mycophenolic-acid and Herpes-Zoster

The purpose of this study was to compare the efficacy and safety of tacrolimus and mycophenolate mofetil (MMF) as induction therapy and low-dose tacrolimus as treatment for lupus nephritis (LN).. Meta-analysis of randomized controlled trials (RCTs) was conducted to compare the efficacy and safety of tacrolimus and MMF as induction therapy for LN. We systematically reviewed RCTs and prospective cohort studies with a tacrolimus dose of 3 mg daily and performed a meta-analysis of the efficacy and safety of tacrolimus as an induction treatment for LN in comparison to MMF.. The inclusion criteria were satisfied by eight studies (five RCTs and three prospective cohort studies) with a total of 408 individuals (289 for tacrolimus vs. MMF and 119 for low-dose tacrolimus). Tacrolimus and MMF had similar complete remission rates (odds ratio [OR] 1.028; 95% confidence interval [CI] 0.589-1.796; p = 0.922). The partial remission rate did not differ between the tacrolimus and MMF groups (OR 1.400; 95% CI 0.741-2.646; p = 0.300). Tacrolimus and MMF showed no differences in proteinuria, serum albumin, serum creatinine, creatinine clearance, renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), or extra-renal SLEDAI. The incidence of infection, severe infection, leukopenia, and hyperglycemia did not differ between the tacrolimus and MMF groups. However, herpes zoster infection was significantly less common in the tacrolimus group (OR 0.137; 95% CI 0.034-0.546; p = 0.005), whereas serum creatinine elevation was significantly higher in the tacrolimus group than in the MMF group (OR 8.148; 95% CI 1.369-48.50; p = 0.021). At 3 mg/d, tacrolimus was shown to be safe, well tolerated, and offered therapeutic benefits in all investigations.. Tacrolimus was comparable to MMF in terms of effectiveness and safety as an induction therapy for LN, with the exception of a reduced risk of herpes zoster infection and a rise in serum creatinine. In individuals with LN, 3 mg/d tacrolimus was proven to be efficacious and safe.. ZIEL: Ziel der Studie war es, die Wirksamkeit und Sicherheit von Tacrolimus und Mycophenolat-Mofetil (MMF) als Induktionstherapie und von niedrigdosiertem Tacrolimus zur Behandlung der Lupusnephritis (LN) zu untersuchen.. Es wurde eine Metaanalyse randomisierter kontrollierter Studien (RCT) durchgeführt, um die Wirksamkeit und Sicherheit von Tacrolimus und Mycophenolat-Mofetil (MMF) als Induktionstherapie bei LN zu vergleichen. Dazu wurden RCT und prospektive Kohortenstudien mit einer täglichen Tacrolimusdosis von 3 mg systematisch überprüft und eine Metaanalyse der Wirksamkeit und Sicherheit von Tacrolimus als Induktionstherapie bei LN im Vergleich zu MMF durchgeführt.. Die Einschlusskriterien wurden von 8 Studien (5 RCT und 3 prospektive Kohortenstudien) mit insgesamt 408 Personen (289 für Tacrolimus vs. MMF und 119 für niedrigdosiertes Tacrolimus) erfüllt. Tacrolimus und MMF wiesen ähnliche komplette Remissionsraten auf (Odds Ratio [OR]: 1,028; 95%-Konfidenzintervall [95%-KCI]: 0,589–1,796; p = 0,922). Die partielle Remissionsrate unterschied sich nicht zwischen der Tacrolimus- und der MMF-Gruppe (OR: 1,400; 95%-KI: 0,741–2,646; p = 0,300). Bei Tacrolimus und MMF gab es keine Unterschiede in Bezug auf Proteinurie, Serumalbumin, Serumkreatinin, Kreatininclearance, den renalen Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) oder den extrarenalen SLEDAI. Auch die Inzidenz von Infektionen, schweren Infektionen, Leukopenien und Hyperglykämien unterschied sich nicht zwischen der Tacrolimus- und der MMF-Gruppe. Allerdings war eine Herpes-zoster-Infektion in der Tacrolimusgruppe signifikant weniger häufig (OR: 0,137; 95%-KI: 0,034–0,546; p = 0,005), während der Serumkreatininanstieg in der Tacrolimusgruppe signifikant höher war als in der MMF-Gruppe (OR: 8,148; 95%-KI: 1,369–48,50; p = 0,021). Bei Gabe von 3 mg/Tag erwies sich Tacrolimus als sicher und gut verträglich und bot in sämtlichen Untersuchungen therapeutische Vorteile.. Tacrolimus war in Bezug auf Wirksamkeit und Sicherheit als Induktionstherapie bei LN mit MMF vergleichbar, außer im Hinblick auf ein vermindertes Risiko für eine Herpes-zoster-Infektion und in Bezug auf einen Anstieg des Serumkreatinins. Bei Personen mit LN stellte sich Tacrolimus in der Dosis von 3 mg/Tag als wirksam und sicher heraus.

