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PubMed1991

[T lymphoma of immature phenotype associated with polycythemia vera].

A 20-year old patient is presented with generalized lymphadenopathy, splenomegaly, hyperleukocytosis and a bone marrow biopsy showing panmyelosis with predominance of immature granulocytes. Lymph node biopsy showed a histopathological feature that was diagnosed as a chronic granulocytic leukemia in blast crisis. The cell surface phenotype of these blast cells showed predominance of immature CD1+, CD7+ T lymphocytes. The T cell lineage was confirmed by DNA rearrangement studies. In addition, the patient showed erythrocytosis, arterial O2 saturation of 92% and thrombocytosis, characteristics of polycythemia vera. After chemotherapy, the patient relapsed with similar symptoms and lymph node cells of similar immature T phenotype. With a revised diagnosis of immature T cell lymphoma associated to a myeloproliferative disorder and polyglobulia, the patient received a combined treatment of Cyclophosphamide-Adriamycin-Vincristine-VM26-Prednisone. Two months later, the patient relapsed again. He received the first phase of induction of the BFM protocol, with partial clinical remission. Five months later, the patient returned with fever, polyadenopathy and splenomegaly. Lymph node cells showed again immature T cell phenotype. The patient was next treated with the m-BACOD scheme, with no response and progression of the disease and he died few days later due to massive bleeding and cardiorespiratory failure.

Adult↗
PubMedDate not supplied

Clinical observation of Wilms' tumor.

Forty-two cases with Wilms' tumor encountered in the National Taiwan University Hospital from 1978 through 1989 were retrospectively reviewed. Included were 19 boys and 23 girls, with an age range at diagnosis from 7 days to 10 years; a majority were in the first 6 years of life. The presenting symptoms and signs included: abdominal mass (89.2%), hypertension (57.9%), hematuria (28.2%), gastrointestinal symptoms (26.3%), fever (24.3%), and body weight loss (21.6%). The initial laterality of tumor was 28 right and 14 left, with one contralateral and one ipsilateral relapse. One extrarenal Wilms' tumor (right inguinal lymph nodes) was encountered. Every case was confirmed by pathology. Histologic findings included typical Wilms' tumor (35/42), rhabdoid (3/42), anaplastic (3/42), and clear cell (1/42) types. The common sites of metastasis were lung, liver and bone. Major complications during or following therapy were severe pancytopenia, ileus, sepsis or pneumonia, delayed wound healing and tumor rupture with hemorrhage. Rare complications included irradiation hepatitis (venooclusive disease) and colitis. There were 20 deaths. The causes of death were respiratory or hepatic failure due to tumor metastasis, sepsis and internal hemorrhage. Mortality (19/20) usually occurred within two years after diagnosis and therapy. The two-year's relapse-free survival and two-year's survival rates were 51.2% and 53.7%, respectively.

Cause of Death↗
PubMed1993

[Ofloxacin treatment of salmonella infections].

In the present study, 33 adult patients with salmonella infections consisting of 13 typhoid fever, 9 paratyphoid fever, 8 enterocolitis, 2 carriers, 1 acute gastroenteritis have been treated with ofloxacin. The duration of treatment was 10 days for typhoid fever, 7 days for paratyphoid fever, 5 days for enterocolitis, 3 days for acute gastroenteritis and 7 days for asymptomatic carriers. All the patients recovered without any complication and fever declined to normal levels within a mean of 3.0 +/- 1.34 days. Two carriers of S. enteritidis became salmonella free after 7 days of ofloxacin treatment. One of the patients who had severe S. paratyphi B bacteremia remained carrier for about 6 months. None of the patients have relapsed. The antibiotic therapy proposals on salmonella in adults were discussed in the light of our results and the other studies.

Carrier State↗
PubMed1993

[Early phase II study of Idarubicin combined with cytarabine in acute myelogenous leukemia. Idarubicin Study Group].

