scholarly journals Azathioprine Hypersensitivity Syndrome: Two Cases of Febrile Neutrophilic Dermatosis Induced by Azathioprine

2017 ◽  
Vol 9 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Majed Aleissa ◽  
Perrine Nicol ◽  
Marion Godeau ◽  
Emilie Tournier ◽  
Frederic de Bellissen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Hypersensitivity Syndrome ◽  
Hair Follicles ◽  
High Fever ◽  
Lower Limbs ◽  
Neutrophilic Dermatosis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythematous Plaques

Background: Azathioprine is an immunosuppressive agent used in the treatment of immune-mediated diseases. Azathioprine hypersensitivity syndrome is a rare adverse reaction occurring a few days to weeks after the administration of azathioprine. Case 1: A 36-year-old male with ulcerative colitis presented with erythematous plaques, pustules and erosions on the lower back, buttocks and thighs associated with high fever (39°C) 2 weeks after the initiation of azathioprine 100 mg/day. Additional findings included leukocytosis (18.6 g/L) with neutrophilia (11.1 g/L) and elevated C-reactive protein (128 mg/L). Histopathology showed a dense infiltrate of neutrophils in the hair follicles. We increased the dose of prednisone to 1 mg/kg/day (60 mg/day) and azathioprine was discontinued. He had marked improvement within 3 weeks and did not have any relapse with a 1-year follow-up. Case 2: A 57-year-old male with ulcerative colitis presented with erythematous plaques and pustules on the lower limbs associated with high fever (40°C) 1 week after the initiation of azathioprine 75 mg/day. Leukocytosis with neutrophilia (13.6 g/L) and elevated C-reactive protein (344 mg/L) were among the laboratory findings. Histopathology showed a dense infiltrate of neutrophils in the hair follicles. The dose of prednisone was increased to 20 mg/day and azathioprine was discontinued, which led to complete remission within 7 days. He did not have any relapse with a 6-month follow-up. Conclusion: The development of acute neutrophilic dermatitis 2 weeks after the initiation of azathioprine and the complete resolution after its withdrawal were in favor of azathioprine hypersensitivity syndrome. It should not be confused with Sweet syndrome associated with inflammatory bowel disease, as maintenance of azathioprine treatment may lead to life-threatening reactions.

scholarly journals Synchronous cytomegalovirus infection in a newly diagnosed ulcerative colitis patient

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Jin Yu Chieng ◽  
Yasotha Sugumaran ◽  
Sellymiah Adzman ◽  
Pan Yan
Keyword(s):  
Ulcerative Colitis ◽  
Medical Illness ◽  
C Reactive Protein ◽  
Colitis Patient ◽  
Intravenous Ganciclovir ◽  
Reactive Protein ◽  
Chronic Medical Illness ◽  
History Of ◽  
Cmv Colitis

A 61-year-old Punjabi female patient presented with six months history of mild abdominal discomfort with bloody diarrhea. She did not have underlying chronic medical illness; she neither took steroid nor immunosuppressant. She was found anemic, thrombocytosis, and elevated C-reactive protein. Colonoscopy showed moderate left sided colitis, with histopathology evidence of ulcerative colitis (UC) with cytomegalovirus (CMV) infection. Her serum anti-CMV IgM antibody was detected. She was treated with intravenous ganciclovir, together with 5-ASA and tapering dose of steroid. Anemia was corrected. Subsequent clinic reviews and follow up endoscopies showed dramatically improvement. CMV colitis should be considered for the patients presenting with moderate to severe UC. Early prescription of antiviral would be beneficial in the treatment of flare of UC.

