scholarly journals Severe COVID-19 Pneumonia Treated by Intensive Immune Suppression Therapy With a Combination of Steroid Pulse and Tocilizumab Followed by a Tapering Dose of Steroid Therapy During the Delta (B.1.617.2) Variant Outbreak: A Successfully Treated Case

Cureus ◽  
2021 ◽  
Author(s):  
Ken-ichi Muramatsu ◽  
Kouhei Ishikawa ◽  
Arisa Komatsu ◽  
Kei Jitsuiki ◽  
Youichi Yanagawa
Keyword(s):  
Steroid Therapy ◽  
Immune Suppression ◽  
Steroid Pulse

P0430EFFECT OF CORTICOSTEROIDS THERAPY FOR PATIENTS OF IGA NEPHROPATHY WITH CRESCENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mengjun Liang ◽  
Aihua Li ◽  
Zongpei Jiang
Keyword(s):  
Renal Function ◽  
Side Effects ◽  
Iga Nephropathy ◽  
Steroid Therapy ◽  
Oral Prednisone ◽  
Pulse Therapy ◽  
The Other ◽  
Intravenous Methylprednisolone ◽  
Steroid Pulse ◽  
Renal Function Deterioration

Abstract Background and Aims Patients with IgA nephropathy (IgAN) presented proteinuria≥1g/d and eGFR≥50ml/min/1.73m2 after supportive treatment had been advised 6-month course of corticosteroids therapy. Update of Oxford classification of IgAN had recommended crescents be added to the MEST score for they were predictive of outcome. Whether we should take some more positive therapy for crescents? Method We conducted a single-center, retrospective cohort study enrolling 46 patients from 2017.01 to 2018.06, diagnosed with IgAN by renal biopsy. Eligible patients had proteinuria of 0.5∼3.5g/d, eGFR≥30ml/min/1.73m2 and crescent proportion <50%. Patients were divided into two groups, one for classical steroid treatment (intravenous methylprednisolone 0.25g/d for 3 days at the beginning of months 1, 3 and 5, plus oral prednisone 0.5 mg/kg/d for 6 months, called 1-3-5 Group) and the other assigned an optimized steroid therapy (intravenous methylprednisolone 0.25g/d for 3 days at the beginning of months 1, 2 and 3, plus oral prednisone 0.5 mg/kg/d for 6 months, called 1-2-3 Group). The primary endpoint was remission of proteinuria, secondary endpoint was deterioration in renal function. Results There were 23 patients in each group and no significant differences in age, gentle, baseline proteinuria and eGFR between the two groups, except for the proportion of crescents (for Oxford C1 and C2: 52.5% and 13% in 1-3-5 Group vs. 95.7% and 4.3% in 1-2-3 Group respectively, p=0.001). After 6 months therapy, proteinuria in 1-3-5 Group was 0.5(0.2,0.8)g/d (vs. 1.2(0.8,2.6)g/d at baseline, p <0.001) and that in 1-2-3 Group was 0.3(0.2,0.6)g/d (vs. 1.5(0.7,2.6)g/d at baseline, p <0.001). 78.3% of patients in 1-3-5 Group had got remission of proteinuria, while 95.7% in 1-2-3 Group (p=0.187). The 6th month eGFR in 1-3-5 Group was 80.7(59.8,116.2)ml/min/1.73m2 (vs. 77.5(54.8,104.6)ml/min/1.73m2 at baseline, p=0.212), while that in 1-2-3 Group was 97.8(68.6,130.9)ml/min/1.73m2 (vs. 79.5(52.9,108.7)ml/min/1.73m2 at baseline, p=0.002). The slope of eGFR in 1-3-5 Group was 0.7(-1.7,3.3)ml/min/1.73m2/month, while that in 1-2-3 Group was 3(1.2,5.4)ml/min/1.73m2/month, p=0.027. For side effects, two patients in 1-2-3 Group had met bronchitis during the 2nd and 3rh therapy-month respectively; in 1-3-5 Group, one patient had got glaucoma during the 2nd therapy-month and the other had happened steroid-induced diabetes mellitus during the 3rd therapy-month. Conclusion Our preliminary results had indicated that optimized steroid therapy had equal effect on reducing proteinuria but more significant advantage to protect against renal function deterioration in IgAN with crescents. 1-2-3 month-steroid pulse therapy had not increase the morbidity of irreversible or severe side effects.

scholarly journals Paraneoplastic Dermatomyositis in Hepatocellular Carcinoma with Colonic Perforation: A Case Report

2016 ◽  
Vol 9 (3) ◽  
pp. 547-553 ◽  
Author(s):  
Naoteru Miyata ◽  
Katsura Emoto ◽  
Yoshiaki Dei ◽  
Kazuhiro Tomiyasu ◽  
Ryoko Ishiyama ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Abdominal Pain ◽  
Steroid Therapy ◽  
Symptomatic Relief ◽  
Colonic Perforation ◽  
C Reactive Protein ◽  
Muscle Enzymes ◽  
Steroid Pulse ◽  
Reactive Protein ◽  
Proximal Myopathy

