OBJECTIVE: To investigate the effect of corticosteroids therapy on the inflammatory response in a critically ill coronavirus disease 2019 (COVID-19) patient. METHODS: A 55-year old female patient with critical ill COVID-19 was admitted in Taizhou Hospital on January 19, 2020. The patient was treated with methylprednisolone 80 mg on the 2nd day after admission. Thereafter, the dose was adjusted in a timely manner and the therapy lasted for 13 days. The peripheral lymphocyte subsets (CD3T, CD4 T, CD8 T, NK cells, B cells), as well as serum levels of lymphocyte factors (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ) were dynamically monitored. RESULTS: On D1 of admission, the numbers of peripheral blood CD3 T, CD4 T, CD8 T, and NK cells were significantly lower than the normal range. With the improvement of the disease, the numbers of CD3 T, CD8 T and CD4 T cells gradually recovered and showed a linear growth trend (linear fitting equation: =18.59+109.4, <0.05). On D2 of admission, the patient's IL-6 and IL-10 levels were significantly higher than normal values, IFN-γ was at a normal high value, and then rapidly decreased; IL-2, IL-4, and TNF-α were all in the normal range. On the D6 and D7, the IL-6 and IL-10 decreased to the normal range for the first time. On the D18, the sputum virus nucleic acid test was negative for the first time, and the fecal virus nucleic acid test was still positive; on the D20 the sputum and fecal virus nucleic acid test were both negative. On D34, the patient recovered and was discharged. At the discharge the muscle strength score of the patient was 44 and the daily life ability evaluation was 90. CONCLUSIONS In the absence of effective antiviral drugs, early use of appropriate doses of corticosteroids in critically ill patient with COVID-19 can quickly alleviate inflammatory response and improve clinical symptoms, however, it may reduce the number of T cells, and to adjust the dose in time is necessary.
Betacoronavirus ; isolation & purification ; Cell Count ; Coronavirus Infections ; diagnosis ; drug therapy ; immunology ; physiopathology ; Critical Illness ; Cytokines ; blood ; Female ; Humans ; Methylprednisolone ; administration & dosage ; adverse effects ; Middle Aged ; Pandemics ; Pneumonia, Viral ; diagnosis ; drug therapy ; immunology ; physiopathology ; T-Lymphocyte Subsets ; drug effects ; Treatment Outcome

Acute hemorrhagic leukoencephalitis (AHLE) is an acute, rapidly progressing, fulminant demyelinating disease. It is a rare disease of the central nervous system with high mortality; survivors commonly present with significant neurological deficit. We report the case of a 16-month-old girl who survived AHLE and presented with the associated neurologic deficit. The patient came into the emergency department with febrile seizure. She showed bilateral pinpoint-sized pupils and hyperactive deep tendon reflexes. Her mental status was initially drowsy and rapidly progressed to stupor. Extensive demyelination and microbleeds were found in the cerebral white matter, thalamus and left cerebellum on Magnetic resonance imaging (MRI) scans. Her mental status was improved by intravenous administration of immunoglobulin and methylprednisolone. Five months after being discharged, increased white matter connectivity was found on color-coded follow-up MR diffusion tensor imaging (DTI) as compared to previous MRI. We therefore suggest adding the DTI technique when a follow-up MRI is performed in patients with AHLE. It could be useful to visualize the status of axonal injury and to encourage patients and their parents to continue the rehabilitation program.
Administration, Intravenous ; Axons ; Central Nervous System ; Cerebellum ; Child ; Demyelinating Diseases ; Diffusion Tensor Imaging* ; Diffusion* ; Emergency Service, Hospital ; Female ; Follow-Up Studies* ; Humans ; Immunoglobulins ; Infant ; Leukoencephalitis, Acute Hemorrhagic* ; Magnetic Resonance Imaging ; Methylprednisolone ; Mortality ; Neurologic Manifestations ; Parents ; Pupil ; Rare Diseases ; Reflex, Stretch ; Rehabilitation ; Seizures ; Seizures, Febrile ; Stupor ; Survivors ; Thalamus ; White Matter