Topics: Creatinine; Cyclophosphamide; Herpes Zoster; Humans; Immunosuppressive Agents; Lupus Nephritis; Mycophenolic Acid; Tacrolimus; Treatment Outcome

Various immunosuppressive regimens have been developed for the treatment of lupus nephritis (LN). This study aimed to compare the efficacy and safety of immunosuppressive regimens in adults with LN.. We systematically searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials databases, including conference proceedings, trial registries, and reference lists, from inception until July 10, 2022. The effects of treatment were compared and ranked using the surface under the cumulative ranking curve (SUCRA). The primary endpoint was total remission. The secondary endpoints were complete remission, systemic lupus erythematosus disease activity index (SLEDAI), relapse, all-cause mortality, end-stage renal disease (ESRD), infection, herpes zoster, ovarian failure, myelosuppression, and cancer.. Sixty-two trials reported in 172 studies involving 6,936 patients were included in the network meta-analysis. The combination of tacrolimus (TAC), mycophenolate mofetil (MMF), and glucocorticoid (GC) provided the best result for the total remission rate (SUCRA, 86.63%) and SLEDAI (SUCRA, 91.00%), while the combination of voclosporin (VCS) , MMF and GC gave the best improvement in the complete remission rate (SUCRA, 90.71%). The combination of cyclophosphamide (CYC), MMF and GC was associated with the lowest risk of relapse (SUCRA, 85.57%) and cancer (SUCRA, 85.14%), while the combination of obinutuzumab (OTB), MMF and GC was associated with the lowest risk of all-cause mortality (SUCRA, 84.07%). Rituximab (RTX) plus MMF plus GC was associated with the lowest risk of ESRD (SUCRA, 83.11%), while the risk of infection was lowest in patients treated with azathioprine (AZA) plus CYC plus GC (SUCRA, 68.59%). TAC plus GC was associated with the lowest risk of herpes zoster (SUCRA, 87.67%) and ovarian failure (SUCRA, 73.60%). Cyclosporine (CsA) plus GC was associated with the lowest risk of myelosuppression (SUCRA, 79.50%), while AZA plus GC was associated with the highest risk of myelosuppression (SUCRA, 16.25%).. This study showed that a combination of TAC, MMF and GC was the best regimen for improving the total remission rate. The optimal regimen for specific outcomes should be highlighted for high-risk patients.

Topics: Adult; Azathioprine; Bone Marrow Diseases; Cyclophosphamide; Glucocorticoids; Herpes Zoster; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Lupus Nephritis; Mycophenolic Acid; Neoplasms; Network Meta-Analysis; Recurrence; Tacrolimus; Treatment Outcome

Visceral disseminated varicella zoster virus (VZV) infection is a rare but life-threatening complication in immunosuppressed patients. Herein, we report a survival case of visceral disseminated VZV infection in a patient with systemic lupus erythematosus (SLE).. A 37-year-old woman was diagnosed as SLE and initial induction therapy was started. Two months after starting the immunosuppressive therapy consisting of 40 mg of prednisolone (PSL) and 1500 mg of mycophenolate mofetil (MMF) daily, she suddenly developed strong abdominal pain, which was required opioid analgesics, followed by systemic skin blisters, which were diagnosed as varicella. Laboratory findings showed rapid exacerbation of severe liver failure, coagulation abnormalities and increased numbers of blood VZV deoxyribonucleic acid (DNA). Therefore, she was diagnosed as visceral disseminated VZV infection. Multidisciplinary treatment with acyclovir, immunoglobulin and antibiotics was started, the dose of PSL was reduced, and MMF was withdrawn. By their treatment, her symptoms were resolved and she finally discharged.. Our case highlights the importance of a clinical suspicion of visceral disseminated VZV infections, and the necessity of immediate administration of acyclovir and reduced doses of immunosuppressant to save patients with SLE.

