mycophenolic-acid and Granuloma

In general, sarcoidosis treatment should be offered to palliate symptoms and improve quality of life or to prevent end-organ disease. Symptoms include pulmonary as well as extra-pulmonary manifestations of the disease. The assessment of response to disease includes functional studies such as the forced vital capacity. Radiologic imaging such as chest x-ray has also been used to assess response, although standardized measures have rarely been tested. There are sufficient clinical trials to make specific recommendations regarding treatment of symptomatic pulmonary disease. Initial therapy is usually prednisone or a similar glucocorticoid. However, there are several features of this treatment which are unknown. This includes the initial dose, timing of reduction of dose, and when to discontinue treatment. Since many patients are intolerant of prednisone, steroid-sparing alternatives have been studied. Methotrexate is the most widely used anti-metabolite, but azathioprine, leflunomide, and mycophenolate have also been reported as helpful. The biologic agents, especially monoclonal anti-tumor necrosis factor (anti-TNF) antibodies, have proved effective in patients who have failed other treatments. Infliximab, the most widely studied anti-TNF antibody, has proved effective for a range of refractory sarcoidosis. However, there remain questions regarding dose and duration of therapy. For the clinician, the many treatment options allow for a specific treatment regimen for each patient which minimizes risk while enhancing benefit.

Topics: Anti-Inflammatory Agents; Azathioprine; Clinical Trials as Topic; Drug Administration Schedule; Granuloma; Humans; Immunologic Factors; Infliximab; Isoxazoles; Leflunomide; Lung; Methotrexate; Mycophenolic Acid; Prednisone; Respiratory Function Tests; Sarcoidosis; Skin; Tomography, X-Ray Computed

Pulmonary alveolar echinococcosis is a rare but potentially severe condition.. We report the case of a 50-year-old woman suffering from pulmonary alveolar echinococcosis who had had a renal transplant for polycystic liver and kidney disease. A lung opacity was identified radiologically in May 2013. Both broncho-alveolar lavage and bronchial biopsy were uninformative. In January 2014, a follow up CT-scan showed the opacity to be enlarging. A surgical biopsy revealed a giant cell epithelioid granuloma with caseous necrosis suggesting a diagnosis of pulmonary tuberculosis. Antituberculous treatment was started but cultures remained negative. A histological revue was therefore requested in March 2014. This suggested bronchocentric granulmatosis, possibly associated with echinococcosis. This hypothesis was finally confirmed serologically. Treatment for alveolar echinococcosis was begun in June 2014 after consultation with the national reference centre for parasitology.. Outside endemic areas and in the absence of hepatic involvement pulmonary alveolar echinococcosis can be difficult to diagnose. This case report focuses on the diagnostic criteria and treatment.

Topics: Echinococcosis; Echinococcosis, Hepatic; Echinococcosis, Pulmonary; Female; Granuloma; Humans; Immunocompromised Host; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Radiography, Thoracic; Renal Insufficiency; Tacrolimus

Granulomatous interstitial nephritis (GIN) is a rare histologic disease. Various causes have been reported in the literature, including drugs, sarcoidosis, and infections. Other incidents have no discernible cause and are identified as idiopathic. We report a 68-year-old white man who presented with acute kidney injury and was given a diagnosis of idiopathic GIN. Mycophenolate mofetil treatment was elected because of steroid toxicity. He responded well to mycophenolate mofetil and has been in remission for more than 3 years. To our knowledge, this is the first report of successful treatment with mycophenolate mofetil of an adult patient with idiopathic GIN.

Topics: Acute Kidney Injury; Aged; Anti-Inflammatory Agents, Non-Steroidal; Creatinine; Glucocorticoids; Granuloma; Humans; Kidney; Male; Methylprednisolone; Mycophenolic Acid; Nephritis, Interstitial; Remission Induction; Treatment Failure

Splenic marginal zone lymphomas (SMZL) constitute about 20% of primary splenic NHLs. We report a case of primary SMZL with a florid granulomatous reaction which obscured the underlying lymphoma. Although granulomas have been described in splenic non-Hodgkin lymphoma, it can be extensive and mask the underlying lymphoma. A careful search for the cytoarchitectural features of SMZL is warranted in such a case.

Topics: Adrenal Cortex Hormones; Anemia, Hemolytic, Autoimmune; Enzyme Inhibitors; Granuloma; Humans; Immunohistochemistry; Immunosuppressive Agents; Lymphoma, Non-Hodgkin; Male; Middle Aged; Mycophenolic Acid; Splenectomy; Splenic Neoplasms

Topics: Cyclophosphamide; Drug Therapy, Combination; Glucocorticoids; Granuloma; Granulomatosis with Polyangiitis; Humans; Injections, Intravenous; Male; Methotrexate; Methylprednisolone; Middle Aged; Mycophenolic Acid; Prednisone; Pulse Therapy, Drug; Remission Induction; Uveitis, Anterior