scholarly journals Is Thymoglobulin or Rituximab the Cause of This Serum Sickness? A Case Report of Serum Sickness Dilemma and Literature Review

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Amarpreet Sandhu ◽  
Antonia Harford ◽  
Pooja Singh ◽  
Eduardo Alas
Keyword(s):  
Polyclonal Antibodies ◽  
Case Reports ◽  
Treatment Options ◽  
Serum Sickness ◽  
Evidence Based ◽  
Humoral Rejection ◽  
Transplant Patients ◽  
Potential Offender ◽  
Kidney Transplant Patients ◽  
Evidence Based Guidelines

Serum sickness is an immune-complex-mediated systemic illness that can occur after treatment with monoclonal or polyclonal antibodies such as Rituxan (Rituximab) or antithymocyte globulin (Thymoglobulin), respectively. Since Rituximab is now being used as an adjuvant treatment for acute humoral rejection and its prevalence to cause serum sickness is comparable to Thymoglobulin-associated serum sickness (20% versus 27%), it should be considered a potential cause of serum sickness after rejection treatment. In kidney transplant patients, there are no case reports where patient received both Thymoglobulin and Rituximab before developing serum sickness. We are reporting a patient who developed serum sickness after receiving Thymoglobulin and Rituximab that led us to consider Rituximab as one of the potential causes in this patient’s serum sickness. Since diagnosis of serum sickness is clinical, and Rituximab use has expanded into treatment of glomerulonephritis and acute humoral rejection, it should be considered as a potential offender of serum sickness in these patient populations. There are not any evidence-based guidelines or published clinical trials to help guide therapy for antibody-induced serum sickness; however, we successfully treated our case with three doses of Methylprednisone 500 mg intravenously. Further studies are needed to evaluate Rituximab-associated serum sickness in nephrology population to find effective treatment options.

scholarly journals Are Community Acquired Respiratory Viral Infections an Underestimated Burden in Hematology Patients?

2019 ◽  
Vol 7 (11) ◽  
pp. 521 ◽  
Author(s):  
Popescu ◽  
Ursache ◽  
Feketea ◽  
Bocsan ◽  
Jimbu ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Viral Infections ◽  
Treatment Options ◽  
Published Data ◽  
Evidence Based ◽  
Respiratory Viral Infection ◽  
Improve Outcome ◽  
Diagnosis And Management ◽  
Respiratory Viral Infections ◽  
Evidence Based Guidelines

Despite a plethora of studies demonstrating significant morbidity and mortality due to community-acquired respiratory viral (CRV) infections in intensively treated hematology patients, and despite the availability of evidence-based guidelines for the diagnosis and management of respiratory viral infections in this setting, there is no uniform inclusion of respiratory viral infection management in the clinical hematology routine. Nevertheless, timely diagnosis and systematic management of CRV infections in intensively treated hematology patients has a demonstrated potential to significantly improve outcome. We have briefly summarized the recently published data on CRV infection epidemiology, as well as guidelines on the diagnosis and management of CRV infections in patients intensively treated for hematological malignancies. We have also assessed available treatment options, as well as mentioned novel agents currently in development.

scholarly journals BK polyomavirus nephropathy in two kidney transplant patients with distinct diagnostic strategies for BK virus and similar clinical outcomes: two case reports

2017 ◽  
Vol 11 (1) ◽  
Author(s):  
Ana Luisa Figueira Gouvêa ◽  
Rachel Ingrid Juliboni Cosendey ◽  
Ana Lucia Rosa Nascimento ◽  
Fabiana Rabe Carvalho ◽  
Andrea Alice Silva ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Kidney Transplant ◽  
Case Reports ◽  
Bk Virus ◽  
Diagnostic Strategies ◽  
Transplant Patients ◽  
Bk Polyomavirus ◽  
Kidney Transplant Patients

scholarly journals The Treatment and Prognosis of Refractory and Super-Refractory Status Epilepticus

2017 ◽  
Vol 01 (03) ◽  
pp. E204-E210
Author(s):  
Stephanie Gollwitzer ◽  
Hajo Hamer
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Evidence Based ◽  
New Approach ◽  
Refractory Status ◽  
First Choice ◽  
Evidence Based Guidelines

