We report treatment of a 38-year-old man with minimal change disease (MCD) who developed pneumatosis intestinalis (PI) during administration of immune-suppressive agents. His immunosuppressive medication had been tapered to 15 mg/day of prednisolone. MCD was steroid-resistant type. Abdominal examination and laboratory studies were not clinically remarkable. Radiologic findings were consistent with PI. Abnormal air accumulation was noted in the bowel, peritoneum, mediastinum and retroperitoneum. Conservative therapy with oxygen and metronidazole improved the PI symptoms. In 1993, a case of PI with nephrotic syndrome following steroid treatment was reported in Japan. However this is only the second case reported in the literature, and the first in English.
Adult ; Case Report ; Human ; Immunosuppressive Agents/*adverse effects ; Male ; Nephrosis, Lipoid/*drug therapy ; Pneumatosis Cystoides Intestinalis/*chemically induced ; Prednisolone/*adverse effects

Rituximab, a chimeric monoclonal antibody directed against CD20, has become a part of the standard therapy for patients with non-Hodgkin's lymphoma either in combination with other drugs or as a single agent. The CD20 antigen is expressed on 95% of B-cell lymphoma cells and normal B-cells but, is not found on precursor B-cells or stem cells. Rituximab is now approved for patients with diffuse large B-cell lymphoma when combined with standard CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisone) or patients with follicular lymphoma who have failed first line chemotherapy. The monoclonal antibody is generally well tolerated. Most of the adverse events are infusion-associated, mild to moderate non-hematological toxicities. Severe respiratory adverse events have been infrequent. Here, we report two patients with non-Hodgkin's lymphoma in whom interstitial pneumonitis developed with rituximab therapy.
Prednisolone/therapeutic use ; Methylprednisolone/therapeutic use ; Male ; Lung Diseases, Interstitial/*chemically induced/diagnosis/drug therapy ; Humans ; Antineoplastic Agents/*adverse effects ; Antibodies, Monoclonal/*adverse effects ; Aged

Systemic steroids are highly effective for patients with moderate-to-severe asthma exacerbations. Steroid-induced psychosis is known to be one of the adverse effects of steroid therapy, although infrequent. However, there is no reliable method of predicting steroid psychosis. We experienced the case of a 40-year-old asthmatic man who had previously taken steroids without any psychological side effect, but became acutely delirious after receiving some doses of steroids, higher than the previous doses, under a condition of emotional stress. The mean dose of prednisolone administered was 82 mg/day (1.37 mg/kg/day) for 10 days but the patient had taken two courses of steroids (0.82 mg/kg/day and 0.5 mg/kg/day, respectively) for asthma exacerbations without any psychiatric episodes during the previous year.At this time, the patient was under a condition of emotional stress related to family reasons. The asthmatic exacerbation of this case may be precipitated from sudden emotional stress and the following treatment with a high dose of steroida should be used cautiously due to the possibility of psychotic side reactions.
Adult ; Asthma/drug therapy ; Case Report ; Delirium/*chemically induced ; Glucocorticoids, Synthetic/administration & dosage/*adverse effects ; Human ; Male ; Prednisolone/administration & dosage/*adverse effects

In Singapore, the approved influenza A (H1N1) vaccines are Panvax® and Pandemrix®. An estimated 425,000 doses of Panvax and less than 100 doses of Pandemrix had been distributed in Singapore from November 2009 to February 2010. Reviews on the H1N1 vaccine have concluded that it has a safety profile similar to that of seasonal influenza vaccines. From the time the H1N1 vaccination was implemented in Singapore on November 3, 2009, up to October 11, 2010, the Health Sciences Authority had received 173 adverse event reports from healthcare professionals. We report a case of prolonged illness after H1N1 vaccination.
Adult ; Exanthema ; chemically induced ; diagnosis ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza Vaccines ; adverse effects ; Prednisolone ; therapeutic use ; Pruritus ; chemically induced ; diagnosis ; Singapore ; Treatment Outcome ; Vaccination ; adverse effects

INTRODUCTIONLong-term, high-dose corticosteroid therapy is well-known to cause systemic and ocular complications. A lesser known complication is chronic central serous chorioretinopathy (CSCR). Although idiopathic central serous chorioretinopathy (CSCR) is known to be mild with spontaneous recovery and minimal effects on the final visual acuity, chronic CSCR as a complication of long- term steroid therapy behaves differently, and may cause irreversible visual impairment.

CLINICAL PICTUREThree cases of chronic, recurrent CSCR were precipitated by longterm corticosteroids prescribed for post-renal transplant immunosuppressive therapy, postpituitary surgery and pemphigus vulgaris.

