A Case of Influenza Virus-Induced Acute Cerebellitis Treated with Steroid Pulse Therapy

Acute cerebellitis (AC) is characterized by acute onset cerebellar ataxia brain magnetic resonance imaging (MRI) abnormalities of the cerebellum. The most common cause of AC is viral infection, and some patients with AC experience neurological sequelae. AC associated with influenza virus is extremely rare, and its prognosis and treatment are unknown. We present the case of a 2-year-old boy with influenza virus-induced AC who was treated with pulse steroid therapy. The patient presented with fever, anorexia, vomiting, malaise, altered consciousness, truncal ataxia, dysmetria, and dysarthria. He was diagnosed with influenza using a nasopharyngeal antigen test. Brain MRI showed hyperintense T2 and diffusion-weighted signal abnormalities in the cerebellar white matter and dentate nuclei bilaterally. The patient was treated with two courses of pulse methylprednisolone therapy and recovered completely in 2 months after the onset. The prognosis of AC is poorer than that of acute cerebellar ataxia, which shows similar symptoms to AC with normal brain MRI. The type of virus might also be associated with the prognosis of AC. Literature review showed that one of the five cases (including the present case, 20%) reported with influenza-associated AC was noted to have neurological sequelae, which might be more severe than those of varicella-zoster-related AC. Given that the pathogenesis of AC is assumed to be immune-mediated, pulse methylprednisolone therapy might be a good option for the treatment of influenza virus-induced AC.

The Clinical Profile of Idiopathic Optic Neuritis at the Ophthalmology OPD of Tertiary Centre of Army Hospital, Nepal

Introduction: Inflammation of the optic nerve is a common cause of visual loss due to optic nerve pathology. This study was conducted to report the clinical features, demographic pattern and response to pulse steroid therapy in patients with idiopathic optic neuritis in a tertiary care teaching institute in Kathmandu, Nepal. Methods: The hospital data of patients with idiopathic optic neuritis admitted to the Department of Ophthalmology of Shree Birendra Hospital, Chhauni, Kathmandu, Nepal between Jan 2015 to Dec 2018 were retrospectively analysed. The parameters studied were demographic pattern, clinical features, and visual acuity. Results: Eighteen eyes of 15 patients were found to have optic neuritis (papillits in eight and retrobulbar optic neuritis in 10 eyes). The male to female ratio was 1.4:1. The mean age of the patients was 38.07 ± 11.37 years (95% CI = 31.77- 42.37). The most common modes of presentation were loss of visual acuity, painful ocular movement and colour vision defect. One patient had features suggestive of multiple sclerosis. Response to pulse methylprednisolone therapy was good in most (16 eyes) of the cases except for the patients having recurrent episode and started oral steroid elsewhere before presenting to our hospital. Conclusions: Response to pulse methylprednisolone therapy was good in patients with initial visual acuity of at least perception of light. Demographic and clinical features of our patients were different from those reported from the western world.

The Effectiveness of Oral Mini-Pulse Methylprednisolonein - the Treatment of Alopecia Areata in Vietnam

BACKGROUND: Systemic corticosteroid is used to treat alopecia areata, but it is associated with side effects. Mini-pulse therapy is thought to be effective but able to reduce side effects. AIM: The study aimed to evaluate the effectiveness of oral mini-pulse methylprednisolone in the treatment of alopecia areata. METHODS: Patients received methylprednisolone 16 mg orally for 2 consecutive days every week. RESULTS: After 3 months, among patients, 40% recovered well, and 55.6% recovered fairly. After 6 months, 82.2% recovered well, 17.8% recovered fairly. No adverse events were detected, and the recurrence rate was low (2.2%). CONCLUSION: Oral mini-pulse methylprednisolone therapy is an effective and safe therapeutic option for alopecia areata without side effects, and the time of the treatment is short.

Safety of IV pulse methylprednisolone therapy during breastfeeding in patients with multiple sclerosis

Background: Women with multiple sclerosis (MS) experience an increased risk of relapse in the postpartum period. High-dose methylprednisolone is the first-line treatment for acute relapses. Objectives: To determine the transfer of methylprednisolone into human milk in breastfeeding MS patients. Methods: Methylprednisolone therapy was given for postpartum relapse to nine patients for three consecutive days, and seven patients received a daily infusion once a month. Breast milk samples were obtained before infusion and 1, 2, 4, 8, and 12 hours after completion of infusion. Results: Methylprednisolone concentrations in milk were below detection limits immediately before infusion. Cmax was measured at 1, 2, 4, 8, and 12 hours after infusion and levels of 2.100, 1.659, 0.680, 0.174, and 0.102 µg/mL were determined, respectively. The absolute infant dose was 98.98 µg/kg/day, and the relative infant dose (RID) was 0.71% of the weight-adjusted maternal dose. Conclusion: The level of methylprednisolone transfer into breast milk is very low. The RID for methylprednisolone was lower than the generally accepted value. As methylprednisolone therapy is of short duration, infant exposure would be very low should a mother choose to breastfeed 1 hour after infusion. Waiting 2–4 hours after infusion will limit infant exposure still further.