Successful treatment of orbital myositis with intravenous immunoglobulins

Shambal, S.; Lindner, Alfred; Zierz, Stephan

doi:10.1002/(sici)1097-4598(199810)21:10<1359::aid-mus26>3.0.co;2-w

Cited by 16 publications

(4 citation statements)

References 3 publications

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“…Intravenous gamma globulin (IVIG) administration of either unselected or selected antibody preparations, specifically enriched from seropositive individuals primarily for prophylaxis against various infectious agents, has been shown to modulate or attenuate primary infections [ 1–3]. IVIG administration at higher concentrations and multiple doses has been shown to be beneficial in diseased patients [ 4–17], including cytomegalovirus (CMV) infections [ 18, 19]. IVIG has been shown to decrease or neutralize the autoantibody titres and induce clinical improvement in patients with autoimmune disorders [ 20–24].…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus immune globulin intravenous (human) administration modulates immune response to alloantigens in sensitized renal transplant candidates

Sivasai

Mohanakumar

Phelan

et al. 2000

Clinical and Experimental Immunology

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SUMMARYOne of the important parameters for prolonged waiting time for potential renal transplant recipients is the presence of preformed antibodies to human leucocyte antigen (HLA) antigens, which is often caused by previous transplants, pregnancy or transfusions. In vivo administration of speci®c and unselected polyclonal intravenous immunoglobulin (IVIGs) preparations have been shown to inhibit anti-HLA alloantibodies in highly sensitized patients. We sought to determine whether Cytogam (Medimmune Inc., Gaithersburg, MD, USA), a hyperimmune anticytomegalovirus immunoglobulin would (1) effect either in vitro or in vivo alloreactivity, and (2) whether Cytogam therapy could reduce the titre of preformed anti-HLA antibodies in highly sensitized patients. Alloreactivity was assessed by mixed lymphocyte reaction (MLR) and cytotoxic T lymphocyte (CTL) assay. A complement dependent microlymphocytotoxicity assay was done to assess for panel reactive antibody (PRA) status and the presence of anti-idiotypic antibodies in the Cytogam preparation. The MLR was inhibited by Cytogam in vitro in a dose-dependent fashion ranging from 31±92%. Signi®cant inhibition of the MLR responses was not observed in recipients who received Cytogam in vivo (50 mg/kg). This could be a result of adminstration of a low dose of IVIG. However, CTL activity against the alloantigens in all individuals assessed was signi®cantly inhibited after in vivo administration of Cytogam. Three of ®ve individuals experienced a decrease of 5±32% in the PRA status at 4 weeks post administration of Cytogam. Cytogam also blocked the anti-HLA antibody titres in a microlymphocytotoxicity assay, suggesting the presence of anti-idiotypic antibodies. Our study was based on a single prophylactic dose of Cytogam (50 mg/kg), however, higher dose administration could be feasible by removing more¯uid at dialysis, but should be given intradialytically to avoid volume overload. Overall, our results suggest that Cytogam can modulate the in vivo and in vitro T cell responses against the alloantigens.

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Section: Introductionmentioning

confidence: 99%

Cytomegalovirus immune globulin intravenous (human) administration modulates immune response to alloantigens in sensitized renal transplant candidates

Sivasai

Mohanakumar

Phelan

et al. 2000

Clinical and Experimental Immunology

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“…Muscle biopsy should be deserved to unresponsive cases, histopathology previously demonstrated non-specific lymphocyte, macrophage, plasma cell infiltrates [2,6,7,9]. The pathophysiologic basis of IOM is still uncertain, therefore the treatment plans and the choice of immunomodulatory treatment remains empiric [6,11,12]. Mycophenolate mofetil (MM) was used successfully in 5 cases.…”