Background: Dermatomyositis (DM) is an autoimmune disease characterized by cutaneous Gottron papules, heliotrope rash, and proximal myopathy. It may also present as a paraneoplastic syndrome that can complicate a variety of different cancers, such as lung, cervical, and breast cancer. However, the association with hepatocellular carcinoma (HCC) is extremely rare. Moreover, to our knowledge, there are no previous reports of colonic perforation following steroid pulse treatment for a DM patient. Case Summary: A 61-year-old male complained of a skin rash that began in his neck and spread to his face and abdomen. On physical examination, the patient was also found to have symmetrical proximal muscle weakness, abdominal pain, heliotrope rash in the periorbital skin, and poikiloderma on his face and abdomen. Serum level of muscle enzymes was remarkably increased. Muscle examination revealed symmetrical proximal weakness. The diagnosis of DM was made, and steroid treatment was started for symptomatic relief. A search for causative malignancy revealed HCC. Despite steroid therapy for DM, his symptoms did not improve. Additionally, C-reactive protein elevation was seen along with severe abdominal pain on day 14 of admission. Shortly after this, the patient died of septic shock due to suppurative peritonitis after perforation of the ascending colon. Conclusion: Here, we present a rare case of DM caused by non-hepatitis-associated advanced HCC with colonic perforation. The cause of colonic perforation is still unclear. This case demonstrates the need to carefully monitor abdominal pain in DM patients as symptoms can be masked by steroid therapy.

Comparison of steroid pulse therapy and conventional oral steroid therapy as initial treatment for autoimmune pancreatitis

2010 ◽  
Vol 46 (5) ◽  
pp. 696-704 ◽  
Author(s):  
Takashi Tomiyama ◽  
Kazushige Uchida ◽  
Mitsunobu Matsushita ◽  
Tsukasa Ikeura ◽  
Toshiro Fukui ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Autoimmune Pancreatitis ◽  
Initial Treatment ◽  
Pulse Therapy ◽  
Steroid Pulse Therapy ◽  
Oral Steroid ◽  
Steroid Pulse ◽  
Oral Steroid Therapy

scholarly journals Drug-Induced Interstitial Pneumonia due to Application of FOLFOX as Adjuvant Chemotherapy after Rectal Cancer Surgery: A Case Report and Literature Review

2020 ◽  
Vol 13 (2) ◽  
pp. 768-773 ◽  
Author(s):  
Senichiro Yanagawa ◽  
Nozomi Karakuchi ◽  
Tetsuya Mochizuki ◽  
Shinya Kodama ◽  
Yukio Takeshima ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Interstitial Pneumonia ◽  
Steroid Therapy ◽  
Disease Free Survival ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
High Dose ◽  
Drug Induced ◽  
Steroid Pulse

The regimen of oxaliplatin with 5-fluorouracil plus l-leucovorin (FOLFOX) has become one of the most commonly used first-line chemotherapy for patients with advanced colorectal cancer and it provides an increase in disease-free survival as well as an overall survival benefit. Although FOLFOX chemotherapy has helped to improve the clinical outcomes in these patients, the regimen is associated with some therapeutic issues or uncontrolled side effects. Gastrointestinal, neurosensory, and hematological toxicities have frequently been observed in patients treated with FOLFOX, and consequently, some palliative treatment has been established to combat such complications. However, pulmonary toxicities including drug-induced interstitial pneumonia (DI-IP) is rarely observed in these patients and a curative treatment is yet to be established. DI-IP due to chemotherapy is most commonly observed in patients treated with mitomycin, paclitaxel, docetaxel, or gemcitabine. Steroid therapy is mostly used to treat DI-IP, although the efficacy of such treatments is not supported with adequate evidence. FOLFOX-induced interstitial pneumonia (FIIP) is rarely observed, and several case reports of FIIP treated with steroids have been published previously that showed the mortality is extremely high. Here, we present a 74-year-old woman who received modified FOLFOX6 as adjuvant chemotherapy after rectal cancer surgery. The patient experienced FIIP, which improved after application of steroid pulse (high-dose methylprednisolone at 1,000 mg/day for 3 days) and tapering (starting with prednisolone at 40 mg/day) therapy. Our data suggest that such a steroid therapy could represent an effective treatment option for FIIP.

Steroid Therapy as Treatment for Idiopathic Fibrosis of the Retroperitoneum and Mediastinum

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 936-938
Author(s):  
CHARLES FEILD ◽  
WATSON ARNOLD ◽  
ELIZABETH S. GLOSTER ◽  
GREG SHARP ◽  
JOHN REDMAN
Keyword(s):  
Steroid Therapy ◽  
Retroperitoneal Fibrosis ◽  
Oral Prednisone ◽  
Pulse Therapy ◽  
Chief Complaint ◽  
Oral Steroid ◽  
Shortness Of Breath ◽  
Steroid Pulse ◽  
Alternative Modality ◽  
Oral Steroid Therapy

Multifocal idiopathic fibrosis of both mediastinum and retroperitoneum is rare in childhood.1,2 We describe a patient who presented with biopsyproven mediastinal and retroperitoneal fibrosis associated with progressive pulmonary fibrosis, cardiomyopathy, and bilateral ureteropyelocaliectasis; the patient responded to intravenous pulse and oral steroid therapy with relief of his uretenal obstruction and an improvement in pulmonary and cardiac function. Although surgical ureterolysis is generally the management of choice for ureteral obstruction caused by retroperitioneal fibrosis,3,4 steroid pulse therapy and a regimen of oral prednisone may provide an alternative modality of themapy.5-7 CASE REPORT This 12-year-old black boy was seen in the emergency room with a chief complaint of shortness of breath.

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