Diffuse alveolar hemorrhage is a very rare manifestation in Henoch-Schoenlein purpura. Recently we experience a case of diffuse alveolar hemorrhage associated with Henoch-Schoenlein purpura which was diagnosed by typical clinical manifestation and renal biopsy. A 25 year old male was admitted due to hemoptysis and dyspnea. Chest X-ray, HRCT and BAL revealed diffuse alveolar hemorrhage. He also had a history of skin rash, polyarthralgia, and hematochezia with abdominal pain. Renal biopsy which was taken for the evaluation of microscopic hematuria showed IgA nephropathy. Under the diagnosis of Henoch-Schoenlein purpura, we treated him with solumedrol pulse therapy, plasma-pheresis and prednisolone with cytoxan. After then he showed marked improvement in clinical manifestation and was discharged with prednisolone and cytoxan.
Abdominal Pain ; Arthralgia ; Biopsy ; Cyclophosphamide ; Diagnosis ; Dyspnea ; Exanthema ; Gastrointestinal Hemorrhage ; Glomerulonephritis, IGA ; Hematuria ; Hemoptysis ; Hemorrhage* ; Humans ; Male ; Methylprednisolone Hemisuccinate ; Prednisolone ; Purpura, Schoenlein-Henoch* ; Thorax

PURPOSE: The incidence of complete remission is lower and the relapse is more frequent in adult-onset minimal change nephrotic syndrome (MCNS) are observed especially when compared with those in children. This study was designed to examine the effect of methylprednisolone pulse therapy in adultonset MCNS comparing to oral steroid as an initial therapeutic modality. METHODS: We have retrospectively reviewed the clinical data of 25 adult-onset MCNS patients. Twelve patients were treated with three intravenous pulses of methylprednisolone (1 g daily) followed by oral prednisolone 1 mg/kg daily for 4-8 weeks and also by low doses of oral prednisolone for 4-6 months (MP group) Thirteen patients were initially treated with oral prednisolone 1 mg/kg daily for 4-8 weeks and then with low doses of oral prednisolone (PD group). RESULTS: The response to therapy was similar between MP and PD group, with a complete remission obtained in 83.3% and 84.6%, respectively. No statistically significant difference between the two groups was observed in the rate of response at 8 weeks (58.3% versus 69.2%). The mean time to response was not different between MP group (37.9+/-28.0 days) and PD group (45.5+/-40.2 days). No difference was recognized between the two groups with respect to relapse rate. CONCLUSION: These data suggest that a short course of methylprednisolone pulse therapy followed by oral prednisolone is not superior to oral prednisolone therapy as an initial therapeutic modality in adult-onset MCNS.
Child ; Humans ; Incidence ; Methylprednisolone* ; Nephrosis, Lipoid* ; Prednisolone ; Recurrence ; Retrospective Studies

Acute disseminated encepahalomyelitis(ADEM) is acute monophasic infammatory demyelinating disease of the central nervous systems occurring several days to two weeks after viral illness or vaccination. ADEM following rubella infection is very rare. We experienced a case of 24-years old man who developed confusion, nysmgmus, paraparesis, and voiding difficulty three days after the recovery form rubellar infection expressing skin rash and fever. CSF study showed pleocytosis(119cells/mm3), increased titer of [gM and IgG for rubella,, and myelin basic protein, whereas the level of the glucose and protein is normal. MRI of brain, cervical and thoracic spinal cord showed multiple high signa] intensities in the deep white matter of brain, entire cervical and upper thoracic spinal cord. He had been treated with high dose solumedrol intravenously for six days, and then oral prednisolone for ninteen days. Follow-up CSF study after seven days showed normal profiles and MRI after three weeks demonstrated remarkably decreased size of the previous lesions. He showed much improvement of neurologic symptoms except mild voiding difficulty. We report a case diagnosed as ADEM with good prognosis following rubella infection.
Brain ; Central Nervous System ; Demyelinating Diseases ; Exanthema ; Fever ; Follow-Up Studies ; Glucose ; Humans ; Immunoglobulin G ; Magnetic Resonance Imaging ; Methylprednisolone Hemisuccinate ; Myelin Basic Protein ; Neurologic Manifestations ; Paraparesis ; Prednisolone ; Prognosis ; Rubella* ; Spinal Cord ; Vaccination ; Young Adult