An early phase II study of a combination regimen consisting of Idarubicin and Cytarabine was performed in patients with acute myelogenous leukemia. Idarubicin at a dose of 10 mg/m2 or 12 mg/m2 was given by 5-min. iv bolus, once daily for 3 consecutive days and Cytarabine at a dose of 80 mg/m2 was given by 2-hour iv infusion, twice daily for 7 consecutive days. Of 19 patients treated, 17 were evaluable for responses. The patients who showed a response (complete or partial remission) were 4 of 10 (40.0%) in the 10 mg/m2 group, 6 of 7 (85.7%) in the 12 mg/m2 group, and in total, 10 of 17 patients (58.8%), respectively. Analysing relationship between prior chemotherapy and responses, all of 3 patients without pretreatment, 6 of 10 patients (60.0%) in the first relapse, and 1 of 4 patients (25.0%) whose disease had been refractory to induction therapy after relapse responded. Seven of 14 patients (50%) who had received prior anthracycline therapy, showed a response. The principal adverse effects were gastrointestinal symptoms, alopecia, fever and infection, similarly to those observed in Idarubicin single therapy. When combined with Cytarabine, Idarubicin increased the incidence and severity of gastrointestinal symptoms. Considering effectiveness and safety, the clinical optimal dosage of Idarubicin when used concomitantly with Cytarabine was judged to be 12 mg/m2 once daily for 3 consecutive days.

Adult↗
PubMedDate not supplied

[Ambulatory management of moderately and severely malnourished children in the rural health district of Kapolowe in Shaba (Zaire)].

In Kapalowe rural health district, hospitalisation of malnourished children is restricted to complicated cases; once the complication is under control or eliminated, the child's treatment is continued at home, based on a 13 weeks contract, between parents and health centre. The parents commit themselves to feed their child four times a day (two porridge and two family dish portions), to consult once a week at the health centre and to welcome a weekly home visit. The objective of this visit is to support the parents, to detect possible problems and to reach the roots for this particular child. During the contract period, cost of medical treatment and recommended soya flour, is borne by the parents through a lump sum contribution. In this article, data concerning the first 95 children home rehabilitated (1989-1991) in Kapalowe are analysed. Characteristics of these children are classical regarding malnutrition; for example, age distribution is similar to that of weaning and of defunction of children at the hospital during the same year. Approximately half of them are still breastfed at the beginning of the contract. Most of them are correctly immunized and have been seen at the health centre at least two times in the last six months. Seventy-four children finished the contract; there were 17 abandons and 4 deaths. Weight gain is inferior to that observed in specialized feeding centres which do benefit from external resources, which is not the case here. It was not possible to show a significant catch up for the height for age indicator after the three months contract. These anthropometrical results are less important than the global and subjective improvement in the child's general health status observed at the end of the contract. None of the children reached the target weight after 13 weeks but important changes were observed in their behaviour, in their resistance to infection and in the attitude of their parents. The parents generally followed the instructions quite well. The middle of the contract seems to be a key period when either significative changes happen or when the attention is released. Treatment instructions have been amended to avoid monotony and overload, and to stimulate staff creativity and self-satisfaction. Payment was not a problem for the parents as malnutrition is not linked to extreme poverty. Mother's attitude and confidence and child initial weight for height status are two important contract success determinants. Abandons are more frequent when the mother is pessimistic and in case of kwashiorkor. Despite this, most of these children had gained more than one kilo before the contract was interrupted. Some didn't fulfill the W/H inclusion criteria (-2 standard deviations) and should probably not have been under contract. The four deaths were linked to insufficient treatment instructions for usually banal diseases that have another meaning in case of malnutrition, such as diarrhoea, fever, etc. An evaluation performed three months after the end of the contract in 26 children show 13 further improvements, 8 statu quo, 4 relapses and 2 new deaths. Conclusions are that home nutritional rehabilitation is possible where a health district is fully operational, that anthropometric data are useful to monitor rehabilitation but not to be pursued only as sole and ultimate objectives, and that adequate follow up after the first intensive stage is essential. The paper also shows how such a research result can have direct consequences on the organization of health activities.

