudinal study on the effect of ultra short course of steroid therapy on clinical and hematologic parameters of secondary hemophagocytic lymphohistiocytosis in children

Background: The aim was to study the effect of ultra-short course of injectable steroid followed by oral steroid therapy for cumulative 14 days on clinical and hematologic parameters of secondary hemophagocytic lymphohistiocytosis in children.Method: A retrospective longitudinal study was conducted by collecting data from case records. Cases diagnosed with secondary hemophagocytic lymphohistiocytosis had been included. The cases with malignancy were excluded. Remaining cases had been given injectable methyprednisolone (30 mg/kg/day) for three days followed by oral prednisolone (1 mg/kg/day) for 11 days. The time to cessation of fever and organomegaly were noted. The changes in mean hematologic parameters, ferritin and triglycerides were noted at the time of suspicion of HLH or MAS, after therapy and on follow up.Results: About 96% of children were afebrile within five days of therapy. There was regression of hepatospleenomegaly in all 100% surviving children by day seven of therapy. Improvement in hemoglobin (mean value 8.1 mg/dl to 8.7 mg/dl) and platelet count (mean value 0.89 lakh to 1.47 lakh) was seen by day seven of therapy. Fall in serum ferritn (mean value 1419 ng/ml to 298 ng/ml) and serum triglycerides (mean value 307 mg/dl to 176 mg/dl) was seen at one-month follow-up. 96% survival was observed. None of the survivors had any recurrence at 6 months follow up.Conclusion: Ultra short course of injectable methyprednisolone for 3 days followed by oral prednisolone for 11 days was successful in 95% survival in our study. This cost-effective regimen, with use of less toxic drugs leading to a shorter hospital stay maybe helpful in resource limited settings.

Improvement or Recovery From Sudden Sensorineural Hearing Loss With Steroid Therapy Does Not Preclude the Need for MRI to Rule Out Vestibular Schwannoma.

There is a common misconception that improvement in sudden sensorineural hearing loss (SSNHL) after treatment with steroid therapy effectively excludes the diagnosis of a vestibular schwannoma (VS) and such cases do not warrant an MRI. Paralleling this, steroids are commonly withheld for SSNHL in patients with an existing diagnosis of VS, believing that this condition is not steroid-responsive. This study seeks to underscore that improvement or recovery of SSNHL with steroid therapy does not exclude the diagnosis of VS and does not preclude the need for magnetic resonance imaging. A retrospective chart review was performed (2002-2017) of patients with previously untreated sporadic VS who developed SSNHL that improved after steroid treatment. A clinically significant audiometric improvement was defined as an increase of more than or equal to 15% in word recognition score (WRS) and/or decrease of more than or equal to 15 dB in 4-frequency pure-tone average (PTA). To supplement these data, a separate population of patients with incomplete or missing audiometric data, who reported unequivocal subjective improvement in hearing after steroid treatment, were also described to reinforce the study objective. Patient demographics, tumor characteristics, steroid regimen, and data regarding treatment response were recorded. A total of 29 patients (55% women; median age of 47 yr) met inclusion criteria. Fourteen (48%) cases had objective audiometric documentation of SSNHL, while 15 (52%) had either subjective report only or incomplete audiometric data available. Eighteen (62%) had a single event, while 11 (38%) had more than one episode of SSNHL that was treated with steroids. For all patients, the median time between SSNHL and diagnosis of VS was 1.3 months (range, 0.13-148.4 mo). At the time of diagnosis, 15 tumors were purely intracanalicular, while 15 tumors had cerebellopontine angle extension. Of the latter, the median cisternal tumor size was 15.9 mm (range, 5.3-33). Twenty-six (90%) cases received oral steroid therapy alone, two (9%) had intratympanic steroid therapy alone, and one (3%) required combination therapy. The median PTA improvement with steroid therapy was 21 dB HL (range, -10-101.2) and the median WRS improvement was 40% (range, 4-100%). A therapeutic response to steroid therapy for SSNHL does not exclude the diagnosis of VS. All patients with SSNHL should undergo appropriate diagnostic imaging to prevent delays in diagnosis and potential treatment.

