Eosinophilic granulomatosis with polyangiitis (EGPA) is a vasculitis characterized by an abnormally high number of eosinophils in the peripheral blood and tissues. EGPA is an extremely rare disorder, with an incidence of 0.5 to 3.7 new cases per million people per year and an overall prevalence of 2.4 to 14 per million adults. There is little knowledge about the genetic factors that influence this disease. There are only two reports of familial EGPA: one in Japan and one in Turkey. We herein report a third case of familial EGPA in a brother and sister who were negative for myeloperoxidase-antineutrophil cytoplasmic antibodies.
Immune checkpoint inhibitors (ICIs) are reportedly effective against many kinds of neoplasm, but may be responsible for several kinds of immune‐related adverse events (irAEs). Among these irAEs, the incidence of myelosuppression due to ICIs is relatively low. Corticosteroids are needed to control most cases of myelosuppression. Here, we report an 88‐year‐old woman with squamous cell lung cancer who was administered pembrolizumab. After five cycles of pembrolizumab, she developed severe pancytopenia. The pancytopenia improved under observation without steroid administration after cessation of pembrolizumab. During recovery from this irAE, the patient also maintained long‐term antitumor efficacy.
Key points
Significant findings of the study
There are several kinds of immune‐related adverse events. We encountered a case of pembrolizumab‐induced pancytopenia with squamous cell lung cancer.
What this study adds
Corticosteroids are needed to control most cases of myelosuppression induced by ICIs, but pancytopenia induced by pembrolizumab in our case improved without steroids.
In addition to therapeutic options such as steroid ointment, immunosuppressive drug and ultraviolet phototherapy, recent reports have demonstrated the clinical efficacy of topical vitamin D3 for vitiligo vulgaris. However, there seems to be little clinical effect of vitamin D3 without UV exposure. In the present study, we evaluated the clinical difference of sun irradiation vs. narrowband UVB in combination with tacalcitol assessing the change of lesion size and color tone by a spectrophotometer. Thirty-three vitiligo patients were composed of 19 treated with sun illumination and 14 treated with narrowband UVB in combination with topical use of tacalcitol. The mean % size reduction was higher in the group of sunbathing than narrowband UVB (29% vs. 23%). Delta L score, which represented the difference of whiteness between lesional and perilesional skin, was significantly improved after treatment in the group of sun irradiation instead of narrowband UVB (p = 0.0023). Therefore, we consider that sun illumination along with tacalcitol may be able to induce natural repigmentation and be an alternative therapeutic option for vitiligo vulgaris.
High-flow nasal cannula (HFNC) can be effective in treating type 1 respiratory failure by reducing the severity of coronavirus disease 2019 . The purpose of this study was to assess the reduction of disease severity and safety of HFNC treatment in patients with severe COVID-19. We retrospectively observed 513 consecutive patients with COVID-19 admitted to our hospital from January 2020 to January 2021. We included patients with severe COVID-19 who received HFNC for their deteriorating respiratory status. HFNC success was defined as improvement in respiratory status after HFNC and transfer to conventional oxygen therapy, while HFNC failure was defined as transfer to non-invasive positive pressure ventilation or ventilator, or death after HFNC. Predictive factors associated with failure to prevent severe disease were identified. Thirty-eight patients received HFNC. Twenty-five (65.8%) patients were classified in the HFNC success group. In the univariate analysis, age, history of chronic kidney disease (CKD), non-respiratory sequential organ failure assessment (SOFA) ≥ 1, oxygen saturation to fraction of inspired oxygen ratio (SpO 2 /FiO 2 ) before HFNC ≤ 169.2, were significant predictors of HFNC failure. Multivariate analysis revealed that SpO 2 /FiO 2 value before HFNC ≤ 169.2 was an independent predictor of HFNC failure. No apparent nosocomial infection occurred during the study period. Appropriate use of HFNC for acute respiratory failure caused by COVID-19 can reduce the severity of severe disease without causing nosocomial infection. Age, history of CKD, nonrespiratory SOFA before HFNC ≤ 1, and SpO 2 /FiO 2 before HFNC ≤ 169.2 were associated with HFNC failure.
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