Ambulatory Care↗
PubMed1975

A comparative evaluation of the treatment of typhoid fevers with co-trimoxazole and chloramphenicol in Egypt.

Seventy-two patients with bacteriologically proven enteric fever were treated with either co-trimoxazole (41 cases) or chloramphenicol (31 cases). C0-trimoxazole was found to be superior to chloramphenicol in relieving the toxaemia. The average number of days required for patients to become afebrile was 5-5 days in the co-trimoxazole group and 4-5 days in the chloramphenicol group. The cure rate was 97 per cent in each of the treatment groups. There occurred two relapses in the co-trimoxazole group and four relapses in the chloramphenicol group. No side effects of the co-trimoxazole were detected during the study. Co-trimoxazole can be considered as a good alternative to chloramphenicol in the treatment of the enteric fevers.

Adolescent↗
PubMed2000

Infusional vinorelbine in relapsed or refractory lymphomas.

Vinorelbine (Navelbine is a semisynthetic vinca alkaloid devoid of serious neurotoxicity. When given weekly vinorelbine has documented activity against many tumors, including lymphomas. Since weekly schedules cannot be easily incorporated in combination regimens, we tested an infusional schedule of vinorelbine given every 21 days in adults with relapsed or refractory lymphoma. Patients with inadequate organ or bone marrow reserve, HIV or other serious infection, central nervous system disease, or prior stem cell or bone marrow transplantation were ineligible. In the phase I part, patients received a constant intravenous bolus of 8 mg/m(2), followed by intravenous continuous infusion over 24 hours daily for four days increasing from 10, 12, to 14 mg/m(2) /d in successive three-patient cohorts. Cycles were repeated every 21 days, and the daily continuous infusion dose was adjusted for toxicity. Dose-limiting mucositis and neutropenia were reached at the continuous dose of 14 mg/m(2) /d. Consequently, for the Phase II trial the starting continuous infusion dose was 12 mg/m(2) /d. After the first 19 patients were entered in the phase II study, the starting infusion dose was reduced to 10 mg/m(2) /d because of frequent grade (3/4) myelosuppression and mucositis. Forty-four patients were entered in the phase II study, of whom 41 are evaluable. Median age was 61 years, 23 were males, with clinically aggressive non-Hodgkin's lymphoma (NHL) in 22, indolent NHL in 18, and Hodgkin's Disease in one patient. The median number of prior regimens was 3 (range 1-11). The lymphoma was refractory to the initial regimen in nine patients, and to the regimen immediately before vinorelbine in 20 patients. Serum LDH was high in 2(1/4)1, and serum beta(2) -microglobulin > 3.0 mg / L in 16/31 patients. Responses were observed in four of 22 patients with aggressive NHL (18%, 95% confidence interval 5%-40%), and in six of 18 with indolent NHL (33%, 95% confidence interval 13%-59%). Median progression-free survival was 6 months for responders. During the Phase II trial 114 vinorelbine courses were administered. Neutrophil nadir was < 1000/microl in 65% and < 100/microl in 35% of courses, respectively. Platelet nadir was < 100,000/microl in 30% and < 20,000/microl in 8% of courses, respectively. Grade (3/4) mucositis was seen in 18% of courses, and neutropenic fever in 13%, and was complicated by death in one patient. We conclude that this dosage and schedule of vinorelbine has modest activity in patients with relapsed or refractory NHL. Myelosuppression is frequent but reversible, but there is no significant neurotoxicity. The role of vinorelbine in combination regimens for patients with relapsed lymphomas, particularly those of indolent histology, should be further investigated.

Adult↗
PubMed2004

[Disseminated histoplasmosis and AIDS in an Argentine hospital: clinical manifestations, diagnosis and treatment].

