单剂量Tocilizumab治疗小儿视神经脊髓炎后出现曲霉感染的十二指肠穿孔。

Q2 Medicine
Esther L Albuquerque, Damaris Jacota, Megan Vu, Sarah E Kubes
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引用次数: 0

摘要

视神经脊髓炎谱系障碍(NMOSD)是一种自身免疫性中枢神经系统疾病,炎症事件在视神经和脊髓复发。视神经脊髓炎(NMO)在儿童中很少见,儿童患者通常在感染后出现视神经炎。缺乏对脉冲剂量静脉注射皮质类固醇或复发发作的反应需要治疗,如血浆置换,静脉注射免疫球蛋白(IVIG)和利妥昔单抗。在成人研究中,托珠单抗已被使用并发现可减少NMO复发;然而,由于缺乏研究和正式的治疗指南,在儿科人群中存在局限性。胃肠道穿孔(GIP)是一种罕见的,危及生命的并发症,在临床试验中发现托珠单抗治疗。我们报告了一个15岁男性难治性NMO单剂量托珠单抗后致死性感染GIP的病例。该病例强调了在使用tocilizumab治疗小儿NMO时需要更多的结果数据。此外,应概述对患者特定风险因素的评估,以更好地指导安全治疗并尽量减少负面不良后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Aspergillus-Infected Duodenal Perforations Following a Single Dose of Tocilizumab for Pediatric Neuromyelitis Optica.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system disease with inflammatory events recurring in the optic nerves and spinal cord. Neuromyelitis optica (NMO) is rare in children, and pediatric patients typically present with optic neuritis following infections. Lack of response to pulse-dose intravenous corticosteroids or recurrent relapse episodes warrant therapies such as plasma exchange, intravenous immunoglobulin (IVIG), and rituximab. In adult studies, tocilizumab has been used and found to reduce NMO relapse; however, limitations exist in the pediatric population due to the lack of studies and formal treatment guidelines. Gastrointestinal perforation (GIP) is a rare, life-threatening complication identified in clinical trials during tocilizumab therapy. We report a case of a fatal, infected GIP following a single dose of tocilizumab for refractory NMO in a 15-year-old male. This case highlights the need for more outcomes data when using tocilizumab to treat pediatric NMO. Additionally, an assessment of patient-specific risk factors should be outlined to better direct safe therapy and to minimize negative adverse outcomes.

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来源期刊
Journal of Pediatric Pharmacology and Therapeutics
Journal of Pediatric Pharmacology and Therapeutics Medicine-Pediatrics, Perinatology and Child Health
CiteScore
2.40
自引率
0.00%
发文量
90
期刊介绍: The Journal of Pediatric Pharmacology and Therapeutics is the official journal of the Pediatric Pharmacy Advocacy Group. JPPT is a peer-reviewed multi disciplinary journal that is devoted to promoting the safe and effective use of medications in infants and children. To this end, the journal publishes practical information for all practitioners who provide care to pediatric patients. Each issue includes review articles, original clinical investigations, case reports, editorials, and other information relevant to pediatric medication therapy. The Journal focuses all work on issues related to the practice of pediatric pharmacology and therapeutics. The scope of content includes pharmacotherapy, extemporaneous compounding, dosing, methods of medication administration, medication error prevention, and legislative issues. The Journal will contain original research, review articles, short subjects, case reports, clinical investigations, editorials, and news from such organizations as the Pediatric Pharmacy Advocacy Group, the FDA, the American Academy of Pediatrics, the American Society of Health-System Pharmacists, and so on.
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