Acute Inflammatory Syndrome with Elevated Procalcitonin Induced by Mycophenolate Sodium: Figure 1.

Loock, J.; Lamprecht, Peter; Gross, Wolfgang L.

doi:10.3899/jrheum.111083

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Contrary to previous reports, the patient presented with mild arthralgias rather than impressive oligoarthritis . Also, measured CRP values were significantly lower than reported before .…”

Section: Discussioncontrasting

confidence: 99%

“…Here, we provide first evidence of a kidney‐transplanted patient, who presented with pneumonitis and high fever because of pharmacotherapy with enteric‐coated MPA. MPA has already been described to induce inflammatory syndromes in patients with either autoimmune diseases such as granulomatosis with polyangiitis and rheumatoid arthritis or kidney transplantation . Interestingly, our described patient developed the observed MPA side effect 5 months after starting MPA treatment.…”

Section: Discussionmentioning

confidence: 58%

“…The major, dose‐dependent side effects of MPA – CMV infections, leucopenia and gastrointestinal symptoms – are equally well‐described as its clinical efficacy in reducing acute rejection rates and graft loss. Within the past years, few reports were published on pro‐inflammatory effects of MPA . They described patients with granulomatosis and polyangiitis, rheumatoid arthritis or renal transplant recipients who presented with fever, arthralgias, oligoarthritis and elevated C‐reactive protein (CRP) levels due to MPA treatment .…”

mentioning

confidence: 99%

“…Within the past years, few reports were published on pro‐inflammatory effects of MPA . They described patients with granulomatosis and polyangiitis, rheumatoid arthritis or renal transplant recipients who presented with fever, arthralgias, oligoarthritis and elevated C‐reactive protein (CRP) levels due to MPA treatment . Two reports suggested a pro‐inflammatory reaction of the innate immune system shown by either increased IL‐6 serum levels or PMN activation .…”

mentioning

confidence: 99%

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Fever and pneumonitis induced by enteric-coated mycophenolate sodium in a patient after kidney transplantation

Pocivalnik¹,

Kirsch

Hassler

et al. 2013

Transpl Int

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Summary Here, we report on a patient after kidney transplantation, who developed fever and pneumonitis due to mycophenolic acid (MPA) treatment. Decreasing MPA dosages improved the symptoms, but after rechallenge with higher MPA doses the symptoms recurred. Discontinuation of MPA resulted in a complete resolution of fever within 24 h and a rapid improvement in pneumonitis. In vitro, the patient's polymorphonuclear neutrophils (PMNs) developed increased oxidative burst when incubated with MPA and N‐formyl Met‐Leu‐Phe. We first report on MPA‐induced pneumonitis and show that MPA can induce a pro‐inflammatory response in kidney‐transplanted patients. These pro‐inflammatory changes might be due to paradoxical activation of PMNs.

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“…Contrary to previous reports, the patient presented with mild arthralgias rather than impressive oligoarthritis . Also, measured CRP values were significantly lower than reported before .…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 58%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Fever and pneumonitis induced by enteric-coated mycophenolate sodium in a patient after kidney transplantation

Pocivalnik¹,

Kirsch

Hassler

et al. 2013

Transpl Int

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“…In order to clarify whether PCT has a role in discriminating between bacterial infection and disease flares in AAV, we examined PCT levels in AAV patients with elevated CRP measured by a highly sensitive assay, the Thermo Scientific BRAHMS PCT sensitive KRYPTOR assay. As elevated PCT levels have been described in single cases of drug fever due to carbamezepine [ 9 ] and mycophenolate [ 10 ], we aimed to assess PCT levels in the context of drug fever induced by azathioprine (AZT) which is the most frequently used maintenance treatment in AAV.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Procalcitonin in ANCA-Associated Vasculitis (AAV) to Differentiate Between Disease Activity, Infection and Drug Hypersensitivity

Herrmann¹,

Schinke²,

Csernok³

et al. 2015

TORJ

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Objective: Procalcitonin (PCT) is considered to be a specific marker for severe bacterial infections and sepsis. Elevated PCT levels have been reported in active autoimmune diseases without infection.The aim of this study was to assess the diagnostic value of PCT serum levels in ANCA-associated vasculitis (AAV) patients with respect to infection, disease activity and drug fever using a high sensitive PCT detection method.Methods: In 53 AAV patients with elevated C-reactive protein (CRP) PCT was determined by the Thermo Scientific BRAHMS PCT sensitive KRYPTOR assay. Patients underwent standardized diagnostic procedures for evaluation of disease activity and infection.Results: 53 patients with AAV and elevated CRP (7.7±6.9 mg/dl, PCT 0.34±1.02 ng/ml) were assessed, 10 had infection with elevated CRP levels of 11.2±10.2 mg/dl and PCT levels of 1.06±2.07 ng/dl. 43 patients had no evidence of infection, 36 of them were presented with AAV with normal or only slightly positive PCT levels in active disease (n=36) (PCT 0.06±0.06 ng/ml). 7 patients had increased PCT levels due to azathioprine hypersensitivity (0.76±1.01 ng/ml). For discrimination between infection and vasculitis activity PCT was more useful than CRP with the best cut-off at 0.1 ng/ml (sensitivity 60%, specificity 92%).Conclusion: In contrast to previous studies using semiquantitative PCT assays, the KRYPTOR performs better with respect to discrimination of infection from active AAV. In all patients assessed with active AAV (and without infection) PCT levels remained below the PCT reference limit (0.5 ng/ml) for infections. Drug hypersensitivity seems to be an important differential diagnosis in the setting of elevated CRP and PCT in patients who receive azathioprine.

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An adolescent with lupus nephritis presenting with fever, lymphadenomegaly, and arthralgia: Answers

et al. 2019

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Acute Inflammatory Syndrome with Elevated Procalcitonin Induced by Mycophenolate Sodium: Figure 1.

Cited by 5 publications

References 7 publications

Fever and pneumonitis induced by enteric-coated mycophenolate sodium in a patient after kidney transplantation

Fever and pneumonitis induced by enteric-coated mycophenolate sodium in a patient after kidney transplantation

Diagnostic Value of Procalcitonin in ANCA-Associated Vasculitis (AAV) to Differentiate Between Disease Activity, Infection and Drug Hypersensitivity

An adolescent with lupus nephritis presenting with fever, lymphadenomegaly, and arthralgia: Answers

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