We describe 16 HIV-infected patients with disseminated histoplasmosis (14 men, mean age 28 +/- 7.84 years), diagnosed at Hospital Eva Perón in Argentina during the period of October 1993 to July 2000. Disseminated histoplasmosis occurred in 5.3% of HIV-infected patients over the study period. The main symptoms included fever, weight loss and hepatosplenomegaly in 93.8%. Other relevant findings were respiratory compromise (56.3%), digestive symptoms (43.8%), mucocutaneous lesions (75%) and multiple lymphadenopathy (69%). Treatment consisted of amphotericin B 1 mg/kg/day up to a total dose of 1 g, followed by 400 mg/day of oral itraconazole. Mortality in the acute phase was 19% and 37.5% of patients relapsed.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

High dose of primaquine in primaquine resistant vivax malaria.

The efficacy of low dose chloroquine, characteristic pattern of relapse and the relapse rate in vivax malaria after high dose primaquine were investigated in 167 Thai patients. 87 patients were allocated at random to receive 300 mg, and 80 received 450 mg of chloroquine on the first day of admission. All patients in both groups showed a rapid response with comparable fever clearance times (27.3 vs. 26.1 h) and parasite clearance times (67.1 vs. 58.1 h). After recovery and clearance of parasitaemia, the patients were allocated at random (double blind) to receive 2 dosage regimens of primaquine, a daily dose of 15 mg or 22.5 mg for 14 d. Relapses in both groups occurred within 6 months; no patient relapsed beyond that period. The relapse rate in the primaquine 15 mg group was significantly higher than that in the 22.5 mg group (17.5% vs. 2.4%).

Adolescent↗
PubMed1975

Waterborne typhoid fever in Dade County, Florida. Clinical and therapeutic evaluation of 105 bacteremic patients.

An extensive outbreak of waterborne typhoid fever occurred in 1973 at a migrant labor camp in Dade County, Florida. Blood cultures from 105 of the 188 patients with proved or presumptive cases of typhoid fever grew Salmonella typhi. The clinical and laboratory findings in these patients were reviewed. Fever, usually with temperatures above 38.8 degrees C and of the sustained type, was a primary manifestation of disease, although a majority of the patients also complained of headache and gastroenteric symptoms. Hepatic or splenic enlargement was present in 52 per cent and 42 per cent, respectively, whereas rose spots were detected in only 13 per cent. The total leukocyte count was normal in 74 per cent, but serum levels of liver and muscle enzymes were frequently elevated. Gastrointestinal, pulmonary and neurologic complications were infrequent; circulatory failure was not observed. Defervescence in response to antibiotic therapy was variable; however, the median response among 68 patients who received chloramphenicol was two days less than that in 34 patients treated with ampicillin. There was one possible treatment failure with ampicillin. The relapse rate of 10 per cent in chloramphenicol-treated patients was not significantly greater than the 3 per cent rate among those treated with ampicillin. Serologic studies for typhoid fever were of limited diagnostic value since the titer of agglutinins was 1:160 or higher in 49 per cent of the serums obtained before treatment, and a fourfold rise in titer occurred in only 24 per cent of 57 patients studied. The serologic response to chloramphenicol treatment did not differ from that to ampicillin.

Adolescent↗
PubMed2001

Successful treatment of a small cohort of patients with adult onset of Still's disease with infliximab: first experiences.

