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no abstract avaliable
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No abstract available.
Asunto(s)
Claritromicina , Polimialgia Reumática , Prednisolona , TacrolimusRESUMEN
A 41-year-old man suffering from eosinophilic granulomatosis with polyangiitis (EPGA), diagnosed at another clinic on the basis of American College of Rheumatology Criteria, with a history of bronchial asthma, eosinophilia, mononeuritis multiplex, and non-fixed pulmonary infiltrates, was admitted to our department for further treatment. The patient complained of chest pain that started recently. An echocardiogram identified myocardial thickening and decreased wall motion, based on which the patient was diagnosed as having EPGA with myocarditis. The patient was successfully treated using glucocorticoids, such as methyl prednisolone (PSL) and PSL in combination with cyclophosphamide (CPM). However, CPM administration was discontinued afterwards because of the risk of bone marrow toxicity, the increased eosinophilic count (EOC) that we considered as an index of disease activity. Subsequently, the patient received additional clarithromycin (CAM) and tacrolimus (TAC) treatment considering their immunomodulatory effects. As a result, the EOC decreased and the PSL dosage could be reduced. This case shows that additional CAM and TAC treatment may be beneficial in some cases of EPGA.
Asunto(s)
Adulto , Humanos , Asma , Médula Ósea , Dolor en el Pecho , Claritromicina , Ciclofosfamida , Eosinofilia , Eosinófilos , Glucocorticoides , Granulomatosis con Poliangitis , Mononeuropatías , Miocarditis , Prednisolona , Reumatología , TacrolimusRESUMEN
A 74-year-old man suffering from cryptogenic organizing pneumonia (OP) visited our department with arthralgia accompanied with partial swellings of proximal interphalangeal and metacarpophalangeal joints with morning stiffness. A diagnose of rheumatoid arthritis (RA) was made. It was thought that OP was associated with RA. We initiated a treatment with salazosulfapyridine and loxoprofen for RA. Although this treatment was effective, it was discontinued due to the development of drug eruption. As an alternative, the patient was treated with prednisolone (PSL) and clarithromycin (CAM). This treatment demonstrated being effective for OP and RA, to a certain extent; however, the RA activity was not completely suppressed. In order to suppress the RA activity further, tacrolimus (TAC) was successfully added with increasing the dosage of CAM that is assumed to raise blood TAC concentrations. The present case shows that treatment with PSL, CAM and TAC may be effective in some cases of RA.
Asunto(s)
Anciano , Humanos , Artralgia , Artritis Reumatoide , Claritromicina , Neumonía en Organización Criptogénica , Erupciones por Medicamentos , Articulación Metacarpofalángica , Neumonía , Prednisolona , Sulfasalazina , TacrolimusRESUMEN
We report a case of Waldenström's macroglobulinemia (WM) treated using clarithromycin (CAM) and prednisolone (PSL). An 84-year-old woman was admitted to our hospital for bleeding after a tooth extraction and hematuria. Computed tomography showed multiple ill-defined nodules in the omentum (omental cake). Although the cause of the omental cake remained unclear, the patient was diagnosed with WM, based on the detection of M-protein of immunoglobulin (Ig) M in serum and lymphoplasmacytes in bone marrow. The bleeding tendency in the patient may have been due to acquired hemophilia and/or hyper IgM-induced platelet dysfunction. The patient was treated using CAM (800 mg/day) and PSL (10 mg/day). As a result, IgM levels gradually decreased. Because the omental cake contracted along with improvement in IgM, it was thought to be lymphoplasmacytic lymphoma-like lymphoma. This case shows that treatment using CAM and PSL may be effective in some cases of WM.
Asunto(s)
Anciano de 80 o más Años , Femenino , Humanos , Plaquetas , Médula Ósea , Claritromicina , Hematuria , Hemofilia A , Hemorragia , Inmunoglobulina M , Inmunoglobulinas , Linfoma , Epiplón , Prednisolona , Extracción Dental , Macroglobulinemia de WaldenströmRESUMEN
A 60-year-old man who had been diagnosed with protein-losing enteropathy (PLE) and vitiligo at age 51 years was admitted with dyspnea, hemoptysis, and lower-limb edema. On the basis of computed tomography findings, the cause of respiratory symptoms was thought to be diffuse alveolar hemorrhage (DAH). The final diagnosis of late-onset systemic lupus erythematosus (SLE) was established on the basis of renal biopsy examinations that revealed evidence of active SLE with lupus nephritis (World Health Organization, class V) and positive results for antinuclear antibody. DAH, as well as PLE and vitiligo were attributed to SLE. The patient was successfully treated with methylprednisolone and then prednisolone in combination with cyclosporin A. Because late-onset SLE is rare and patients tend to show atypical symptoms, close attention should be paid to the preceding symptoms.