Non-Invasive Assessment of Inflammation and Treatment Response in Patients with Crohn’s Disease and Ulcerative Colitis using Contrast-Enhanced Ultrasonography Quantification

2015 ◽  
Vol 24 (4) ◽  
pp. 457-465 ◽  
Author(s):  
Mihai Socaciu ◽  
Lidia Ciobanu ◽  
Brindusa Diaconu ◽  
Claudia Hagiu ◽  
Andrada Seicean ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Contrast Enhanced ◽  
Before And After ◽  
Contrast Enhanced Ultrasonography ◽  
The Difference

ackground & Aim: Novel biological therapies in Crohn’s disease (CD) or Ulcerative colitis (UC) require a proper follow-up for the assessment of bowel inflammation. While endoscopy is the standard method, the imaging techniques using contrast, particularly contrast enhanced ultrasonography (CEUS), are better tolerated by the patients and can be used more frequently. Our aim was to find the usefulness of dynamic CEUS quantification as compared to endoscopy in the assessment of disease activity and in the follow-up under therapy of the patients suffering from either CD or UC. Method: We have prospectively evaluated 67 patients with UC and 46 with CD, diagnosed by ileo-colonoscopy and biopsy, comparing the endoscopic scores with clinical scores, C reactive protein (CRP), intestinal wall thickness, layer scores after CEUS and TIC parameters (using SonoLiver® software – Imax, RT, TTP, mTT and AUC). For 25 patients with UC and 13 with CD we performed comparisons of the parameters before and after 3 months of treatment and correlated them with the changes in the endoscopic scores. Results: For UC, time-intensity curves (TIC) volume parameters (AUC) correlated better with endoscopy (ρ=0.64) than the clinical score (ρ =0.62). Other parameters such as CRP and thickness showed significant but less strong correlation, while TIC flow parameters (RT, TTP and mTT) did not show a significant correlation. Results were similar for CD (ρ=0.64 for Imax vs ρ=0.58 for CDAI). The best predictor for endoscopic improvement in both UC and CD was ln(AUC), with a Wilcoxon Z score of 3.76 and 2.61, respectively. There was also a good correlation between the difference of its values and the difference in endoscopic scores before and after the treatment (rho is 0.68 in UC and 0.73 in CD). Abbreviations: CD: Crohn’s disease; CDAI: Crohn‘s disease activity index; CDEIS: Crohn‘s disease endoscopic index of severity; CEUS: Contrast-enhanced ultrasonography; CICDA: Composite index of CD activity; CRP: C-reactive protein; IBD: Inflammatory bowel disease; Imax: Maximum intensity; ln(AUC): Natural logarithm of AUC; MPI: Maximum peak intensity; mTT: Mean transit time; ROI: Region of interest; RT: Rise time; SES-CD: Simple endoscopic score for Crohn‘s disease; TIC:

scholarly journals P473 Long-term follow-up of switching from original adalimumab to adalimumab biosimilar: real-world data in IBD

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S416-S416 ◽  
Author(s):  
C Padilla Suarez ◽  
K Webb ◽  
N Persad ◽  
J Sercombe ◽  
E Tyler ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
C Reactive Protein ◽  
Drug Levels ◽  
Reactive Protein ◽  
Loss Of Response ◽  
Mayo Score

Abstract Background Studies have reported good efficacy outcomes for patients with inflammatory bowel disease (IBD) treated with biosimilars. There are limited long-term data. We assessed the long-term efficacy data and safety after switching from adalimumab to adalimumab biosimilars in patients with IBD. Methods A prospective single-centre observational study involving patients with Crohn’s disease or ulcerative colitis switched from adalimumab to adalimumab biosimilar and reviewed up to 12months. Efficacy and loss of response were measured using the Harvey–Bradshaw (HB) index and partial Mayo score for patients with Crohn’s disease and ulcerative colitis respectively. Blood tests including C-reactive protein, adalimumab drug levels and anti-drug antibodies were monitored. We have recorded side effects and possible serious adverse effects. The plan is to continue the study for 24 months. Results 109 patients with IBD have completed at least 6 months of treatment with adalimumab biosimilar, 12 of which have ulcerative colitis and 97 Crohn’s disease. Most of them (88%) continued on biosimilar after 6 months. Patients discontinued the therapy due to loss of response or development of antibodies in one case. Two patients were switched to a different biosimilar due to the presence of side effects which were however not serious. Of those who remained on the treatment, 74.5% were in clinical remission at 6 months and 71.4% at 9 months. HB index, partial Mayo score, C-reactive protein and adalimumab drug levels did not show significant changes. We have not reported any serious adverse events. We hope than by February, at least 60% of these patients will have been on Adalimumab for 12 months and further amended date would be added. Conclusion Most of the patients switching from original adalimumab were maintained on biosimilar at 6 and 12months of follow-up with similar efficacy and safety as the original drug.