OBJECTIVE: To test the efficacy of infliximab in the treatment of patients with severe and active adult onset Still's syndrome (AOSD) despite conventional immunosuppressive therapy. PATIENTS AND METHODS: Six patients with the diagnosis of AOSD according to the Yamagushi criteria of 1992 were treated with infliximab. All patients had severe disease with high clinical and serological activity. Patients were treated initially with high dose steroids or more intensive immunosuppressive therapy. Two patients had a history of multiple disease modifying antirheumatic drug (DMARD) treatments. One patient had a history of three years of AOSD with fever, chills, pleural and pericardial effusions, and hepatosplenomegaly. Despite these treatments, he developed increasing serological signs of inflammation and arthritis of both hips and peripheral joints. Another patient had a history of five years of AOSD with oligoarthritis, myalgias, and recurrent fever despite multiple DMARD treatment, including cyclophosphamide pulse therapy. Our patients with AOSD presented with massive polyarthralgias, polyarthritis, splenomegaly or hepatomegaly, the typical rash, sore throat, weight loss, serositis, continuing fever, leucocytosis, and raised C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ferritin levels. Four patients with early onset of the disease, fulfilling the diagnostic criteria for AOSD and a clinical and serological high disease activity, were included in our pilot study without any further DMARD treatment apart from the initial steroid treatment. Reduction of established treatment, mainly with steroids, caused a relapse of the disease in all our patients. Patients then received 3-5 mg/kg infliximab on weeks 0, 2, and 6, continuing with intervals of 6-8 weeks depending on the patient's individual disease activity. RESULTS: In all patients, fever, arthralgias, myalgias, hepatosplenomegaly, and the rash resolved after the first courses of treatment with infliximab. All serological variables (CRP, ESR, hyperferritinaemia) returned to normal. After three courses of infliximab infusions, splenomegaly could not be detected in any of our patients. One caused by hip postarthritic osteoarthrosis, requiring hip replacement. After three courses of treatment with infliximab, splenomegaly could not be detected in any of our patients. Up to now, our patients have received infliximab infusion treatment for between five and 28 months. Throughout this period all patients have continued to benefit from this treatment, with improvement in their clinical symptoms, joint counts, and serological disease activity. One of our patients had a moderate infusion reaction during the second treatment. The infusion was discontinued for one hour and then was resumed with no further problems. CONCLUSION: The disease improved remarkably in all six patients with AOSD after treatment with infliximab, also in the early stage of AOSD. These preliminary data suggest the potential therapeutic benefit of anti-tumour necrosis factor alpha treatment in AOSD.

Acute Disease↗
PubMed2004

Adjuvant interleukin-2 therapy for patients refractory to donor lymphocyte infusions.

OBJECTIVE: Donor lymphocyte infusions (DLI) can induce durable second remissions in patients relapsed after allogeneic stem cell transplantation (SCT) for hematologic malignancies. However, some patients are refractory or respond only partially to DLI. Recombinant interleukin-2 (IL-2) can increase the anti-leukemic activity of donor lymphocytes and has previously been reported as a potential enhancer of DLI. We assessed the response to adjuvant IL-2 on relapsed SCT who had failed to respond to DLI alone. PATIENTS AND METHODS. A total of 13 patients (8 with CML, 2 with AML, 2 with MM, 1 with NHL) relapsed after SCT and were treated with DLI. All had achieved only partial or no response after DLI. Recombinant IL-2 was thereafter administered. RESULTS: Five patients achieved a CR and four a PR after DL/IL-2 therapy. Those achieving a CR appeared to have a survival advantage compared to partial or nonresponders. The IL-2 was well tolerated; the most frequent side effects were fever (100%), lethargy (69%), and anorexia and vomiting (31%). Five patients experienced graft-vs-host disease (grade II-IV) after the treatment. CONCLUSIONS: IL-2 increases the response rate with improved survival in a proportion of patients who relapse after allo-SCT and do not respond well to DLI alone. There is no major toxicity. It may therefore be valuable as adjuvant therapy in conjunction with DLI.

Graft vs Host Disease↗
PubMed1999

Amphotericin B lipid complex in the management of antimony unresponsive Indian visceral leishmaniasis.