PURPOSE: The purpose of this paper was to examine the correlation between the development of posterior subcapsular cataract and the dosage and duration of systemic steroid therapy. METHODS: Twenty-two eyes which underwent cataract surgery at our ophthalmologic department were enrolled, along with 20 randomly selected eyes, which received prednisolone therapy at least for 1 year. We examined prednisolone dosage, duration and systemic disorders. We compare daily prednisolone dosage, and duration between the subcapsular opacity group and the non-subcapsular opacity group. SPSS, with 2 way- ANOVA system, was used for statistical analysis. RESULTS: The development of posterior subcapsular cataract was correlated with the daily prednisolone dosage, but not with the duration of prednisolone therapy (p<0.05). CONCLUSIONS: Careful attention to the daily steroid dosage is required to prevent posterior subcapsular cataract formation.
Cataract* ; Prednisolone*

A 42-year-old man presented with severe pancytopenia and uncontrolled epistaxis. The diagnosis of SLE was made and the pancytopenia was found to be due to myelofibrosis. The pulse therapy with methylprednisolone and maintenance therapy with prednisolone reversed both pancytopenia and myelofibrosis. Although myelofibrosis has been described in SLE, this coexistence must be very rare since there has been only 19 cases showing this combination. We report a case of SLE with myelofibrosis which was reversed by the treatment with glucocorticoid.
Adult ; Diagnosis ; Epistaxis ; Humans ; Lupus Erythematosus, Systemic* ; Methylprednisolone ; Pancytopenia ; Prednisolone ; Primary Myelofibrosis*

Methylprednisolone pulse therapy was performed for 8 patients of childhood nephrotic syndrome who showed resistance to conventional prednisolone therapy of 4 to 8 weeks. The pathological diagnosis of the patients were: 1 case of membranous nephropathy, membrano-proliferative glomerulonephritis, Menbranoproliferative glomerulonephritis with epithelial crescent (70%), sclerosing glomerulonephritis, mesangial proliferative glomerulonephritis, focal and global glomerulonephritis, and 2 cases of focal and segmental glonerulosclerosis. Creatinine clearance was above 50% of the normal in 7 cases, and less than 20% in crescentic glomerulonephritis. 20% in crescentic glomerulonephritis. 30gm/kg/D. of methylprednisolone was administered intravenously over 1~2hours, which was repeated 2 to 9 times on every other day. Thereafter, alternate day prednisolone therapy was continued. The results were as follows: Remission was attained in membranous nephropathy and MPGN, within 9 weeks and 13 weeks respectively. Marked improvement was noted in crescentic glomerulonephritis. Ccr increased from 18.5ml/min/1.73mm(2) to 59.1ml/min/1.73mm(2) 10 days later after pulse? Sclerosing glomerulonephritis showed significant improvement in clinical finding and serum albumin. There was no improvement in mesangial proliferative glomerulonephritis, focal and global glomerulonephritis, and 2 cases of focal and segmental glomerulosclerosis. These findings suggest that methylprednisolone pulse?therapy may benefit the childhood nephrotic syndrome with resistance to conventional prednisolone therapy.
Creatinine ; Diagnosis ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Humans ; Methylprednisolone ; Nephrotic Syndrome* ; Prednisolone* ; Serum Albumin

Optic neuritis is an acute inflammatory disease of the optic nerve. Visual loss in optic neuritis is typically sudden and accompanied visual field defects. We attempted to characterize the clinical manifestations of optic neuritis based on visual acuity and visual field changes. Eighteen patients were included in this study who completed at least 3 month follow-up. we observed these patients with no medication in ten, with oral prednisolone in seven and with intravenous methylprednisolone in one. Statistically significant visual recovery occurred at first and second month and twenty eyes of 27 eyes (74%) had improved o.5 or more. Most common type of visual field defect was central scotoma (74%) and 85% of eyes who showed abnormal visual fields at first visit recovered normal visual field during follow-up period.
Follow-Up Studies ; Humans ; Methylprednisolone ; Optic Nerve ; Optic Neuritis* ; Prednisolone ; Scotoma ; Visual Acuity ; Visual Fields