Chirurgie de la cataracte uvéitique non infectieuse de l’enfant : bilan des pratiques actuelles en France

To evaluate the medical-surgical management of cataract surgery in children with chronic uveitis in various French pediatric ophthalmology centers. Two-part study: first, a descriptive observational segment on the evaluation of French practices. A questionnaire was sent to the various pediatric ophthalmologists in France. A second retrospective chart review, including children with non-infectious chronic uveitis who had cataract surgery in the pediatric ophthalmology department of Bordeaux University Hospital from 2008 to 2017. Twenty-one ophthalmologists responded to the questionnaire. Only 23.8% systematically initiated immunosuppressive drugs (aside from corticosteroids) before surgery. A total of 88.2% prescribed oral corticosteroid treatment preoperatively. Eleven surgeons administered intravenous corticosteroid boluses during the surgery, and primary lens implantation is the most common method used in 95.2%. A total of 76.2% initiated oral steroid therapy after surgery. Postoperatively, all surgeons started local therapy with high-dose corticosteroids. At one year, 100% achieved improvement of visual acuity greater than or equal to 2 lines. On our service, 10 eyes (7 children) underwent cataract surgery. Seven were treated with systemic immunosuppressive drugs (aside from corticosteroids) and 80% of cases received oral corticosteroid therapy a few days before surgery. An intravenous corticosteroid bolus was administered preoperatively in 8 cases, and primary lens implantation was performed in 100% of cases. Postoperatively, 5 children received oral corticosteroid treatment. All were treated with local high dose steroids. At one year, the mean best-corrected visual acuity was 0.18 LogMar (0-0.7, SD: 0.25). When performed with an aggressive anti-inflammatory protocol, cataract surgery leads to a good visual outcome in selected children with chronic uveitis.

Abstract P3-14-10: Intralesional steroid injection: A novel method to treat the symptoms of idiopathic granulomatous mastitis

Abstract Background: Idiopathic granulomatous mastitis (IGM) is a chronic, inflammatory breast condition of benign nature that can clinically mimic breast cancer. Patients frequently present with a large, painful breast mass with associated inflammatory changes of the skin, and possible ulceration or fistula of the breast. Attempted methods for symptomatic relief include surgical excision and medical therapies including oral corticosteroids. Due to the success of treating dermatologic conditions with intralesional steroid injections, it was hypothesized that injecting the subdermal lesions of IGM may benefit patients with this disease. The use of intralesional steroid injections for the treatment of IGM has not been previously described in the literature. Methods: Retrospective chart review was performed on a series of four patients with IGM who received intralesional steroid injections between August 2017 and April 2018. Patients were selected for treatment with injections based on their subjective report of painful breast lesions, lesion characteristics including size and depth, and the patient's desire to stop oral steroid therapy due to side effects despite active or residual disease. Data were collected on demographics, initial physical examination findings, prior and current treatments, characteristics of disease, details of injections performed, objective and subjective response to treatment, and recurrence. Results: All patients presented with breast pain and either a mass, swelling, or hardness of the breast. Each patient received between one and three injection treatments, with one to four lesions treated in each session. Patients demonstrated improvement in subjective and objective symptoms after 87.5% of injection sessions (7 out of 8) by the subsequent follow-up visit (21-34 days). During the study period, three patients experienced resolution of at least one breast lesion within about 2 months (31-139 days, mean 68 days) without recurrence. One patient had four breast lesions that completely resolved (35-217 days, mean 88 days), but three of them recurred (63-217 days, mean 149 days). Conclusion: In a small group of patients with idiopathic granulomatous mastitis, intralesional steroid injections were associated with an improvement in both subjective symptomatic relief and objective breast lesion characteristics in most cases. This treatment was associated with a good rate of lesion resolution and a low short-term recurrence rate. Citation Format: Manst DJ, Ganschow PS, Marcus EA, Holden C, Datta S. Intralesional steroid injection: A novel method to treat the symptoms of idiopathic granulomatous mastitis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-10.