Fifty-eight Indian patients with visceral leishmaniasis who did not respond or relapsed after 30 days of consecutive sodium stibogluconate therapy were randomised to treatment with amphotericin B lipid complex (ABLC) using a total dose of 7.5 or 10 mg/kg. Treatment induced a prompt clinical response in all patients with resolution of fever and regression in spleen size. Fever and chills developed during ABLC infusion, but it diminished with successive infusions. Fourteen days after treatment, 26 of 28 (93%) patients in the 7.5 mg/kg group and all 30 (100%) in the 10 mg/kg group had splenic aspirate parasite density scores of 0 and were considered apparent clinical and parasitologic responders. Four and three patients in the 7.5 and 10 mg/kg groups respectively relapsed during six months of followup; thus, overall 22 of 28 (79%) patients treated with 7.5 mg/kg and 27 of 30 (90%) treated with 10 mg/kg were definitive cures. All initial non-responders and relapses were retreated successfully with higher dose of ABLC. These results confirm the efficacy of short-course ABLC therapy for antimony-unresponsive Indian patients with visceral leishmaniasis. Since treatment with a total dose of 7.5 mg/kg did not appear to increase efficacy (79% vs. 84% induced by 5 mg/kg in a prior study), initial treatment with a total dose of 5 mg/kg followed by retreatment of any non-responders represents a potentially less costly approach in patients who fail antimony therapy. Though high cure rates are achieved with > or = 10 mg/kg total dose of ABLC, treatment using lower doses with retreatment of non-responders or relapses with higher dose can result in considerable savings.

Adolescent↗
PubMed1979

Relapse of pneumonia caused by cytomegalovirus in two recipients of renal transplants.

Two cases of relapse of pneumonia caused by cytomegalovirus (CMV) in recipients of renal transplants were studied. Between episodes of pneumonia, both patients recovered completely as judged by X-ray clearing and by resolution of fever and respiratory symptoms. CMV was isolated during each episode of pneumonia from lung tissue, pleural fluid, or buffy coat cultures. Serologic studies revealed a rise in titer of antibody, confirming recent infection with CMV during the first epidose of pneumonia in each patient. Intranuclear inclusions consistent with CMV infection were detected in each of the three episodes where lung tissue was obtained. Special stains and cultures for Pneumocystis carinii, fungi, Nocardia, and mycobacteria yielded negative results. The renal allograft continued to function in both patients after they recovered from the first bout of pneumonia, and the relapse was temporally related to reinstitution of aggressive immunosuppressive therapy. The relapse of pneumonia emphasizes the need for caution when immunosuppressive therapy is reinstituted after recovery from serious CMV infection.

Adolescent↗
PubMedDate not supplied

Fever of unknown origin (FUO) caused by multiple myeloma: the diagnostic value of the Naprosyn test.

Fever of unknown origin (FUO) remains a difficult diagnostic problem. The causes of FUO have changed over the years. Neoplastic disorders have now displaced infectious diseases as the most common cause of FUOs. Most neoplasms are associated with no or low-grade temperatures, with some important exceptions. Hypernephromas and lymphomas are neoplasms typically associated with high spiking fevers or may present as FUOs. Hematologic malignancies, that is, the acute and chronic leukemias, myeloproliferative disorders, and multiple myeloma, do not usually present with acute fevers or as FUOs. We present an elderly male patient who presented with an FUO, whose history is significant for multiple myeloma in remission. Differential diagnostic possibilities in this patient included plasma cell leukemia, relapse of multiple myeloma, secondary/superimposed malignancy, or opportunistic infection. The main differential diagnosis for his FUO was between neoplastic and infectious disorders. As part of the diagnostic workup, a Naprosyn test (naproxen 375 mg [by mouth] every 12 hours for 3 days) was used to differentiate neoplastic from infectious causes of FUO in this patient. The Naprosyn test was positive, which indicated a neoplastic explanation for the patient's FUO and eliminated, along with the infectious disease workup, an infectious explanation for his FUO. The patient's FUO was finally determined to be the result of a relapse of multiple myeloma and not of a secondary malignancy or malignant transformation of myeloma into plasma cell leukemia. We conclude the Naprosyn test remains a valuable diagnostic test to use to narrow differential diagnostic possibilities in patients with FUOs when a malignancy is a diagnostic consideration.