BACKGROUND: Acute diffuse alopecia areata (AA) was described as a unique AA which mimics anagen effluvium, or in which the initial hair loss is diffuse and followed by total denudation of scalp within several weeks or months. In spite of its peculiar clinical feature, there was neither further characterization nor known effective treatment for this form of AA. OBJECTIVE: To evaluate the characteristic clinical findings of acute diffuse AA and confirm the effect of high dose methyl prednisolone therapy. METHODS: The medical records of 13 patients with acute diffuse AA between January 2002 and April 2006 at the Department of Dermatology, Chungnam National University Hospital were reviewed. All patients were treated with high dose methylprednisolone therapy. RESULTS: Of the 13 patients who completed the study, 8 patients (61.5%) were male and 5 patients (38.5%) were female. The mean age was 29.6 years old. The progress of hair loss stopped 2.4 weeks on average after initial treatment and newly emerging hairs were recognized 4.1 weeks on average after initial treatment. 84.6% (11/13) of patients showed terminal hair growth, and 46.2% (6/13) of patients completely responded to this therapy. CONCLUSION: Acute diffuse alopecia areata can occur in male as well as in female patients. High dose methylprednisolone therapy appears to be effective in patients with rapidly progressing acute diffuse alopecia areata to prevent the progression of the disease.
Alopecia Areata* ; Alopecia* ; Chungcheongnam-do ; Dermatology ; Female ; Hair ; Humans ; Male ; Medical Records ; Methylprednisolone ; Prednisolone ; Scalp

PURPOSE: Since Mendoza(1990)'s report that long term methylprednisolone pulse therapy by Mendoza protocol (MP therapy) is a good treatment option in focal segmental glomerulo -sclerosis(FSGS), there have been reports of the effects of this therapy in steroid-resistant nephrotic syndrome. However, no studies have been performed on the effects of MP therapy in steroid-dependent nephrotic syndrome and secondary nephrotic syndrome. In this study, we investigated the effects of long term MP therapy in primary and secondary nephrotic syndrome in which previous treatment options were not effective. METHODS: We chose 10 children who were diagnosed with steroid-dependent minimal change nephrotic syndrome(SD-MCNS), who had shown frequent relapse during the immunocompromised or cytotoxic therapy period, and 6 children with FSGS and 5 children with secondary nephrotic syndrome children, who had shown no response during the previous therapy period. We treated these patients according to Mendoza protocol involving infusions of high doses of methyl- prednisolone, often in combination with oral cyclophosphamide for 82 weeks. RESULTS: In all the 10 children with SD-MCNS, complete remission was visible on average of 18+/- days after MP therapy was started. However, all these children relapsed during or after MP therapy. In these children, the mean relapse rate prior to MP therapy was 2.1+/-.0 relpases/year, which was reduced to 1.4+/-.9 relapses/year during MP therapy(P>0.05) and rose to 2.7+/-.0 relapse/year after MP therapy. Of the 6 children with FSGS, 4 children(67%) showed complete remission, of whom 3 children(50%) remained in the remission status during the follow up period, 1.2+/-.7 years, after the end of MP therapy. 2 children(33%) showed no response. All of the 5 children with secondary nephrotic syndrome showed remission and remained in the remissiom status during the follow up period, 1.7+/-.6 years. The only side effect of MP therapy was transient hypertension in 10 children of all subjects during the intravenous infusion of methylprednisolone. CONCLUSION: We conclude that although long term MP therapy is not effective in the treatment of SD-MCNS, it is an effective therapy against intractable FSGS and secondary nephrotic syndrome.
Child ; Cyclophosphamide ; Follow-Up Studies ; Humans ; Hypertension ; Infusions, Intravenous ; Methylprednisolone* ; Nephrotic Syndrome* ; Prednisolone ; Recurrence

Thyrotoxic periodic paralysis (TPP) is a disease characterized by sudden onset and muscle paralysis. It occurs in the setting of hypokalemia of thyrotoxicosis. Cases of TPP induced by a glucocorticoid such as prednisolone or methylprednisolone have been reported. We report on two patients, each of whom received a dexamethasone injection and subsequently developed TPP. Both patients experienced sudden, flaccid paralysis of both extremities after the injection but recovered completely after receiving a potassium replacement. Laboratory results revealed thyrotoxicosis. The patients were diagnosed with Graves' disease and discharged after receiving treatment with methimazole and propranolol. This report provides the clinical description of TPP induced by dexamethasone injection. These cases suggest that clinicians must consider the presence of hyperthyroid disease in patients who develop acute paralysis after treatment with a glucocorticoid, even in the absence thyrotoxic symptoms. Furthermore, physicians should be aware that TPP can occur even in response to dexamethasone used for treatment of thyrotoxic crisis or Graves' ophthalmopathy.
Dexamethasone ; Extremities ; Graves Disease ; Humans ; Hypokalemia ; Methimazole ; Methylprednisolone ; Muscles ; Paralysis ; Potassium ; Prednisolone ; Propranolol ; Thyroid Crisis ; Thyrotoxicosis