Topics: Acyclovir; Adult; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lupus Erythematosus, Systemic; Mycophenolic Acid; Prednisolone; Varicella Zoster Virus Infection

To assess the safety and effectiveness of mycophenolate mofetil (MMF) in Japanese adults with lupus nephritis (LN) in real-world clinical practice.. This multicentre, prospective, post-marketing surveillance study investigated the effectiveness and safety of MMF, as induction or maintenance therapy, in LN patients. Primary endpoints were adverse drug reactions (ADRs), changes in renal function from baseline, and relapse rate (RR) after 6 months in the maintenance group, estimated using the Kaplan-Meier method. Complete remission (CR) and partial remission (PR) were estimated by renal measurements.. Overall, 112 patients were enrolled in the induction group and 340 in the maintenance group. Of these 452 patients, 418 were evaluable for safety and 396 for effectiveness. Eighty-three patients (19.85%) experienced ADRs, most commonly herpes zoster (3.34%) and diarrhoea (3.11%). Serious ADRs occurring in more than three patients were cytomegalovirus infections (1.43%), acute pyelonephritis (0.71%), and herpes zoster (0.71%). One patient died from herpes zoster disseminated. CR and PR were 19.54% and 44.82%, respectively, in the induction group, and 40.62% and 66.16%, respectively, in the maintenance group. RR in the maintenance group was 0.70%.. The tolerability of MMF is in line with that reported in other studies. Since the average dose of MMF was <1.5 g/day, research into the optimal dose for achieving effectiveness is required.

Topics: Adult; Cyclophosphamide; Herpes Zoster; Humans; Immunosuppressive Agents; Japan; Lupus Nephritis; Mycophenolic Acid; Prospective Studies; Remission Induction; Treatment Outcome

To study the prevalence of herpes zoster infection in patients with biopsy-confirmed lupus nephritis undergoing immunosuppressive therapies.. Patients who had histologically active lupus nephritis between 2004 and 2018 were retrospectively reviewed. Clinical and laboratory data at baseline and six months post-therapy were collected. The incidence of herpes zoster reactivation within two years of lupus nephritis treatment was calculated. Risk factors for herpes zoster reactivation were studied by logistic regression.. Herpes zoster reactivation is common in lupus nephritis patients but unpredictable from clinical parameters. Although adverse outcomes of herpes zoster infection are uncommon, using the minimally effective doses of mycophenolate mofetil and cyclophosphamide during induction therapy may help reduce the risk of herpes zoster infection.

Topics: Adult; Antiviral Agents; Cyclophosphamide; Female; Herpes Zoster; Hong Kong; Humans; Immunosuppressive Agents; Incidence; Logistic Models; Lupus Nephritis; Male; Middle Aged; Mycophenolic Acid; Prednisolone; Prevalence; Retrospective Studies; Risk Factors; Young Adult

The risk of life-threatening complications, such as visceral disseminated varicella zoster virus (VZV) infection, is greater in immunosuppressed individuals, such as systemic lupus erythematosus (SLE) patients.. Here, a case is reported of a Caucasian woman diagnosed with lupus nephritis and anti-phospholipid syndrome, who was subjected to mycophenolate mofetil and high-dose steroid remission-induction therapy. Two months later she developed abdominal pain followed by a fatal rapid multi-organ failure. As no typical skin rashes were evident, death was initially attributed to catastrophic anti-phospholipid syndrome. However, autopsy and virological examinations on archival material revealed a disseminated VZV infection.. Overall, this case highlights the importance of having a high clinical suspicion of fatal VZV infections in heavily immunosuppressed SLE patients even when typical signs and symptoms are lacking.

Topics: Abdominal Pain; Antiphospholipid Syndrome; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Lupus Nephritis; Middle Aged; Mycophenolic Acid; Real-Time Polymerase Chain Reaction; Steroids

BACKGROUND There have been no reports concerning the efficacy of pretransplant herpes zoster (HZ) vaccination following living donor liver transplantation (LDLT). MATERIAL AND METHODS From January 2013 to May 2016, 24 patients age 50 years and older received vaccination of HZ prior to transplantation and underwent LDLT at a single institution. We compared this to the 1-year HZ incidence of unvaccinated recipients (N=180) who underwent LDLT in the same time period. RESULTS For general characteristics, the MELD scores (p<0.001) and CTP grades (p=0.007) of the vaccinated group were significantly lower than those of the unvaccinated group. In Kaplan-Meier analysis, the 1-year HZ incidence rates of the vaccinated and unvaccinated groups were 2 (8.7%) and 16 (9.9%) cases, respectively (p=0.883). In the subgroup aged 50-59 years, 2 vaccinated recipients had HZ after LDLT. However, in the subgroup aged 60 years and older, no vaccinated recipients had HZ after LDLT. Multivariate analysis showed the independent risk factor for HZ after LDLT was use of mycophenolate mofetil (MMF; hazard ratio [HR]=3.00; p=0.041). CONCLUSIONS The efficacy of pretransplant vaccination for preventing HZ was not apparent in our study. A large prospective study is needed to determine the indications for pretransplant HZ vaccination according to age group and to evaluate the efficacy of HZ vaccination after LDLT.