Aged↗
PubMed1990

Comparative efficacies of aztreonam and chloramphenicol in children with typhoid fever.

We compared aztreonam with chloramphenicol in a randomized trial involving the treatment of 36 children with typhoid fever. Eighteen children were randomized to receive aztreonam, 150 mg/kg/day intravenously, and 18 to receive chloramphenicol, 100 mg/kg/day orally. On entry in the study the clinical characteristics of the two treatment groups were comparable. The duration of therapy was 14.9 +/- 3.6 days for the aztreonam group and 12.8 +/- 2.6 days for the chloramphenicol group. The mean duration of fever was 5.9 +/- 3.1 days and 4.05 +/- 2.1 days for aztreonam and chloramphenicol groups respectively (P greater than 0.05). Clinical cure was observed in all patients treated with aztreonam and in 17 of 18 children given chloramphenicol; one patient died in the latter group. There were no relapses in either group. We observed clinical adverse reactions during the treatment with aztreonam in 2 patients. All strains of Salmonella typhi were susceptible to aztreonam, 1 strain was resistant to chloramphenicol and 3 strains were resistant to ampicillin. Aztreonam appears to be a satisfactory alternative to chloramphenicol in cases of typhoid fever caused by resistant strains or when chloramphenicol is contraindicated.

Adolescent↗
PubMed2002

A new acute inflammatory syndrome related to the introduction of mycophenolate mofetil in patients with Wegener's granulomatosis.

Mycophenolate mofetil (MMF) is increasingly used for prevention of allograft rejection and to treat immune disorders. We report the development of an acute inflammatory syndrome in two patients with Wegener's granulomatosis after MMF was introduced, because of persistent renal and systemic disease activity despite cyclophosphamide treatment. Within 1 week both patients developed an acute inflammatory syndrome, characterized by fever, arthralgias and muscle pain. No infection could be detected and no indications for increased Wegener's activity were present. MMF was stopped resulting in a rapid and complete resolution of the syndrome. A rechallenge with 2 g of MMF in the second patient resulted in a relapse of the syndrome within 4 days. There was an association between symptoms and increased levels of mycophenolic acid (MPA) acyl glucuronide and serum interleukin-6, suggesting the induction of inflammatory cytokines by MPA acyl glucuronide as the cause of the syndrome. Therefore, special attention should be given to side effects such as fever, arthralgias and muscle pain when treating patients with Wegener's granulomatosis during the active phase. Because this side effect of MMF may also occur after solid organ transplantation and in other immune disorders, pharmacokinetic profiling of MPA and MPA acyl glucuronide is needed in future studies with MMF.

Acute Disease↗
PubMed1997

Tuberculosis in childhood nephrotic syndrome in India.

We studied the prevalence, clinical features, and impact of tuberculosis (TB) on children with nephrotic syndrome (NS). Of the 300 children with NS, 28 (9.3%) were diagnosed as having TB. This occurred following the initiation of immunosuppressive therapy in 27 children, and in 1 child it preceded the onset of NS. Pulmonary involvement was the commonest (22/28), followed by tubercular lymphadenitis (2/28), meningitis (2/28), and occult TB (2/28). Of the various diagnostic criteria, history of previous cough, fever, or exposure to a case of TB (23/28) and chest skiagram (21/28) were the most useful. The occurrence of TB did not induce a relapse or affect the subsequent response to steroid therapy (as is often seen with other infections) or have a deleterious effect on renal function. Patients who received higher doses of steroids (frequent relapsers, steroid dependent, initial non-responders, and subsequent non-responders) had a significantly higher prevalence of TB (19/148) than those who received lower doses (infrequent relapsers 8/151) (P = 0.04). We thus found TB to be an important complication of children with NS in our country. The conventional diagnostic tests, such as Mantoux and acid-fast bacilli isolation, are often unhelpful in these children, and a high index of suspicion is required, especially in children who require frequent courses of steroid therapy.

Adolescent↗