mycophenolic-acid and Pleural-Effusion

Topics: Acute Kidney Injury; Aged; Antirheumatic Agents; Diagnosis, Differential; Humans; Hydroxychloroquine; Immunologic Tests; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Lupus Nephritis; Male; Methylprednisolone; Mycophenolic Acid; Pleural Effusion; Prognosis; Remission Induction; Renal Dialysis

Topics: Acute Kidney Injury; Cord Blood Stem Cell Transplantation; Cyclosporine; Graft Rejection; HLA-B Antigens; Humans; Immunosuppressive Agents; Middle Aged; Mycophenolic Acid; Nephrotic Syndrome; Pleural Effusion; Radiography, Thoracic; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome

Fever with generalised lymphadenopathy is a common presentation in clinical practice. A degree of lymphadenopathy is frequently a characteristic of established systemic lupus erythematosus (SLE), but it is rarely the primary presenting feature. A 25-year-old man presented with night sweats, weight loss and generalised lymphadenopathy. A chest computed tomography scan confirmed the presence of mediastinal, hilar and axillary lymphadenopathy, with bilateral pleural effusions. The double stranded DNA antibody (anti-dsDNA) was absent. Subsequently, there was mild renal impairment and a renal biopsy showed lupus nephritis. Anti-dsDNA was positive using an alternative assay. Treatment with prednisolone and mycophenolate mofetil led to considerable clinical improvement. Extensive lymphadenopathy as the first clinical manifestation of SLE is rare and this case also illustrates the variable results obtained from different anti-dsDNA antibody assays.

Topics: Adult; Biopsy; Diagnosis, Differential; Glucocorticoids; Humans; Immunosuppressive Agents; Lupus Nephritis; Male; Mycophenolic Acid; Pleural Effusion; Prednisolone; Tomography, X-Ray Computed

Herein we present a case of a patient with systemic lupus erythematosus (SLE) and a sterile empyematous pleural effusion, a complication not generally associated with SLE. A discussion of the diagnostic and treatment dilemmas follows the case presentation.

Topics: Adult; Biopsy; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Kidney; Lupus Erythematosus, Systemic; Lupus Nephritis; Mycophenolic Acid; Pleura; Pleural Effusion; Pleurisy

Generation of oxidative stress induced by reactive oxygen species (ROS) and nitrogen (RNS) is believed to be a primary factor in the etiology of various inflammatory diseases. Although, the process of generation of oxygen species is a physiological event, in the inflammatory process this event is increased and produces large amounts of reactive species that leads to lipid peroxidation and to cell death. Mycophenolate mofetil (MMF) is a drug effective in protecting against chronic allograft failure and recently was introduced as an alternative for the treatment of various inflammatory diseases such as glomerulopathies, systemic lupus erythematosus and systemic vasculitis. Based on studies of the anti-inflammatory effect of MMF the aim of this study was to evaluate the effects of MMF on the inhibition of leukocytes and exudation, as well as myeloperoxidase and some antioxidant enzyme activities using carrageenan-induced pleurisy in mice. Our results showed that MMF significantly decreased leukocyte influx (P<0.01), exudation (P<0.01), superoxide dismutase (P<0.05), catalase (P<0.05), glutathione peroxidase (P<0.01), glutathione S-transferase (P<0.01) activities, levels of lipid peroxidation (P<0.05), as well as myeloperoxidase activity (P<0.05) on both phases (4h and 48h) of the inflammatory response induced by carrageenan into the mice pleural cavity. In conclusion, the anti-inflammatory effect of MMF may be, at least in part, via inhibition of ROS and/or NRS overgeneration, and consequently, attenuating the related oxidative stress.

Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Carrageenan; Catalase; Cell Count; Cell Movement; Dexamethasone; Disease Models, Animal; Glutathione Peroxidase; Glutathione Transferase; Indomethacin; Leukocytes; Leukocytes, Mononuclear; Lipid Peroxidation; Mice; Mice, Inbred Strains; Mycophenolic Acid; Neutrophils; Oxidative Stress; Peroxidase; Pleural Effusion; Pleurisy; Superoxide Dismutase; Thiobarbituric Acid Reactive Substances