TREATMENT AND OUTCOMETwo cases resolved with tapering of corticosteroids while one case was treated by focal laser photocoagulation. Two eyes had severe impairment of vision as a result of subretinal scar formation while the other 4 eyes had mild reduction of visual acuity from retinal epithelium pigment atrophy.

CONCLUSIONLong-term corticosteroid therapy can be complicated by severe, chronic and recurrent CSCR and occasionally peripheral exudative retinal detachment. This may result in subretinal fibrosis and permanent loss of vision.

Adult ; Blindness ; chemically induced ; Choroid Diseases ; chemically induced ; diagnosis ; therapy ; Fluorescein Angiography ; Glucocorticoids ; adverse effects ; Humans ; Hydrocortisone ; adverse effects ; Male ; Middle Aged ; Prednisolone ; adverse effects ; Retinal Detachment ; chemically induced ; diagnosis ; therapy

OBJECTIVETo investigate the feasibility and efficacy of rituximab combined with high-dose chemotherapy supported by autologous peripheral blood stem cell transplantation (ASCT) in patients with aggressive B-cell non-Hodgkin lymphoma (NHL).

METHODSTwenty-eight patients with aggressive B-cell NHL (22 newly diagnosed, 6 relapsed) were enrolled in this study. The high-dose chemotherapy included CHOP regimen (CTX + ADM + VCR + PDN) for the newly diagnosed patients and DICE (DEX + IFO + DDP + VP-16) or EPOCH (VP-16 + PDN + VCR + CTX + ADM) for the relapsed patients. Each patient received infusion of rituximab at a dose of 375 mg/m(2) for four times, on D1 before and on D7 of peripheral blood stem cell mobilization, and on D1 before and D8 after stem cell reinfusion.

RESULTSComplete remission was achieved in all patients after high dose chemotherapy and ASCT. At a median follow-up of 37 months, the estimated overall 4-year survival and progression-free survival rate for all patients were 75.0% and 70.3%, respectively, while both were 72.7% for the previously untreated patients. The therapy was generally well tolerated with few side-effects attributable to rituximab.

CONCLUSIONThese results suggest that adding rituximab to high-dose chemotherapy with peripheral blood stem cell transplantation is feasible and may be beneficial for patients with aggressive B-cell non-Hodgkin lymphoma.

Adolescent ; Adult ; Antibodies, Monoclonal, Murine-Derived ; adverse effects ; therapeutic use ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Cisplatin ; adverse effects ; therapeutic use ; Combined Modality Therapy ; Cyclophosphamide ; adverse effects ; therapeutic use ; Dexamethasone ; adverse effects ; therapeutic use ; Disease-Free Survival ; Doxorubicin ; adverse effects ; therapeutic use ; Etoposide ; adverse effects ; therapeutic use ; Female ; Fever ; chemically induced ; etiology ; Humans ; Ifosfamide ; adverse effects ; therapeutic use ; Lymphoma, Large B-Cell, Diffuse ; therapy ; Male ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Prednisolone ; adverse effects ; therapeutic use ; Prednisone ; adverse effects ; therapeutic use ; Prospective Studies ; Remission Induction ; Rituximab ; Survival Rate ; Vincristine ; adverse effects ; therapeutic use ; Vomiting ; chemically induced ; Young Adult

By means of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay, the association between vitamin D receptor (VDR) genotypes and bone mineral density (BMD) in the patients receiving long-term glucocorticoid therapy was studied. The clinical data and blood of 71 patients with rheumatosis who received long-term glucocorticoid therapy were collected. BMD was measured by dual-energy X-ray absorptimometry. VDR gene fragment (about 185 bp) was amplified by PCR from the extracted genomic DNA, then digested with restriction endonuclease Bsm I. The genotypes were evaluated based on the fragment length following endonuclease digestion and the association between genotypes and BMD or Z-score values was analyzed. Among the 71 cases, the detected genotypes were Bb and bb with the distribution frequency being 11.3% and 88.7% respectively. The distribution frequency of the alleles was in agreement with the Hardy-Weinberg equilibrium. There was no significant difference between the two genotypes in age, gender, body mass index (BMI), disease duration, disease types, time of glucocorticoid administration and cumulative dosage (P > 0.05). Osteoporosis rate of the patients with Bb or bb genotype was 37.5% and 33.3% respectively, with the difference being not significant (chi 2 = 0.05, P = 0.8). The BMD and Z-score values at lumbar spine and femur in two genotypes were not similar, but the difference had no significant (P > 0.05). The distribution frequency of bb type of VDR genotypes in Han populations of China was more prevalent, followed by Bb and bb types in turn. In the patients receiving long-term glucocorticoid therapy, there was no significant difference in BMD between Bb and bb genotypes. The data suggest that the VDR genotypes may not be means of identifying patients at greater risk of glucocorticoid-induced osteoporosis, which await to be further confirmed by a large sample size.
Arthritis, Rheumatoid/drug therapy ; Bone Density ; Genotype ; Lupus Erythematosus, Systemic/drug therapy ; Osteoporosis/chemically induced ; Osteoporosis/*genetics ; *Polymorphism, Restriction Fragment Length ; Prednisolone/*adverse effects ; Prednisolone/therapeutic use ; Receptors, Calcitriol/*genetics

