Effective infliximab treatment for a recurrent type of acute intestinal graft-versus-host disease accompanied by steroid-induced depression

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  • TAMURA Shinichi
    Department of Pediatrics, Matsushita Memorial Hospital
  • ISHIDA Hiroyuki
    Department of Pediatrics, Matsushita Memorial Hospital
  • FUJIKI Atsushi
    Department of Pediatrics, Matsushita Memorial Hospital
  • YOSHIHARA Takao
    Department of Pediatrics, Matsushita Memorial Hospital
  • KONDO Osamu
    Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health
  • INOUE Masami
    Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health
  • KAWA Keisei
    Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health
  • KAWABATA Kenji
    Department of Pathology, Matsushita Memorial Hospital
  • IMAMURA Toshihiko
    Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine

Bibliographic Information

Other Title
  • Infliximabが有用であったステロイド誘発性のうつ状態を伴った再燃型急性消化管GVHD
  • 症例報告 Infliximabが有用であったステロイド誘発性のうつ状態を伴った再然型急性消化管GVHD
  • ショウレイ ホウコク Infliximab ガ ユウヨウ デ アッタ ステロイド ユウハツセイ ノ ウツ ジョウタイ オ トモナッタ サイゼンガタ キュウセイ ショウカカン GVHD

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Abstract

A 22-year-old man with chronic active Epstein-Barr virus infection underwent allogeneic bone marrow transplantation (allo-BMT) from an HLA two allele-mismatched unrelated donor. Ten months after allo-BMT, he developed protein-losing enteropathy following a respiratory syncytial virus infection. A diagnosis of a recurrent type of acute graft-versus-host disease (GVHD) was made based on the histopathological findings, such as the infiltration of T lymphocytes into the superficial epithelium and crypts, and apoptotic bodies in crypts. Although methylprednisolone (mPSL: 10mg/kg) administration for two consecutive days improved gastrointestinal symptoms, acute pancreatitis and severe depression developed in association with corticosteroid treatment. Reduction of mPSL and administration of infliximab (5mg/kg/dose, 3 times) resulted in rapid improvement of depression and pancreatitis without aggravating intestinal GVHD. Recent studies have demonstrated that tumor-necrosis-factor (TNF)-α is associated with not only GVHD but also depression and acute pancreatitis. In the present case, anti-TNF-α treatment enabled us to reduce corticosteroid dose without aggravating GVHD, which suggests that this approach might be effective for the treatment of depression and acute pancreatitis.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 53 (3), 361-366, 2012

    The Japanese Society of Hematology

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