Spontaneous remission of cytomegalovirus-related immune thrombocytopenia in a healthy adult

A previously healthy 59-year-old woman was admitted to our hospital due to petechiae. Investigations showed profound thrombocytopenia (1.5×10(4)/μl) and mild elevation of transaminases. The serological examination revealed acute cytomegalovirus (CMV) infection. We intermittently measured CMV load in her clinical course. The petechiae improved with no therapy. One month later, the platelet count was increased up to 7.6×10(4)/μl and CMV-DNA was reduced to undetectable levels. CMV-induced thrombocytopenia in an immunocompetent adult is rare. We also recognized the association of platelet counts and virus load in the natural course of this patient with CMV-induced thrombocytopenia.     

Bone mineral density evaluation of patients with type 2 diabetes mellitus

[Purpose] Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. A consequence of this is chronic hyperglycemia with disturbances in carbohydrate, fat and protein metabolism. We investigated whether there is any difference among DM patients and a control group in terms of lumbar and femur BMD (bone mineral density), and standard deviation scores (Z score and T score). [Subjects and Methods] This randomized, prospective, controlled, single-blind study was conducted in the Physical Medicine and Rehabilitation Department Faculty of Medicine, Bezm-i Alem Vakıf University. Patients with type 2 diabetes mellitus were included in the patient groups. Healthy individuals were included in the control group. [Results] A total of 126 patients completed the study (63 in the study group, 63 in the control group). There was no significant difference in the results of the laboratory examinations of the cases. The bone mineral densities of the cases were found to be significantly low in terms of the lumbar (L1–4) T scores in the type 2 diabetes group. [Conclusion] Although osteoporosis is one of the potential complications of type 1 diabetes, its effect on bone mineral density in type 2 DM is controversial. In different studies, the bone mineral density values have increased, decreased or remained normal. With the exception of the lumbar (L1–4) T score, similar results were obtained in this study.Key words: Type 2 diabetes mellitus, Osteoporosis, Bone mineral density     

ANCA-associated systemic vasculitis in Japan: clinical features and prognostic changes

Background

This study was conducted to standardize treatment and determine patient and renal outcome in Japanese anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis/rapidly progressive glomerulonephritis (AAV/RPGN) patients, because the prognosis of AAV/RPGN patients in Japan had been poor compared with that of other countries.

Methods

The participants in this retrospective cohort study were 824 ANCA-positive RPGN patients, 705 of whom were only myeloperoxidase (MPO)-ANCA positive.

Results

Among the early-years cohort (group?A; cases diagnosed between 1988 and 1998), patients frequently died due to opportunistic infection. Therefore, we recommended a reduced dose of prednisolone (oral prednisolone dose <0.8?mg/kg/day) with or without cyclophosphamide for initial treatment of Japanese RPGN patients. After this recommendation, 1-year survival of the patients improved: 75% in group?A, 79% in group?B (between 1999 and 2002), and 81% in group?C (after 2003). During the entire observation period, average serum creatinine level at the start of treatment decreased, and improvement of 1-year renal survival was also found (72% in group?A, 83% in group?B, and 83% in group?C), while the recurrence rate was significantly increased in group?C (0.05/patient-year in group?A, 0.07/patient-year in group?B, and 0.13/patient-year in group?C).

Conclusions

Oral prednisolone dose <0.8?mg/kg/day with or without cyclophosphamide as an initial treatment could improve patient survival in older Japanese AAV/RPGN patients. However, maintenance treatment avoiding relapse should be established to improve renal outcomes.