Liver transplantation is the only curative therapy for patients with end-stage liver disease. The high success rate and the increasing demand for the transplantation sometimes calls for ABO-compatible but nonidentical blood group orthotopic liver transplantation (OLT), which affords the opportunity to the production of antibody to red blood cells. Hemolytic anemia usually occurs 1 to 2 weeks after transplantation. Although mild in most patients, it can be life-threatening. Until now, a few cases showing hemolytic anemia due to donor ABO antibody formation after ABO-nonidentical OLT have been reported. In the reported cases of hemolytic anemia, most ABO-nonidentical OLT cases were O-to-A, but few reports are available on this subject with O-to-B ABO- nonidentical OLT. Herein, we report the experience with hemolysis after ABO-nonidentical OLT in a group O donor into a group B recipient and the successful treatment with transfusion of washed group O red blood cells and 60 mg dose of prednisolone for 3 days.
*ABO Blood-Group System ; Adult ; Anemia, Hemolytic/*etiology/therapy ; Blood Group Incompatibility/*complications ; Erythrocyte Transfusion/adverse effects ; Glucocorticoids/*administration & dosage ; Humans ; *Liver Transplantation ; Male ; Prednisolone/*administration & dosage

OBJECTIVESTo identify significantly differentially expression genes of steroid-induced femoral head necrosis (SINFH) of rats by gene chip, and to find out the potential factors and molecular mechanisms that oxidative stress originate or strengthen the SINFH.

METHODSTwenty Wistar rats were divided into experimental group and control group randomly. E. coli endotoxin was given to all rats at a dose of 20 µg/kg body weight by daily i.p. for two times. Then methylprednisolone (40 mg/kg) or saline was daily injected into the left gluteus muscle of the rats in experimental group and control group respectively. Six weeks later, the mRNA was extracted from the femoral head of rats in every group, and the cDNA were obtained by inverse transcript, then carried out microarray detection. The quantitative RT-PCR was used to confirm the result of microarray, and the differentially expressed genes were analyzed for the functional annotation by gene ontology (GO).

RESULTSCompared to the control group, 190 genes in the experimental group were differentially expressed, with 52 up-regulated and 138 down-regulated. Of these genes, 102 are known (have deposited in GeneBank), while 88 of them are unknown. The known genes can be divided into several families according to their biological functions, such as: oxidative stress, apoptosis, signal transduction, angiogenesis, extracellular matrix, lipid metabolism, and gene transcription related genes. The results of quantitative RT-PCR are consistent with gene-chip results.

CONCLUSIONSThe occurrence of SINFH is a complicated process affected by multiple factors and signaling pathways. Our findings indicate that many genes which are involved in different signaling pathways were differentially expressed between SINFH rats and normal rats.

Animals ; Endotoxins ; toxicity ; Female ; Femur Head Necrosis ; chemically induced ; genetics ; Gene Expression ; Genomics ; Male ; Oligonucleotide Array Sequence Analysis ; Prednisolone ; adverse effects ; Rats ; Rats, Wistar

A 53-year-old man having glaucoma treated with acetazolamide. After 7 days, he developed diffuse erythematous papules on both forearms and hands with multiple erosive lesions on his lips and genitalia. In the diagnosis of Stevens-Johnson syndrome, he was treated with systemic prednisolone with no sequale. Acetazolamide, which is a kind of sulfa drug and carbonic anhydrase inhibitor is commonly prediscribed by ophthalmologists. However severe side effects such as Stevens-Johnson syndrome has been overlooked. Moreover, according to recent research, HLA-B59 was known to be detected in Stevens-Johnson syndrome caused by methazolamide, which is analogous to acetazolamide. For these reasons, we emphasized the possibility of adverse drug reaction due to acetazolamide and the need caution about genetic risk factor through HLA typing.
Acetazolamide* ; Carbonic Anhydrases ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Forearm ; Genitalia ; Glaucoma ; Hand ; Histocompatibility Testing ; Humans ; Lip ; Methazolamide ; Middle Aged ; Prednisolone ; Risk Factors ; Stevens-Johnson Syndrome*