Topics: Female; Herpes Zoster; Herpes Zoster Vaccine; Humans; Immunosuppression Therapy; Incidence; Kaplan-Meier Estimate; Liver Transplantation; Living Donors; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Preoperative Care; Prospective Studies; Risk Factors; Treatment Outcome

Visceral disseminated varicella zoster viral (VZV) infection is a rare but severe complication with a high mortality rate in immunosuppressed individuals, and an increased susceptibility to VZV has been reported in kidney transplant recipients who are treated with mycophenolate mofetil (MMF). In Japan, MMF is currently approved for patients with lupus nephritis (LN) and data to indicate its optimal dosage are still insufficient.. A 46-year-old Japanese woman with rheumatoid arthritis was diagnosed as having systemic lupus erythematosus (SLE) and LN class III (A/C). Although initial remission-induction therapy with prednisolone and tacrolimus was started, her serum creatinine level and urinary protein excretion were elevated. Methylprednisolone pulse therapy was added, and tacrolimus was switched to MMF. Two months after admission when she was taking 40 mg of PSL and 1500 mg of MMF daily, she suddenly developed upper abdominal pain and multiple skin blisters, and disseminated visceral VZV infection was diagnosed. Laboratory examinations demonstrated rapid exacerbation of severe acute liver failure and coagulation abnormalities despite immediate multidisciplinary treatment, and she died of hemorrhagic shock 7 days after the onset of abdominal pain. A serum sample collected at the time of admission revealed that she had recursive VZV infection.. MMF together with high-dose glucocorticoid therapy may increase the risk of VZV infection in Asian patients with SLE. Accumulation of evidence for parameters of safety, such as the area under the blood concentration-time curve of mycophenolic acid, should be urgently considered in order to establish a safer protocol for remission induction therapy in Asian patients with LN.

Topics: Arthritis, Rheumatoid; Enzyme Inhibitors; Fatal Outcome; Female; Herpes Zoster; Humans; Lupus Nephritis; Middle Aged; Mycophenolic Acid

The association between immunosuppressive medication use and herpes zoster (HZ) in patients with systemic lupus erythematosus (SLE) has not been clearly defined.. We evaluated the risk of HZ in patients with SLE treated with different immunosuppressants.. A nationwide population-based case-control study was conducted using the Taiwanese National Health Insurance Research Database. Cases (1555 patients with SLE who developed HZ) and controls (3049 age- and sex-matched patients with SLE but without HZ) were analyzed for use of various immunosuppressive medications in the preceding 3-month period, and dose-response relationships were determined. Logistic regression was performed to estimate the adjusted odds ratio for HZ development.. Medications associated with greater HZ risk in patients with SLE included oral corticosteroids, intravenous methylprednisolone, hydroxychloroquine, oral cyclophosphamide, intravenous cyclophosphamide, azathioprine, methotrexate, and mycophenolate mofetil. Combination immunosuppressive therapy was common in patients with SLE and was associated with greatly increased HZ risk. For oral corticosteroids and hydroxychloroquine, the risk of HZ was strongly dependent on the medication dose.. This study is retrospective in nature.. Recent immunosuppressive medication use is associated with increased HZ risk in patients with SLE, particularly those receiving high-dose oral corticosteroids and multiagent immunosuppressive therapy.

Topics: Administration, Intravenous; Administration, Oral; Adrenal Cortex Hormones; Adult; Azathioprine; Case-Control Studies; Cyclophosphamide; Dose-Response Relationship, Drug; Female; Herpes Zoster; Humans; Hydroxychloroquine; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Male; Methotrexate; Methylprednisolone; Middle Aged; Mycophenolic Acid; Retrospective Studies; Risk Factors; Taiwan; Young Adult

