tacrolimus and Dyspnea

Insufficient evidence exists regarding the efficacy of Janus kinase inhibitors (JAKis), a class of targeted synthetic disease-modifying anti-rheumatic drugs (tsDMARDs), in the treatment of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD). Herein, we present a case of RA-ILD refractory to previous treatments that exhibited favorable response to upadacitinib. A 69-year-old man, former smoker, was diagnosed with RA-ILD based on persistent symmetric polyarthritis, elevated C-reactive protein levels and erythrocyte sedimentation rate, reduced diffusing capacity for carbon monoxide/alveolar volume (D

Topics: Aged; Arthritis, Rheumatoid; Dyspnea; Humans; Lung Diseases, Interstitial; Male; Methotrexate; Prednisolone; Tacrolimus

Long-term outcomes after lung transplantation remain poor mainly to the development of bronchiolitis obliterans syndrome (BOS). Currently, treatment options for BOS are very limited. Strategies to prevent and treat this complication include the use of aerosolized therapy with only cyclosporine used in patients to date. We describe the use of aerosolized tacrolimus in a lung transplant recipient with BOS. The patient demonstrated clinical improvement in functional capacity and oxygenation while receiving tacrolimus by nebulization. Further research is needed to study whether aerosolized tacrolimus is beneficial in lung transplant recipients with BOS.

Topics: Administration, Inhalation; Adult; Aerosols; Bronchiolitis Obliterans; Dyspnea; Female; Humans; Immunosuppressive Agents; Lung Transplantation; Nebulizers and Vaporizers; Respiratory Function Tests; Tacrolimus; Time Factors; Treatment Outcome

A 23-year-old Caucasian woman, with cystic fibrosis, bilateral lung-transplantation and immunosuppressive therapy with prednisolone, tacrolimus and sirolimus, presented with clinical symptoms of a chronic transplant rejection.. Since constant sufficient blood level of tacrolimus and sirolimus had never been achieved, a genetic analysis was carried out to clarify drug metabolism.. The genetic analysis for polymorphisms of cytochrome P450 (CYP) 3A4,5,7 revealed no sequence alterations in the CYP 3A4,5,7 gene. Thus, drug intake was scrutinized in detail, disclosing a missing interval between the intake of both immunosuppressive agents. After a correct drug intake the woman's condition ameliorated and the blood levels reached normal range.. This case report highlights the crucial importance of basic medical skills like an accurate and dainty drug anamnesis before high tech approaches were applied.

Topics: Adult; Drug Monitoring; Drug Therapy, Combination; Dyspnea; Female; Graft Rejection; Humans; Immunosuppressive Agents; Lung Transplantation; Medical History Taking; Patient Compliance; Patient Education as Topic; Prednisolone; Sirolimus; Tacrolimus

The use of self-expanding metallic airway stents has been extended in recent years in inoperable patients with malignant and benign airway diseases. The risk of granulation tissue formation in the stent is a major concern. The objective of the present study was to determine whether immunosuppression modulates granulation tissue formation in airway stents, as seen in coronary stents.. The study included 19 patients with benign airway obstructions and 11 recipients of lung transplants with anastomotic obstructions who were receiving immunosuppression therapy.. The degree of in-stent granulation tissue formation was evaluated (score range, 0-3) every 3 months for 2 years.. Granulation tissue formation was significantly lower in the transplant recipients than in the nontransplant patients at 3 months (score 0.7 vs. 1.6, P = .031), 15 months (score 0 vs. 1.1, P = .026), and 18 months (score 0 vs. 1.8, P = .020). During the 2 years of follow-up, the transplant recipients underwent significantly fewer laser resections and brachytherapy treatments for in-stent granulation.. The immunosuppression given to lung transplant recipients may have an inhibitory effect on granulation tissue formation in metallic airway stents. Further studies are needed to evaluate the effect of systemic therapy or coated stents with drugs such as sirolimus.