Profil Penderita Liken Simpleks Kronikus di Puskesmas Padang Pasir Kota Padang Tahun 2017

Lichen simplex chronicus (LSC) is a chronic, itching, circumscribed, inflammation disorder of skin, which the incident rate has increasing lately. Previous studies show some differences regarding LSC profiles. It is important to update the epidemiology of LSC so that it can be used as a new theoretical basis for research, society and health institutions. This study aimed to find out the profile of Lichen Simplex Chronicus in Puskesmas Padang Pasir in 2017 which includes distribution of frequency based on age, gender, major complaints, location of lesion, and therapy. This is a descriptive study where the data was obtained from medical record of LSK 70 patients in Puskesmas Padang Pasir in January – December 2017. The sample size was calculated by total sampling technique and slovin formula. Results show distribution of frequency: mostly, the age distribution was 56-65 years old (34,3%), and the number of women patients (51,4%) were more than male patients (48,6%). The most complained symptom and affected site was itching (82,9%) and foot (54,3%). The most used antihistamine therapy was chlorpheniramine maleate 4 mg (72,9%), the most used oral steroid therapy was dexamethasone 0,5mg (28,6%) and the most topical therapy was betamethasone 0,1% cream (51,4%).

Pembrolizumab-associated diplopia secondary to idiopathic orbital inflammatory syndrome

Purpose: To report a case of pembrolizumab-associated idiopathic orbital inflammatory syndrome (IOIS). Observations: A 57 year-old female with a history of metastatic non-small cell lung cancer treated with radiation therapy and pembrolizumab presented with acute onset of painful horizontal diplopia on right gaze. MRI Orbits and Brain revealed new diffuse enhancement and enlargement of the right lateral rectus muscle that had not been present on imaging six weeks prior. The patient was presumed to have IOIS and was started on oral steroid therapy, which lead to resolution of symptoms. Conclusion and importance: This is the first reported case of pembrolizumab-associated IOIS. Discovery, recognition, and treatment of ophthalmologic side effects of pembrolizumab are necessary for vision preservation in cancer patients who may benefit from the medication.

Significance of 1 kHz Pure-tone Threshold in Acute Low-frequency Sensorineural Hearing Loss.

To analyze risk factors for acute low-frequency hearing loss (ALFHL), and compare treatment outcomes in the presence or absence of such risk factors. A case series featuring retrospective chart review. An academic university hospital. We included 170 ALFHL patients without vertigo. All of the patients received one of four treatments: low-dose steroid (LD-steroid), high-dose steroid (HD-steroid), LD-steroid and diuretics (LD-combination therapy), and ITDI (intratympanic dexamethasone injection) and diuretics (ITDI-combination therapy). To identify risk factors, we reviewed the clinical features of patients such as age, sex, chief complaint, accompanying symptoms, diabetes, hypertension, time from disease onset, the extent of hearing loss, treatment methods, and 1 kHz involvement. ALFHL was diagnosed based on the average hearing loss >30 dB at 250 and 500 Hz. The overall rates of hearing recovery were 70-80% in the four treatment groups. In terms of the prognosis of ALFHL patients, we found that a longer time from disease onset and 1 kHz involvement were independent risk factors for poor prognosis. In addition, we compared treatment outcomes of four treatment methods in the presence or absence of risk factors. In ALFHL patients with risk factors, we found statistically significant differences (p = 0.042) among treatment methods; effectiveness ranged in the order if ITDI-combination therapy, LD-combination therapy, HD-steroid, and LD-steroid. Risk factors for poor hearing recovery in ALFHL included longer symptom duration and 1 kHz involvement. In ALFHL with such risk factors, combination therapy was more effective than oral steroid therapy.