AbstractRefractory status epilepticus (RSE) is defined as status epilepticus (SE) persisting over 60 min and resistant to treatment with benzodiazepines and non-sedating antiepileptic drugs. The term super-refractory status epilepticus (SRSE) refers to a refractory episode continuing under general anesthesia for more than 24 h. RSE is treated with a combination of non-sedating AED and i. v. anesthetics; first choice drugs are midazolam, propofol and thiopental. The management of super-refractory status epilepticus (SRSE) is challenging as clear evidence-based guidelines are lacking. Recommendations are mainly based on case reports and small case series. Therapeutic options include ketamine, inhalational anesthetics, steroids and immunoglobulins. Ketogenic diet, electroconvulsive therapy and epilepsy surgery are also considered as potentially effective. A promising new approach is the neurosteroid allopregnanolone. Mortality of RSE and SRSE is largely influenced by the etiology and is markedly higher as compared to non-refractory status epilepticus. It was reported to be about 30% and 50%, respectively.

scholarly journals Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration Rate

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Julie Belliere ◽  
Céline Guilbeau-Frugier ◽  
Arnaud Del Bello ◽  
Laure Esposito ◽  
Caroline Capuani ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Kidney Transplant ◽  
Kidney Function ◽  
Filtration Rate ◽  
Case Reports ◽  
Rescue Therapy ◽  
Mtor Inhibitors ◽  
Transplant Patients ◽  
Kidney Transplant Patients

Belatacept has been found to be efficient at preserving good kidney function in maintenance kidney-transplant patients. Herein, we report on the use of belatacept as a rescue therapy for two kidney-transplant patients presenting with severe adverse events after treatment with calcineurin inhibitors (CNIs) and mammalian target-of-rapamycin (mTOR) inhibitors. Two kidney-transplant patients developed severely impaired kidney function after receiving CNIs. The use of everolimus was associated with severe angioedema. Belatacept was then successfully used to improve kidney function in both cases, even though estimated glomerular-filtration rate before conversion was <20 mL/min. These case reports show that belatacept can be used as a rescue therapy, even if kidney function is very low in kidney-transplant patients who cannot tolerate CNIs and/or mTOR inhibitors.

Prevention and Treatment of Veno-Occlusive Disease

2001 ◽  
Vol 35 (7-8) ◽  
pp. 935-942 ◽  
Author(s):  
Anita A Pegram ◽  
LeAnne D Kennedy
Keyword(s):  
Bone Marrow ◽  
Clinical Trials ◽  
Vitamin E ◽  
Bone Marrow Transplant ◽  
Case Reports ◽  
Treatment Options ◽  
Marrow Transplant ◽  
Occlusive Disease ◽  
Transplant Patients ◽  
Prevention And Treatment

OBJECTIVE: T o review the current options for prevention and treatment of veno-occlusive disease in bone marrow transplant patients. DATA SOURCES: Articles were selected from a MEDLINE search (1966–October 1999) using the key terms veno-occlusive disease and bone marrow transplantation. In addition, references of all articles were examined for articles not found in the computer-based search. DATA EXTRACTION: All clinical trials, case—control studies, and case reports were evaluated. RESULTS: Heparin, low-molecular-weight heparin, prostaglandin E1, ursodiol, and glutamine have been studied for prevention of veno-occlusive disease. Heparin has been studied most extensively; however, no preventive regimen has a defined role in therapy. For treatment, tissue plasminogen activator has been evaluated most thoroughly, yet its safety and efficacy have not been clearly established in patients with veno-occlusive disease. Other possible treatment options include antithrombin-III, defibrotide, glutamine plus vitamin E, and surgery. CONCLUSIONS: Based on the available data, the most promising agents are ursodiol for prevention and defibrotide or glutamine plus vitamin E for treatment of veno-occlusive disease. Further clinical trials are needed to establish the appropriate preventive and treatment options available for bone marrow transplant patients suffering from veno-occlusive disease. To date, such decisions depend largely on poorly designed trials, case reports, and clinical experience.

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