Effectiveness and Safety of Golimumab in Treating Outpatient Ulcerative Colitis: A Real-Life Prospective, Multicentre, Observational Study in Primary Inflammatory Bowel Diseases Centers

2017 ◽  
Vol 26 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Antonio Tursi ◽  
Leonardo Allegretta ◽  
Nello Buccianti ◽  
Nicola Della Valle ◽  
Walter Elisei ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Diseases ◽  
Real Life ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Background & Aims: Golimumab (GOL) has been recently approved in Italy for the treatment of ulcerative colitis (UC) unresponsive to standard treatments. Our aims were to assess the real-life efficacy and safety of GOL in managing UC outpatients in Italian primary Inflammatory Bowel Diseases (IBD) centres.Methods: Consecutive UC outpatients with at least 3-months follow-up were enrolled. Primary end-point was the induction and maintenance of remission in UC, defined as Mayo score ≤2, at 6-month follow-up.Results: Ninety-three patients were enrolled. At 6-month follow-up, remission was obtained in 34 (36.5%) patients. Shorter duration of disease was the only significant predictive factor of remission. Clinical response was achieved in 60 (64.5%) patients, while mucosal healing (MH) was obtained in 18 (19.3%) patients. Sixteen (47.0%) patients under remission were still under therapy with steroids. C-reactive protein and fecal calprotectin significantly dropped during the follow-up (p<0.001 for both proteins). Adverse events occurred in 4 (4.3%) patients and 3 of them stopped treatment. Colectomy was performed in only one patient (1.1%).Conclusions: Golimumab seems to be safe and effective in inducing and maintaining remission in real life UC outpatients.Abbreviations: ADA: Adalimumab; CRP: C-reactive Protein; GOL: Golimumab; FC: Fecal calprotectin; IBD: Inflammatory Bowel Diseases; IFX: Infliximab; IQR: Interquartile range; MH: Mucosal Healing; SC: Subcutaneously; TBC: Tuberculosis; TNFα: Tumor necrosis factor α; UC: Ulcerative Colitis.    

scholarly journals Pyoderma gangrenosum: A clinico- therapeutic profile of patients attending a tertiary care hospital in Nepal

2012 ◽  
Vol 8 (1) ◽  
pp. 29-35
Author(s):  
C Kharel ◽  
S Agrawal ◽  
A Rijal ◽  
S Bhattarai
Keyword(s):  
Ulcerative Colitis ◽  
Pyoderma Gangrenosum ◽  
Tertiary Care ◽  
Lower Limbs ◽  
Neutrophilic Dermatosis ◽  
Care Hospital ◽  
Medical Sciences ◽  
Inflammatory Bowel ◽  
Therapeutic Profile

Pyoderma gangrenosum (PG) is a primarily sterile inflammatory neutrophilic dermatosis characterized by recurrent cutaneous ulcerations with mucopurulent or hemorrhagic exudate. In many cases, PG is associated with inflammatory bowel disease, rheumatic disorder or neoplasia. The peak of incidence occurs between the ages of 20 to 50 years with women being more often affected than men. To study the clinical and therapeutic profile of patients with pyoderma gangrenosum. All patients diagnosed as pyoderma gangrenosum in the department of dermatology from July 14th 2003- July 12th 2008 were included in the study. Demographic profile, clinical features as well as relevant investigations, treatment and follow-up were noted. A total of 8 patients with pyoderma gangrenosum were diagnosed over a 5 year period. There were 3 males and 5 female patients whose ages ranged from 32 to 80 years. Lower limbs were the commonest site to be involved in 6 patients (75%). Recurrent episodes were noted in 4 patients (50%) and among them 3 patients (75%) had multiple ulcers. Histopathological confirmation of the diagnosis was done in 7 patients (87.5%). Association with ulcerative colitis was seen in 2 patients (25%). All patients were treated with dapsone and systemic steroids which showed resolution of the lesions in all patients. Pyoderma gangrenosum was seen more frequently in females and association with ulcerative colitis was seen in 25% of the patients. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 29-35 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6823

Complementary Effects of Multivitamin and Omega-3 Fatty Acid Supplementation on Indices of Cardiovascular Health in Individuals with Elevated Homocysteine

2012 ◽  
Vol 82 (1) ◽  
pp. 41-52 ◽  
Author(s):  
P. Earnest ◽  
S. Kupper ◽  
M. Thompson ◽  
Guo ◽  
S. Church
Keyword(s):  
Risk Factors ◽  
Cardiovascular Health ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
C Reactive Protein ◽  
Fatty Acid Supplementation ◽  
Omega 3 Fatty Acid ◽  
Reactive Protein ◽  
Daily Ingestion

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.

