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Masashi Ohe,Haruki Shida,Tetsuya Horita,Ken Furuya 대한임상약리학회 2018 Translational and Clinical Pharmacology Vol.26 No.2
A 41-year-old man suffering from eosinophilic granulomatosis with polyangiitis (EPGA), diagnosedat another clinic on the basis of American College of Rheumatology Criteria, with a historyof bronchial asthma, eosinophilia, mononeuritis multiplex, and non-fixed pulmonary infiltrates,was admitted to our department for further treatment. The patient complained of chest pain thatstarted recently. An echocardiogram identified myocardial thickening and decreased wall motion,based on which the patient was diagnosed as having EPGA with myocarditis. The patient was successfullytreated using glucocorticoids, such as methyl prednisolone (PSL) and PSL in combinationwith cyclophosphamide (CPM). However, CPM administration was discontinued afterwardsbecause of the risk of bone marrow toxicity, the increased eosinophilic count (EOC) that we consideredas an index of disease activity. Subsequently, the patient received additional clarithromycin(CAM) and tacrolimus (TAC) treatment considering their immunomodulatory effects. As a result,the EOC decreased and the PSL dosage could be reduced. This case shows that additional CAM andTAC treatment may be beneficial in some cases of EPGA.
A case of Waldenström’s macroglobulinemia treated using clarithromycin and prednisolone
Masashi Ohe,Satoshi Hashino,Haruki Shida,Tetsuya Horita,Mitsuru Sugiura 대한임상약리학회 2017 Translational and Clinical Pharmacology Vol.25 No.3
We report a case of Waldenström’s macroglobulinemia (WM) treated using clarithromycin (CAM)and prednisolone (PSL). An 84-year-old woman was admitted to our hospital for bleeding after atooth extraction and hematuria. Computed tomography showed multiple ill-defined nodules in theomentum (omental cake). Although the cause of the omental cake remained unclear, the patientwas diagnosed with WM, based on the detection of M-protein of immunoglobulin (Ig) M in serumand lymphoplasmacytes in bone marrow. The bleeding tendency in the patient may have been dueto acquired hemophilia and/or hyper IgM-induced platelet dysfunction. The patient was treated usingCAM (800 mg/day) and PSL (10 mg/day). As a result, IgM levels gradually decreased. Becausethe omental cake contracted along with improvement in IgM, it was thought to be lymphoplasmacyticlymphoma-like lymphoma. This case shows that treatment using CAM and PSL may be effectivein some cases of WM.