Asunto(s)
Humanos , Persona de Mediana Edad , Anticuerpos Antinucleares , Biopsia , Ciclosporina , Diagnóstico , Disnea , Edema , Hemoptisis , Hemorragia , Lupus Eritematoso Sistémico , Nefritis Lúpica , Metilprednisolona , Prednisolona , Enteropatías Perdedoras de Proteínas , VitíligoRESUMEN
Macrolide antibiotics provide not only antibacterial activity but also anti-inflammatory effects. We report herein two cases of uncontrolled rheumatoid arthritis (RA), accompanied by hepatitis B and pulmonary empyema, respectively, who were successfully treated using clarithromycin (CAM) in expectation of its anti-inflammatory effects. A 74-year-old woman suffering from RA, presented with exacerbation of arthralgia. Because she was a hepatitis B carrier, she could not receive biological agents. She was successfully treated with CAM as an alternative to biological agents. A 77-year-old man suffering from RA, presented with exacerbation of arthralgia. Because he had suffered from pulmonary empyema, he did not receive biological agents. He was successfully treated with CAM as an alternative to biological agents. These present cases suggest that CAM treatment may be effective for RA.
Asunto(s)
Anciano , Femenino , Humanos , Antibacterianos , Antiinflamatorios , Artralgia , Artritis Reumatoide , Factores Biológicos , Claritromicina , Empiema , Hepatitis BRESUMEN
No abstract available.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Ciclosporina/uso terapéutico , Resistencia a Medicamentos , Sustitución de Medicamentos , Quimioterapia Combinada , Inmunosupresores/uso terapéutico , Prednisolona/uso terapéutico , Enfermedad de Still del Adulto/sangre , Tacrolimus/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
No abstract available.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéutico , Claritromicina/uso terapéutico , Polimialgia Reumática/diagnóstico , Resultado del TratamientoRESUMEN
A 73-year-old woman was admitted with fever, arthralgia, and swelling of the hands and feet. She was diagnosed with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) accompanied by breast carcinoma, a type of paraneoplastic syndrome. Treatment with acetaminophen and diclofenac sodium for fever and arthralgia proved minimally effective. She experienced great difficulty in walking and grasping smoothly due to edema; therefore, clarithromycin (CAM) was added in expectation of its anti-inflammatory effects. About 10 days after starting CAM treatment, pitting edema improved considerably. Fever and arthralgia did not improve satisfactorily after resection of breast carcinoma, and thus she was successfully treated with low-dose prednisolone (PSL). This case suggests that other than surgical resection of the neoplasm, CAM and PSL treatment for RS3PE associated with neoplastic disease may be effective.
Asunto(s)
Anciano , Femenino , Humanos , Acetaminofén , Artralgia , Neoplasias de la Mama , Claritromicina , Diclofenaco , Edema , Fiebre , Pie , Mano , Fuerza de la Mano , Síndromes Paraneoplásicos , Prednisolona , Sinovitis , CaminataRESUMEN
No abstract available.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica , Claritromicina/administración & dosificación , Ciclofosfamida/administración & dosificación , Linfoma Folicular/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Prednisolona/administración & dosificación , Inhibidores de la Síntesis de la Proteína/administración & dosificaciónRESUMEN
Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by eosinophilic infiltration of the gastrointestinal tract, which is usually associated with abdominal pain, diarrhea, ascites, and peripheral eosinophilia. Steroids remain the mainstay of treatment for EGE, but symptoms often recur when the dose is reduced. Macrolides have immunomodulatory effects as well as antibacterial effects. The immunomodulatory effect results in inhibition of T-lymphocyte proliferation and triggering of T-lymphocyte and eosinophil apoptosis. Macrolides also have a steroid-sparing effect through their influence on steroid metabolism. We report a rare case of EGE, which relapsed on steroid reduction but improved following clarithromycin treatment.