Progressive outer retinal necrosis syndrome (PORN) is a severe clinical variant of necrotizing herpetic chorioretinitis, which occurs almost exclusively in patients with advanced acquired immunodeficiency syndrome (AIDS). To date, only a few cases of PORN have been reported in patients, mostly among those who were immunocompromised. To our knowledge, only one case of PORN in a patient with systemic lupus erythematosus (SLE) has been described. We report the case of a 44-year old HIV-negative patient with lupus nephritis, whom was being treated by mycophenolate mophetil (MMF), arechin and prednisone. After 14 months of MMF therapy, the patient revealed PORN symptoms; and several months later, the patient developed Type B primary central nervous system lymphoma (PCNSL). PORN is usually compared to acute retinal necrosis (ARN) syndrome, because of having the same causative agent: varicella zoster virus (VZV). There are also some similarities in clinical findings. Our observation supports the hypothesis that PORN symptoms in HIV-negative patients can be an intermediate form between ARN and PORN, and can vary according to the patient's immune status.

Topics: Adult; Antiviral Agents; Central Nervous System Neoplasms; Chloroquine; Chorioretinitis; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; HIV Seronegativity; Humans; Lupus Erythematosus, Systemic; Lymphoma; Magnetic Resonance Imaging; Mycophenolic Acid; Prednisone; Retinal Necrosis Syndrome, Acute; Visual Acuity

Data on the incidence, timing, and risk factors for herpes zoster (HZ) in heart transplant (HT) recipients are limited.. We determined HZ incidence rates and actuarial estimates of time to first HZ episode in 314 HT recipients at our institution from 1995 to 2010. We developed Cox models to assess potential risk factors for HZ in HT.. Median age at HT was 54 (range, 17-71) years; 237 (76%) were male. There were 60 episodes of HZ in 51 patients, with an overall incidence rate of 31.6 cases (95% confidence interval [CI], 23.5-41.6)/1000 person-years. Although most cases occurred during the first post-HT year, cumulative HZ incidence was 0.078 at 1, 0.15 at 5, and 0.20 at 10 years. Many patients had substantial HZ morbidity, including 14% with HZ ophthalmicus and 45% with post-herpetic neuralgia. Adjusting for age, gender, and acute cellular rejection episodes, exposure to mycophenolate mofetil (MMF) was an independent risk factor for HZ (adjusted hazard ratio [HR] 2.18; 95% CI, 1.20-3.96; P = 0.01), while ganciclovir-based cytomegalovirus prophylaxis reduced HZ risk (adjusted HR 0.09; 95% CI, 0.01-0.71; P = 0.02). Although age and female gender increased HZ risk, the magnitude of their effect was not statistically significant in Cox models.. HZ is common and morbid after HT, particularly with MMF exposure. Ganciclovir prophylaxis is effective in reducing the short-term risk of HZ, but the steady incidence of cases for years post HT makes long-term HZ prevention challenging. Augmenting varicella zoster virus immunity post HT with vaccines warrants further exploration.

Topics: Adolescent; Adult; Age Factors; Aged; Antiviral Agents; Cardiomyopathies; Cohort Studies; Cytomegalovirus Infections; Female; Ganciclovir; Graft Rejection; Heart Defects, Congenital; Heart Transplantation; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; Male; Middle Aged; Mycophenolic Acid; Neuralgia, Postherpetic; Proportional Hazards Models; Retrospective Studies; Risk Factors; Sex Factors; Time Factors; Young Adult

In an earlier study, we compared the duration of kidney graft survival between two groups of recipients; one on triple (cyclosporine, prednisone and mycophenolate mofetil) and the other on quadruple (cyclosporine, prednisone, mycophenolate mofetil, and sirolimus) immunosuppressive therapy.. The aim of this study was to examine the impact of antiviral and statin therapy on graft longevity.. One hundred five kidney allograft recipients were preoperatively assessed for serological markers of infection with various viral agents. All patients were on a prophylactic antiviral regimen of acyclovir and gancyclovir. Seventeen patients were on a statin. Patients were monitored for viral infections and graft rejection or loss for period of 3 years posttransplantation.. We detected a high preoperative prevalence rate of IgG immunoglobulins versus the latency-establishing Herpesviridae viruses. Two patients who were preoperatively IgG positive for CMV had cytomegalovirus disease after transplantation. One patient who was preoperatively IgG positive for VZV had shingles after the surgery. No other confirmed viral infections were reported. Thirteen of 88 patients (14.77%) whose treatment regimen did not include a statin suffered a rejection episode or lost the graft whereas 1 of 17 patients (5.88%) on a statin had a rejection episode.. The low rate of viral infections observed in our study population supports the utility of prophylactic administration of antiviral agents to transplant recipients. However, statins seem to have a protective effect on graft longevity (odds ratio [OR] = 0.361, 95% confidence interval [CI] = 0.044-2.957).