Section: Discussionmentioning

confidence: 99%

“…By concluding, our report highlights the importance of cautious history, detailed clinical examinations and meticulous neuroradiologic studies in patients with suspected IOM. IOM can be regarded by clinicians as a diagnosis of exclusion, which relies heavily on negative results from the baselined laboratory investigations [1][2][3][4][5][6][8][9][10][11][12]. The myositis can be detected on MRI or CT scans through thickening of the affected muscles, uptake of contrast medium, and on MRI through signal-intensity hyperintensity in T2 weighted images [5,6,8].…”

Section: Discussionmentioning

confidence: 99%

Cutting the edge of idiopathic recurrent orbital myositis

et al. 2013

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AbstractThe spectrum of orbital inflammatory diseases ranges broadly from specific diseases as connective tissue disorders, thyroid ophthalmopathy to non-specific inflammations, which may involve one or multiple structures of the orbit and/ or the surrounding sinus. Idiopathic orbital myositis (IOM) may be a localized process or it can be secondary to systemic diseases. We report 4 patients affected by IOM; in all relapsing diplopia was the main complaint, associated with orbital pain in 3 and with abnormal visual evoked responses in 2. Computed tomography (CT), magnetic resonance imaging (MRI) supported the diagnosis revealing enlargement, altered signal intensity of affected muscles. Repeated MRI scans and extensive laboratory examinations comprising of the search for a remote malignacy, lymproliferative, connective tissue diseases, thyroid ophthalmopathy were necessary to confirm the diagnosis. Oral or/and intravenous steroids were main treatments; relapses often occurred when steroid was tapered down. Intravenous immuneglobulins and azathioprine was used in one refractory case

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“…The patient was treated transiently with azathioprine because of gastric intolerance associated with 12 monthly doses of IVIG; a marked improvement in ocular signs was observed, but at 12 months deterioration was observed on magnetic resonance imaging (MRI); the patient was then treated by methotrexate and corticosteroids. Successful treatment of a case of orbital myositis has also been reported with IVIG 43 …”

Section: Efficacy Of Ivig In Interocular Inflammation: the Clinical Ementioning

confidence: 97%

Human Immunoglobulins in Intraocular Inflammation

Tellier

2007

Annals of the New York Academy of Sciences

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Chronic intraocular inflammation (IOI) is a heterogeneous group of rare diseases, which represents one of the leading causes of acquired and treatable blindness in adults. The main anatomical site of inflammation is the uveal tract, which is the vascular organ of the eye, but uveitis is now used to describe IOI more globally. In around 40% of the cases of uveitis an underlying systemic disease, often of autoimmune origin, can be identified. In autoimmune diseases with IOI, uveitis may be the first clinical manifestation and may represent the most severe sign. Studies in animal models, especially in experimental autoimmune uveitis (EAU), offer the opportunity to investigate the pathogenicity of these disorders. The conventional treatment of IOI includes corticosteroids and immunosuppressive agents, which are efficient in around one-half of the patients, but their effectiveness is also limited by their iatrogenicity. The effects of intravenous immunoglobulins (IVIGs) on ocular inflammation have been investigated in a wide spectrum of autoimmune/systemic diseases. Most of the publications are case series or open trials. They show favorable results in a subset of indications, including mainly ocular cicatricial pemphigoid (OCP), Vogt-Koyanagi-Harada (VKH) syndrome, or birdshot disease. Efficacy results are more debated in other conditions such as inflammatory demyelinating optic neuritis. In other diseases with IOI only case reports are available, suggesting that IVIGs may be of some interest. These observations support the need for controlled trials to demonstrate the efficacy of IVIGs and assess their potential steroid-sparing effect.

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Successful treatment of orbital myositis with intravenous immunoglobulins

Cited by 16 publications

References 3 publications

Cytomegalovirus immune globulin intravenous (human) administration modulates immune response to alloantigens in sensitized renal transplant candidates

Cytomegalovirus immune globulin intravenous (human) administration modulates immune response to alloantigens in sensitized renal transplant candidates

Cutting the edge of idiopathic recurrent orbital myositis

Human Immunoglobulins in Intraocular Inflammation

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