Topics: Adult; Aged; Airway Obstruction; Bronchoscopy; Dyspnea; Female; Granulation Tissue; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Lung Transplantation; Male; Methylprednisolone; Middle Aged; Stents; Surgical Wound Dehiscence; Tacrolimus; Tracheal Stenosis

The patient is a 62-year-old man who was diagnosed with myasthenia gravis and invasive thymoma at the age of 45 years, and had received treatment by extended thymectomy and radiotherapy. At the age of 61, he had suffered from a myasthenic crisis, and been administered immunoadsorption therapy under managed ventilatory care. Treatment had then been continued with steroids; however, due to subsequent deterioration of his diabetic state, treatment was switched to the immunosuppressant drug tacrolimus. Three months after the commencement of tacrolimus administration, the patient developed generalized malaise and dyspnea. The serum creatine phosphokinase (CPK) level was abnormally elevated, and abnormal electrocardiographic findings were noted, including atrioventricular dissociation and ventricular escape contraction. Steroid pulse therapy was therefore initiated, however, 4 days later, the patient suddenly died. Autopsy examination revealed inflammatory cell infiltration with giant cells in the myocardium, diffuse myocardial degeneration, and polymyositis. The case was therefore considered as one with the syndrome of myasthenia gravis, polymyositis, giant cell myocarditis, and thymoma.

Topics: Alopecia; Creatine Kinase; Dyspnea; Electrocardiography; Giant Cells; Humans; Immunosuppressive Agents; Male; Middle Aged; Myasthenia Gravis; Myocarditis; Myocardium; Myositis; Polymyositis; Radiography, Thoracic; Tacrolimus; Thymoma; Thymus Neoplasms; Time Factors; Treatment Outcome

To discuss a comprehensive diagnostic approach to an active duty patient presenting with dyspnea on exertion, fatigue, and pallor. A 50-year-old active duty E-6 white male in Al Udeid, Qatar, presented with progressive dyspnea on exertion, fatigue, and new pallor. This case illustrates the course of events from Al Udeid to the Walter Reed Army Medical Center, where the final diagnosis was made. Along the way, questions with discussions explore the various diagnostic and management aspects of his case and highlight military relevant issues that include efficient diagnostic algorithms in the field and transfusion of scarce blood products.

Topics: Algorithms; Anemia, Aplastic; Antilymphocyte Serum; Bone Marrow Examination; Cyclosporins; Decision Trees; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Fatigue; Humans; Immunosuppressive Agents; Male; Middle Aged; Military Medicine; Military Personnel; Pallor; Qatar; Tacrolimus; United States

Systemically administered 3-nitropropionic acid (3-NPA) that inhibits the mitochondrial oxidative phosphorylation induces selective lesions in the striatum. To investigate the nature of these selective lesions, we administered 3-NPA (20 mg/kg, s.c. daily for 2 or 3 days) to Wistar rats and investigated the behavioral disturbance, striatal lesions and their variations after modulating the activity of nitric oxide synthase (NOS). On the second or third day of 3-NPA administration, half the animals manifested behavioral disturbances (paddling, rolling, tremor, abnormal gait, and recumbence). A strong extravasation of immunoglobulin G (IgG) and a decrease in immunoreaction for glial fibrillary acidic protein (GFAP) were detected, and iNOS-like (iNOS-L) immunoreactive small cells appeared in the lateral and central striatum especially around the vessels. A week later, lesions lacking GFAP-immunoreaction were detected in the striatum in survived animals. Pretreatment with N-nitro-L-arginine methyl ester (L-NAME) along with each injection of 3-NPA did not improve the behavioral disturbances nor the survival rate, but attenuated the extravasation of IgG and iNOS-L immunoreaction. Pretreatment with aminoguanidine or FK506 improved the behavioral symptoms and survival rate. Extravasation of IgG and expression of iNOS-L immunoreactivity were attenuated, and the striatal lesion was reduced. Data indicate the involvement of NO in the high vulnerability of the striatum, and that iNOS, one of inflammatory markers, is induced following exposure to 3-NPA.

Topics: Animals; Antihypertensive Agents; Astrocytes; Behavior, Animal; Cell Death; Dyspnea; Enzyme Inhibitors; Glial Fibrillary Acidic Protein; Guanidines; Immunohistochemistry; Immunosuppressive Agents; Injections, Subcutaneous; Male; Neostriatum; Neuritis; Neurotoxins; NG-Nitroarginine Methyl Ester; Nitric Oxide; Nitric Oxide Synthase; Nitro Compounds; Propionates; Rats; Rats, Wistar; Tacrolimus