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S-471 Successful treatment with rituximab in cisplatin-induced refractory HUS patient
( Ji Ae Yang ),( Hyun Woo Kim ),( Sun Ae Han ),( Byungchul Shin ),( Hyun Lee Kim ),( Jong Hoon Chung ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Successful treatment with rituximab in cisplatin-induced refractory hemolytic-uremic syndrome patient Ji ae Yang, Hyun Woo Kim, Sun Ae Han, Byung Chul Shin, Hyun Lee Kim and Jong Hoon Chung Department of Internal Medicine, Division of Nephrology, Chosun University Medical School, Gwangju, Republic of Korea Abstract Hemolytic uremic syndrome (HUS) is a relatively rare disease that can have devastating consequences. It classically includes the triad of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury. HUS may be associated with a variety of etiologies, and chemotherapeutic agents including mitomycin, cisplatin, bleomycin and gemcitabine have also been reported to be associated with HUS. A36-year-old woman patient with cervical cancer wasreceived chemotherapy with four cycles of cisplatin at 60 mg/m2 and radiotherapy. She complained of dizziness and oliguria. Microangiopathic hemolytic anemia was developed and rapidly declining renal function with proteinuria and hematuria. In spite of hemodialysis, plasmapheresis and corticosteroid therapy, the patient’s condition continued to deteriorate. After aggressive therapy with rituximab, MHA and thrombocytopenia was recovered. However, renal function was not recovered and the patient was maintained on regular hemodialysis. In this case, we report the successful treatment with rituximab in cisplatin-induced refractory HUS patient. Keywords: Hemolytic uremic syndrome, Cisplatin, Rituximab
( Ji Ae Yang ),( Jeong Seok Lee ),( Jin Kyun Park ),( Eun Bong Lee ),( Yeong Wook Song ),( Eun Young Lee ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.2
Background/Aims: To analyze clinical characteristics of interstitial lung disease (ILD) associated with rheumatoid arthritis (RA), especially in patients with poor prognosis. Methods: Seventy-seven RA patients with ILD and 231 age, sex, and disease duration-matched RA patients without ILD were enrolled in this retrospective study. Epidemiologic, clinical, and laboratory information were obtained through a medical chart review. Logistic regression analysis was used to estimate the risk of mortality in RA patients with ILD. Results: Compared to the RA without ILD group, the RA with ILD group had significantly higher titers of rheumatoid factor and the anti-cyclic citrullinated peptide (p = 0.001 for both), higher levels of C-reactive protein (CRP) at the time of RA diagnosis (p = 0.014), and a higher erythrocyte sedimentation rate (p = 0.022) and CRP levels (p < 0.001) throughout the 10-year follow-up period. These patients also received a higher mean daily dose of corticosteroids (p < 0.001). In the subgroup analysis of RA patients with ILD, 28 patients (36.4%) died during follow-up. Multivariate analysis revealed that older age at the time of ILD diagnosis was significantly associated with mortality. Usual interstitial pneumonia (UIP) subtype on high-resolution computed tomography (HRCT) was also suggested as a poor prognostic factor. Conclusions: The survival of RA patients with ILD is adversely affected by age at the time of ILD diagnosis. RA-ILD patients diagnosed after age 65 or with a UIP subtype on HRCT may have a poor prognosis.
( Ji Ae Yang ),( Jae Hyun Lee ),( Eun Young Lee ),( Eun Bone Lee ),( Yeong Wook Song ),( Jin Kyun Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Clinical experiences suggest that gout attacks in elderly patients are accompanied by stronger systemic infi ammatory response including fever, higher C-reactive protein(CRP) and erythrocyte sediment ratio(ESR) as compared those in younger patients. As such, it is often diffi cult to differentiate them from septic arthritis. To defi ne whether gout attacks in elderly patients have higher infi ammtory markers. Methods: In this retrospective study, medical records of patients who were evaluated for a possible gout attack between January 2000 and April 2014 were examined. The presence of fever (>37.8°), levels of CRP and ESR on attack were compared between young (=50 years), middle aged (51- 65 years) and elderly patients (>65 years). Results: Gout attacks were observed in 188 patients with 34 young, 54 middle aged and 100 elderly patients. Baseline characteristics of three groups differed; elderly patients had more comorbidities including diabetes mellitus (p<0.001), hypertension (p<0.001), coronary artery disease (p=0.015), cerebrovascular accident (p<0.001), and cancer (p=0.031) as compared other groups. The elderly patients had a low body mass index (BMI) (24.60 ± 4.65, 24.55 ± 3.30, 23.27 ± 3.12, p=0.041) and longer disease duration (2.76 ± 5.16, 4.20 ± 6.13, 6.58 ± 9.23 years, p=0.028 by ANOVA). Fever was more often present in the elderly patients (17.6% in young vs. 29.6% in middle aged vs. 50.0% in elderly, p=0.001 by chi-square test). Although numbers of involved joints during attacks did not differ between groups (p=0.656), CRP and ESR levels during gout attack increased signifi cantly with age (figure 1). Conclusions: Since gout attacks in elderly patients are accompanied by stronger systemic infi ammatory response, often resembling sepsis or septic arthritis, it is crucial to correctly diagnose them as gout so that unnecessary invasive diagnostics including joint lavage and prolonged antibiotic treatment can be avoided.
불응성 염증성 근병증 환자에 대한 Rituximab 치료
양지애 ( Ji Ae Yang ),이상진 ( Sang Jin Lee ),박준원 ( Jun Won Park ),권현미 ( Hyun Mi Kwon ),문진영 ( Jin Young Moon ),고동진 ( Dong Jin Ko ),장성혜 ( Sung Hae Chang ),박진균 ( Jin Kyun Park ),이은봉 ( Eun Bong Lee ),송영욱 ( Yeo 대한류마티스학회 2013 대한류마티스학회지 Vol.20 No.5
Objective. To assess the efficacy and safety of rituximab (RTX) on disease activity and muscle strength in patients with inflammatory myopathies refractory to conventional therapy. Methods. Four inflammatory myopathy patients who had been refractory to glucocorticoids, one or more immunosuppressive therapies and intravenous immunoglobulin were treated on an open-label basis. Each patient received two 500 mg doses of RTX 2 weeks apart in one cycle. In one patient who did not respond after the first cycle of RTX, the infusion schedule was modified by the physician. We measured muscle enzyme including CPK, LDH and assessed muscle strength individually to evaluate RTX response. Additionally anti-CD19 antibody was measured. Results. Three patients responded to the first cycle of RTX treatment with improvements in muscle enzyme and muscle strength, and then maintained physical function over the duration of several infusion cycles. In one patient, muscle enzyme did not decrease after the first cycle of RTX, and a high dose glucocorticoid was given. After modifying the treatment schedule with monthly RTX infusion, his muscle enzyme level and muscle strength improved. Anti-CD19 antibody decreased after RTX generally, but responses were variable. Herpes zoster infection occurred in two patients. Conclusion. Rituximab may be a therapeutic choice in refractory inflammatory myopathy. However a further trial is needed to confirm the efficacy and prove the safety.