C-reactive protein as a marker of progression of carotid atherosclerosis in subjects with type 2 diabetes mellitus

VASA ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Aleš Pleskovič ◽  
Marija Šantl Letonja ◽  
Andreja Cokan Vujkovac ◽  
Jovana Nikolajević Starčević ◽  
Katarina Gazdikova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Carotid Atherosclerosis ◽  
Inflammatory Marker ◽  
Progression Rate ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp ◽  
Unstable Plaques

Abstract. Background: This prospective study was designed to evaluate the effect of inflammatory markers on the presence and progression of subclinical markers of carotid atherosclerosis in a 3.8-year follow-up period in patients with type 2 diabetes mellitus (T2DM). Patients and methods: A total of 595 subjects with T2DM were enrolled. Subclinical markers of carotid atherosclerosis (carotid intima media thickness (CIMT), plaque thickness, and plaques presence) were assessed with ultrasound at the time of recruitment and again after 3.8 years. Subjects with T2DM were divided into 2 groups according to the plasma high sensitive C-reactive protein (hs-CRP) levels (subjects with hs-CRP ≥ 2 mg/L and subjects with hs-CRP below 2 mg/L). Results: Subjects with T2DM and hs-CRP levels ≥ 2 mg/L had higher CIMT in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L, and higher incidence of plaques/unstable plaques in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L. Multivariate logistic regression analysis found the association between the HDL cholesterol level and presence of plaques, whereas the inflammatory marker hs-CRP was not associated with subclinical markers of progression of carotid atherosclerosis. Multiple linear regression analysis found the association between the hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up. Conclusions: We demonstrated an association between the inflammatory marker hs-CRP and either CIMT or incidence of plaques/unstable plaques at the time of recruitment in Caucasians with T2DM. Moreover, we found the association between hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up in subjects with T2DM.

scholarly journals Serum C-reactive protein metabolite (CRPM) is associated with incidence of contralateral knee osteoarthritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Christine Bay-Jensen ◽  
Asger Bihlet ◽  
Inger Byrjalsen ◽  
Jeppe Ragnar Andersen ◽  
Bente Juhl Riis ◽  
...  
Keyword(s):  
Phase Iii ◽  
Response To Treatment ◽  
C Reactive Protein ◽  
Two Phase ◽  
Knee Oa ◽  
Reactive Protein ◽  
Inflammatory Phenotype ◽  
The Mean ◽  
Using Data

AbstractThe heterogeneous nature of osteoarthritis (OA) and the need to subtype patients is widely accepted in the field. The biomarker CRPM, a metabolite of C-reactive protein (CRP), is released to the circulation during inflammation. Blood CRPM levels have shown to be associated with disease activity and response to treatment in rheumatoid arthritis (RA). We investigated the level of blood CRPM in OA compared to RA using data from two phase III knee OA and two RA studies (N = 1591). Moreover, the association between CRPM levels and radiographic progression was investigated. The mean CRPM levels were significantly lower in OA (8.5 [95% CI 8.3–8.8] ng/mL, n = 781) compared to the RA patients (12.8 [9.5–16.0] ng/mL, n = 60); however, a significant subset of OA patients (31%) had CRPM levels (≥ 9 ng/mL) comparable to RA. Furthermore, OA patients (n = 152) with CRPM levels ≥ 9 ng/mL were more likely to develop contra-lateral knee OA assessed by X-ray over a two-year follow-up period with an odds ratio of 2.2 [1.0–4.7]. These data suggest that CRPM is a blood-based biochemical marker for early identification OA patients with an inflammatory phenotype.

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