Acute hemorrhagic leukoencephalitis (AHLE) is an acute, rapidly progressing, fulminant demyelinating disease. It is a rare disease of the central nervous system with high mortality; survivors commonly present with significant neurological deficit. We report the case of a 16-month-old girl who survived AHLE and presented with the associated neurologic deficit. The patient came into the emergency department with febrile seizure. She showed bilateral pinpoint-sized pupils and hyperactive deep tendon reflexes. Her mental status was initially drowsy and rapidly progressed to stupor. Extensive demyelination and microbleeds were found in the cerebral white matter, thalamus and left cerebellum on Magnetic resonance imaging (MRI) scans. Her mental status was improved by intravenous administration of immunoglobulin and methylprednisolone. Five months after being discharged, increased white matter connectivity was found on color-coded follow-up MR diffusion tensor imaging (DTI) as compared to previous MRI. We therefore suggest adding the DTI technique when a follow-up MRI is performed in patients with AHLE. It could be useful to visualize the status of axonal injury and to encourage patients and their parents to continue the rehabilitation program.
Administration, Intravenous ; Axons ; Central Nervous System ; Cerebellum ; Child ; Demyelinating Diseases ; Diffusion Tensor Imaging* ; Diffusion* ; Emergency Service, Hospital ; Female ; Follow-Up Studies* ; Humans ; Immunoglobulins ; Infant ; Leukoencephalitis, Acute Hemorrhagic* ; Magnetic Resonance Imaging ; Methylprednisolone ; Mortality ; Neurologic Manifestations ; Parents ; Pupil ; Rare Diseases ; Reflex, Stretch ; Rehabilitation ; Seizures ; Seizures, Febrile ; Stupor ; Survivors ; Thalamus ; White Matter

OBJECTIVEThis study aimed to investigate the long-term outcomes in children with steroid-resistant nephrotic syndrome (SRNS), who received methylprednisolone pulse therapy (MPT)-based sequential steroid therapy. In particular, we aimed to observe whether these patients had a high risk of adverse events.

METHODSWe conducted a retrospective study over a 5-year period. The long-term outcomes for children with SRNS receiving sequential therapy were observed.

RESULTSSixty-three children were diagnosed with SRNS and underwent MPT-based sequential steroid therapy. Thirty-five (55.6%) achieved complete or partial remission, 19 (30.2%) of whom were in remission even after treatment cessation at last review. The mean time to initial remission after MPT was 24.3±13.1 days. Forty-nine children (77.8%) experienced relapses, of whom 31 (49.2%) demonstrated a frequent relapsing course. Adverse effects relevant to MPT were generally mild and infrequent. Five patients (7.9%) complained of vomiting or nausea during MPT infusion; 25 (39.7%) experienced excessive weight gain and developed an obvious Cushingoid appearance; and 26 (41.3%) had poor growth associated with long-term steroid use. Twenty-eight patients (44.4%) failed to respond to MPT, of whom 21 (33.3%) achieved complete or partial remission with immunosuppressive agents.

CONCLUSIONMPT-based sequential steroid therapy appears to be a safe and effective method for inducing rapid remission in childhood SRNS. Further clinical studies are needed to comprehensively evaluate this therapy.

Adolescent ; Child ; Child, Preschool ; Drug Resistance ; Female ; Humans ; Male ; Methylprednisolone ; administration & dosage ; adverse effects ; Nephrotic Syndrome ; drug therapy ; Retrospective Studies ; Time Factors ; Treatment Outcome

OBJECTIVETo evaluate the safety and effectiveness of a novel therapeutic regimen for bronchiolitis obliterans sydrome (BOS) affter hematopoietic stem cell transplantation (HSCT).

METHODSSeven patients who had received HSCT and had been diagnosed as BOS were enrolled in this study. They received weekly intravenous injection of umbilical cord-derived mesenchymal stem cells (MSC) at a dose of 1 × 10(6)/kg for 4 weeks. Budesonide was given orally at a daily dose of 0.25 g, and salmeterol was inhaled at a dose of 4.5 µg for 3 times per day. Methylprednisolone was given at a dose of 1 mg/(kg·d) for 2 weeks when respiratory failure occured. The dose of methylprednisolone was tapered to 0.25 mg/(kg·d) after 4 weeks and was adjusted according to the occurrence and severity of chronic graft-versus-host disease (cGVHD).

RESULTSThe therapy was generally safe and no severe acute toxicity was observed. One patient died of heart failure during the treatment, the other 6 patients were alive and the pulmonary function parameters including FEV1, FEV1/FVC, PaO2 and AaDO2 were significantly improved after 6 months as compared with the baseline parameters (P < 0.05).

CONCLUSIONMSC combined with budesonide, almeterol and azithromycin has been confirmed to be generally safe and can reduce the dose of glucocorticoid in treatment of BOS after HSCT.

Azithromycin ; therapeutic use ; Bronchiolitis Obliterans ; therapy ; Budesonide ; therapeutic use ; Combined Modality Therapy ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Mesenchymal Stem Cell Transplantation ; Methylprednisolone ; administration & dosage ; therapeutic use ; Salmeterol Xinafoate ; therapeutic use

OBJECTIVETo investigate the clinical efficacy and safety of intravenous injection of low-dose versus high-dose gamma globulin combined with glucocorticoid pulse therapy in the treatment of children with moderate/severe acute Guillain-Barré syndrome (GBS).

METHODSA total of 100 children with moderate/severe acute GBS were randomly assigned to low-dose group (n=48) and high-dose group (n=52). The children in the low-dose and high-dose groups were treated with 0.2 g/(kg · d) and 0.4 g/(kg · d) gamma globulin respectively combined with methylprednisolone. The two groups were compared in terms of the time to improvements of symptoms after treatment, serum levels of inflammatory factors, proportion of children undergoing invasive ventilation, treatment response rate, and adverse events.

RESULTSAfter 5 days of treatment, the low- and high-dose groups had significant reductions in serum levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein, and there were no significant differences in the reductions of these markers between the two groups. There were no significant differences between the two groups in the time to recovery of respiratory muscle paralysis, time to an improvement in muscle strength of one grade, time to recovery of sensory disturbance, and length of hospital stay. There was no significant difference in the treatment response rate between the low- and high-dose groups (90% vs 92%). There were also no significant differences in the incidence rates of pyrexia, headache, nausea, and palpitation between the two groups.

CONCLUSIONSLow-dose versus high-dose gamma globulin combined with methylprednisolone pulse therapy have comparable clinical efficacy and safety in the treatment of children with moderate/severe acute GBS.

Adolescent ; C-Reactive Protein ; analysis ; Child ; Child, Preschool ; Female ; Guillain-Barre Syndrome ; drug therapy ; Humans ; Length of Stay ; Male ; Methylprednisolone ; administration & dosage ; Tumor Necrosis Factor-alpha ; blood ; gamma-Globulins ; administration & dosage

OBJECTIVETo observe the best dose of methylprednisolone improving lung injury in swine with paraquat intoxication.

METHODSAcute lung injury (ALI/ARDS) model was made by an intraperitoneal injection of a large dose of 20%PQ solution20 millilitres in swine. Then 24 swine were randomly divided into 4 groups: exposed PQ control group, 5 mg/kg of methylprednisolone group, 15 mg/kg of methylprednisolone group, 30 mg/kg of methylprednisolone group. All groups were based on the conventional rehydration for intervention, Arterial blood samples were collected before modeling and 0, 12, 24, 36 hours after different processing for blood gas analysis. At the same time heart rate (HR), mean arterial pressure (MAP), extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were measured by using PICCO (pulse indicator continuous cardiac output), lung tissue was obtained by punctureneedle to produce lung biopsy, then observe the pathological changes of lung tissue in the microscope.

RESULTS1. Comparison between groups: there is no significant difference about extravascular lung water index (EVLWI) and semi-quantitative score of lung tissue pathology in four groups (P > 0.05) before modeling, so is t0, there is significant difference at about extravascular lung water index and semi-quantitative score of lung tissue pathology 12 h, 24 h and 36 h after different processing (P < 0.05). Within the group: EVLWI and semi-quantitative score of Lung tissue pathology in four groups significantly increased when the model was made (P < 0.05), after different processing, EVLWI and semi-quantitative score of Lung tissue pathology in exposed PQ control group kept going up, in other three groups, EVLWI and semi-quantitative score of lung tissue pathology went down first and then went up, there is significant difference compared with t0 (P < 0.05). 2. Comparison between groups: there is no significant difference about oxygenation index in four groups (P > 0.05) before modeling, so is t0, there is significant difference about oxygenation at 12 h, 24 h and 36 h after different processing (P < 0.05). Within the group: oxygenation index in four groups significantly decreased when the model was made (P < 0.05), after different processing, oxygenation index in exposed PQ control group kept going down, in other three groups, it showed a downward trend after the first rise, there is significant difference compared with t0 (P < 0.05). 3. After medication for 36h, correlation analysis showed that EVLWI were negatively associated with oxygenation index (r = -0.427, P = 0.022) and positively associated with semi-quantitative score of Lung tissue pathology (r = 0.903, P = 0.034).

CONCLUSIONMethylprednisolone can obviously relieve lung injury caused by paraquat poisoning and improve oxygenation. After the model was made, within 24 hours, 30 mg/kg of methylprednisolone have advantage for the PQ poisoning swine, but 15mg/kg of methylprednisolone is best for improving lung injury induced by paraquat intoxication within 24 hours to 36 hours.

Acute Lung Injury ; chemically induced ; drug therapy ; Animals ; Blood Gas Analysis ; Capillary Permeability ; Extravascular Lung Water ; Heart Rate ; Lung ; Lung Injury ; Methylprednisolone ; administration & dosage ; therapeutic use ; Paraquat ; toxicity ; Swine

PURPOSE: To report characteristics of Vogt-Koyanagi-Harada (VKH) disease as observed on spectral-domain optical coherence tomography (SD-OCT) images. CASE SUMMARY: (Case 1) A 38-year-old female presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, serous retinal detachment and cystoid macular edema in the outer retina were observed and the intraretinal fluid space was divided by a membranous structure forming an intraretinal compartmentalized cystic space. Under the diagnosis of VKH disease, the patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed decreased serous retinal detachment. (Case 2) A 58-year-old male presented with visual impairment in both eyes. On fundus examination, multifocal serous retinal detachment in the posterior pole was observed in both eyes. On enhanced SD-OCT, choroidal folds were observed and the membranous structure showed continuity with ellipsoid zone, suggesting the membranous structure was part of the outer photoreceptor layer of the adjacent attached retina. The patient was treated with intravenous administration of methylprednisolone. After treatment, enhanced SD-OCT images showed cystic space was decreased. CONCLUSIONS: SD-OCT images of VKH disease demonstrated multiple serous retinal detachments and intraretinal compartmentalized cystic space divided by a membranous structure. The membranous structure may be considered a part of the outer photoreceptor layer of the attached retina.
Administration, Intravenous ; Adult ; Choroid ; Diagnosis ; Female ; Humans ; Macular Edema ; Male ; Methylprednisolone ; Middle Aged ; Retina ; Retinal Detachment ; Tomography, Optical Coherence* ; Uveomeningoencephalitic Syndrome* ; Vision Disorders

OBJECTIVE: To evaluate the clinical efficacy on the treatment of the low-middle frequency sudden hearing loss with postaurical injection of methylprednisolone. METHOD: The 80 cases of the low-middle frequency sudden hearing loss were randomly divided into postaurical injection and oral hormone groups. The postaurical injection group (42 cases) received the postaurical injection of methylprednisolone, 40 mg/2 d, combined with the treatment of Ginkgo dipyidamolum and Alprostadil for 14 d; The oral hormone group (38 cases) received the oral prednisone, 1 mg/kg/d, administrated once on the morning for 3 d, if effective, prolonging for another 2 d, as mentioned above for Ginkgo dipyidamolum and Alprostadil. RESULT: The total effective rate was 88.10% in postaurical injection group and 86. 4o%in oral hormone group. There was no significant difference between the twbogroups( P> 0. 5). CONCLUSION Postaurical injection of methylprednisolone for the low-middle frequency sudden hearing loss is effective, safe and simple, which may be an alternative for systemic administration of gulcocorticoid.
Alprostadil ; therapeutic use ; Biological Products ; therapeutic use ; Glucocorticoids ; administration & dosage ; therapeutic use ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; drug therapy ; Humans ; Injections ; Methylprednisolone ; administration & dosage ; therapeutic use ; Prednisone ; administration & dosage ; therapeutic use ; Treatment Outcome

The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.
Acute Disease ; Adult ; Antivenins/*adverse effects ; Glucocorticoids/administration & dosage ; Humans ; Hyperemia/drug therapy/etiology/pathology ; Male ; Methylprednisolone/administration & dosage ; Papilledema/drug therapy/*etiology/pathology ; Snake Bites/*complications/*therapy ; Uveitis, Anterior/drug therapy/*etiology/pathology