Topics: Adult; Anti-Inflammatory Agents; Antiviral Agents; Cyclosporine; Cytomegalovirus; Cytomegalovirus Infections; Female; Graft Rejection; Graft Survival; Herpes Zoster; Herpesvirus 3, Human; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Prednisolone; Sirolimus; Transplantation, Homologous

We have used low doses of mizoribine (MZ) or mycophenolate mofetil (MMF) as induction and maintenance immunosuppressants, but since 2009 have employed a high dose of MZ. We reviewed the efficacy and side effects of MZ compared with MMF. It is difficult to compare graft survivals between these periods because of different patient demographics, though the high dose of MZ cohort showed no significant difference from MMF. High doses of MZ serum to prevent acute rejection episodes as the induction and maintenance therapy. MZ controlled with blood concentrations showed less side effects, suggesting that high MZ doses could be safely used for an induction and maintenance antimetabolite.

Topics: Adolescent; Adult; BK Virus; Child; Cytomegalovirus Infections; Female; Graft Rejection; Graft Survival; Herpes Zoster; Humans; Immunosuppressive Agents; Japan; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Polyomavirus Infections; Retrospective Studies; Ribonucleosides; Treatment Outcome; Young Adult

Topics: Acyclovir; Antiphospholipid Syndrome; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Infusions, Intravenous; Lupus Erythematosus, Systemic; Middle Aged; Mycophenolic Acid; Necrosis; Prednisone; Skin

To evaluate the association between scleritis and systemic disease in a non-university, non-tertiary referral practice and to describe our experience with scleritis treatment.. Retrospective chart review.. The medical records of patients with scleritis between 2001 and 2007 were reviewed for associated systemic disease.. In our series of 86 patients with scleritis, 55 patients (64.0%) had isolated scleritis while 31 patients (36.0%) had associated systemic-disease. Twenty-six patients (83.9%) with systemic disease had diagnosed systemic disease at the time of initial scleritis presentation, while 5 patients (16.1%) were diagnosed following systemic work-up. Those diagnosed after systemic work-up were more likely to have systemic vasculitic disease as opposed to a rheumatic or infectious disease. Patients with and without associated systemic disease were likely to require systemic therapy at similar rates (93.5% and 92.7%, respectively). Five patients with steroid-refractory scleritis were treated with infliximab (Remicade; Centocor Inc, Horsham, Pennsylvania, USA) and all responded without evidence of adverse effect. Seven patients were treated with mycophenolate mofetil (CellCept; Roche Laboratories, Nutley, New Jersey, USA), of which three improved.. The association between scleritis and systemic disease in a community-based referral practice may be lower than in tertiary referral or university-based centers. Although thorough systemic disease evaluation is warranted in scleritis patients, most patients with associated systemic disease will have such a diagnosis prior to the development of scleritis. The need to institute aggressive systemic therapy cannot be predicted by the presence of an associated systemic disease. Infliximab and mycophenolate mofetil are useful additions to the scleritis practitioner's armamentarium for steroid-refractory scleritis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Antibodies, Monoclonal; Autoimmune Diseases; Child; Community Health Services; Female; Herpes Zoster; HIV Infections; Humans; Infliximab; Male; Middle Aged; Mycophenolic Acid; Referral and Consultation; Retrospective Studies; Sarcoidosis; Scleritis; Young Adult

Topics: Adult; Aged; Enzyme Inhibitors; Herpes Zoster; Humans; Incidence; Middle Aged; Mycophenolic Acid; Opportunistic Infections; Pemphigus

Topics: Aged; Granulomatosis with Polyangiitis; Herpes Zoster; Humans; Immunosuppressive Agents; Male; Methylprednisolone; Mycophenolic Acid; Skin Diseases

Disseminated varicella zoster virus (VZV) infection is a rare complication after renal transplantation in adults. We report 4 cases diagnosed in our transplant patients. One of which was a primary infection (chicken pox) with multivisceral involvement (hepatitis, pneumonitis, myocarditis, and disseminated intravascular coagulation). The other 3 patients VZV-seropositive before transplantation suffered from disseminated zoster. No immunosuppressive drug was significantly associated with a higher risk of disseminated VZV infection. However, from our experience, we believe that mycophenolate mofetil (MMF), plays a part in the clinical presentation of the disease. Early treatment with high doses of acyclovir is fundamental in infection control. It is essential to perform a pretransplantation serological VZV study on all patients.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Chickenpox; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid