PubMed · 5049574
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1972-07-15. [Bladder damage due to cyclophosphamide].. https://pubmed.ncbi.nlm.nih.gov/5049574/
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BACKGROUND: Veno-occlusive disease of the liver is a common cause of morbidity and mortality after chemotherapy and/or radiotherapy and bone marrow transplantation. Non thrombotic hepatic venous obstruction is characteristic, but pathogenesis of this disease remains unknown. CASE REPORT: In june 1993, a 58-year-old man was treated by cyclophosphamide and steroid for a POEMS syndrome. In november 1996, he developed hepatalgia, edema, ascitis and jaundice. The diagnosis of hepatic veno-occlusive disease was obtained by hepatic biopsy. Refractory ascitis was treated by transjugular intrahepatic portosystemic shunt. Gradual improvement in clinical status was observed after this therapy. CONCLUSION: This observation offers three original types of information: there has been no prior report of an association between veno-occlusive disease and POEMS syndrome, the role of low dose cyclophosphamide in hepatic veno-occlusive disease was certain, transjugular intrahepatic portosystemic shunt is an interesting therapy with one years remission.
A 48 year old women developed serous otitis, scleritis, myalgia, vertigo, polyneuropathy, crescentic glomerulonephritis, general cerebral dysrythmia, hilar adenopathy, and retroorbital granulomatous inflammation. Pulmonary manifestations were absent and antibodies against neutrophilic cytoplasmic antigens (ANCA) could not be detected. The clinical picture was classified as an overlap syndrome with features of both atypical Cogan syndrome and Wegener's granulomatosis. The patient responded to treatment with high dose corticosteroids and pulse cyclophosphamide.
Glucocorticosteroids (GCs) are the drug of choice in all clinical types of giant cell arteritis (GCA); a study delineated that an unexpectedly high percentage of patients required long-term GCs, with the consequence of significant complications attributable to GC therapy. Azathioprine and methotrexate are recommended as GC-sparing drugs. Cyclosporin A was found to confer no additive effect versus GC treatment alone. Depot GCs intramuscularly every 3 weeks decreased the cumulative GC dose and were associated with fewer bone fractions compared with daily oral GCs. Pulse cyclophosphamide has been shown to be as effective as the standard therapy in necrotizing vasculitides; however, an alarmingly high rate of infections was observed in this study in both arms possibly related to the high dosage of GCs. New drugs such as mycophenolate mofetil and leflunomide appear as alternatives as maintenance therapy in antineutrophil cytoplasm autoantibody-associated vasculitides in pilot studies. Interferon-alpha (IFN-alpha) has been shown to be effective in treatment-resistant Churg-Strauss syndrome, and IFN-alpha or ribavirin can be used successfully in essential mixed cryoglobulinemia (induced by hepatitis C virus). Thalidomide was shown to be effective for treating oral and genital ulcers and follicular lesions in Behçet's syndrome; severe refractory Behçet's syndrome uveitis responded to treatment with IFN-alpha.