Effectiveness and safety of ciclosporin as therapy for autoimmune diseases of the liver in children and adolescents.

BACKGROUND: Conventional treatment for autoimmune hepatitis results in a significant percentage of failures and several, poorly tolerated, side-effects. Therapy for autoimmune cholangitis and giant cell hepatitis associated with autoimmune haemolysis is poorly documented. Ciclosporin is a promising treatment for all of these diseases. METHODS: We reviewed the records of 12 patients treated in our unit between 1987 and 2001. Eight had autoimmune hepatitis, two had autoimmune cholangitis and two had giant cell hepatitis. Indications for ciclosporin were treatment failure (four patients) and contraindications to/refusal of steroids (eight patients). Ciclosporin was administered in five untreated cases and in seven patients during relapse. The mean duration of ciclosporin administration was 35.6 months (8-89 months). The median follow-up was 6.5 years (1.5-15 years). RESULTS: All patients achieved complete remission in a median period of 4.5 weeks (2-12 weeks). No treatment withdrawal due to side-effects occurred. Three patients required a combination of ciclosporin with conventional treatment due to severe liver function impairment. Tolerance to ciclosporin was excellent. A 20% transient elevation of serum creatinine occurred in one case, gingival hypertrophy in two and moderate hypertrichosis in two. CONCLUSIONS: Ciclosporin may be considered as a safe treatment for all autoimmune liver diseases and as an effective alternative for front-line therapy.

[Jacopo's chest (bad history of a pleural empyema). A case report]. / Il polmone di Jacopo (ovvero la brutta storia di un empiema pleurico). Descrizione di un caso clinico.

We present a case of pleural empyema, occurred in a healty 7 years boy. He was admitted to our hospital because of a lobare pneumonitis. The patient was administered with a 2 degrees generation Cefalosporine given intramuscularly and with Corticosteroid (1 mg/kg/die). After an initial improvement of his clinical conditions, he got worse so that he underwent a TC scan which showed the presence of a left pleural empyema requiring the insertion of an intercostal tube drainage followed by an intervention of decortication. The boy had some evidence of a staphylococcal etiology such as the evolution in empyema itself, the augmentation of antistafilolisinic title found during the illness, and the typical finding of blebs on chest radiograph. As cultures from both blood and drainage liquid samples remained sterile, we were unable to demonstrate a clear bacterial etiology of the empyema. It remains doubtful if corticosteroid administration could contribute to the severity of the pneumonia evolution.

[Loeffler syndrome and Mycoplasma pneumonitis. A case report]. / Sindrome di Loeffler e polmonite da Mycoplasma. Descrizione di un caso clinico.

We describe a clinical case of Loeffler syndrome occurred in a famale aged 13 years. This syndrome is characterized by fleeting pulmonary infiltrates and blood eosinophilia until 70%. Patients usually are only mildly ill or asymptomatic and recovery occurs from few days to some months. Principle causes are: a) mycetes as Aspergillus; b) helmints as Toxocara, Ancylostoma, Trichinella, Ascaris, Strongyloides, Schistosoma; c) chemical agents such as penicillin, para-aminosalycilic acid, hydralazine, nitrofurantoine, chlorpropamide. This girl came to our observation in good general conditions with murmur reduction on the thorax left side, marked peripheral eosinophilia (E 55% of 6100 white blood cell), right pulmonary infiltrate on RX and CT scan. One month before she had fever, treated with amoxycillin and clavulanic acid. Mantoux, Prick tests for main inhalant allergenes, ACE, repeated stools and seric investigations for parasites, mycetes and organisms, were negative except for IgM anti-Myco-plasma antibodies. Broncholavage showed marked eosinophilia. Smear didn't show any blast. The girl recovered in about 40 days (E 4.1% of 8500 WBC, RX negative). Our hypotesis is a causative role of amoxycillin in inducing the syndrome, even if this is a rare event, with an overlapping of a Mycoplasma infection.

Antibody-negative chronic hepatitis C virus infection in immunocompetent children.

Antibody-negative hepatitis C virus (HCV) infection, defined by the presence of HCV viremia in the absence of a serologic response to HCV, was detected in two immunocompetent and symptom-free children; each had a history of exposure to blood products. HCV infection may occasionally explain cryptogenic elevation of aminotransferases, even in the absence of serum anti-HCV. HCV-RNA should be investigated in these cases, particularly in the presence of previous exposure to blood products.