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Iltar U, Alhan FN, Vural E, Ataş Ü, Sözel H, Doğan Ö, Boduroğlu A, Yücel OK, Salim O, Ündar L. Recurrent arthritis as an unexpected side effect associated with azacitidine in a patient with myelodysplastic syndrome. J Oncol Pharm Pract 2021; 28:500-503. [PMID: 34636655 DOI: 10.1177/10781552211049728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Hypomethylating agents have confirmed efficacy for myelodysplastic syndrome and acute myeloid leukemia and are widely used. Although arthralgia is common side effect associated with hypomethylating agents, arthritis has not been reported previously. CASE REPORT We present the first recorded patient with arthritis after azacitidine treatment. The patient we presented here had severe cytopenias requiring transfusion with erythrocyte and platelet suspensions, and a complete hematological response was obtained for myelodysplastic syndrome after three cycles of azacitidine (AZA) treatment. However, interestingly, after each AZA treatment cycle, the patient had recurrent attacks of arthritis. MANAGEMENT AND OUTCOMES The episodes of arthritis were possibly acute flares of pre-existing crystal-induced arthritis, as exhibited with azacitidine treatments and were managed effectively with nonsteroidal anti-inflammatory drugs. DISCUSSION Because it is a rare condition, clinicians should not overlook AZA as a possible cause of arthritis exacerbations when arthritis of unknown etiology develops in patients treated with AZA.
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Affiliation(s)
- Utku Iltar
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Fadime Nurcan Alhan
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Ece Vural
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Ünal Ataş
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Hasan Sözel
- Department of Internal Medicine, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Ömer Doğan
- Department of Radiology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Ahmet Boduroğlu
- Department of Pathology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Orhan Kemal Yücel
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Ozan Salim
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
| | - Levent Ündar
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, 37502Akdeniz University, Antalya, Turkey
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Hatayama M, Ikuta K, Ishioh M, Saito T, Toki Y, Yamamoto M, Shindo M, Torimoto Y, Okumura T. Pseudogout Attack after Pegfilgrastim Administration in Anaplastic Large Cell Lymphoma. Intern Med 2018; 57:1779-1782. [PMID: 29434148 PMCID: PMC6047990 DOI: 10.2169/internalmedicine.9362-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 67-year-old man with relapsed anaplastic large cell lymphoma received salvage chemotherapy, and pegfilgrastim was used to prevent febrile neutropenia. On day 18 of chemotherapy, he developed a pseudogout attack. Although the first symptoms improved, another pseudogout attack occurred when he received the second course of chemotherapy and pegfilgrastim. Filgrastim was then used for the third course of chemotherapy, and a pseudogout attack did not occur. The serum granulocyte-stimulating factor (G-CSF) level was extremely elevated only when pegfilgrastim was used, suggesting a relationship between pseudogout and G-CSF. Pseudogout should be recognized as an adverse effect of pegfilgrastim.
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Affiliation(s)
- Mayumi Hatayama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Katsuya Ikuta
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Masatomo Ishioh
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Takeshi Saito
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Yasumichi Toki
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Masayo Yamamoto
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | - Motohiro Shindo
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
| | | | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
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Congenital neutropenia: diagnosis, molecular bases and patient management. Orphanet J Rare Dis 2011; 6:26. [PMID: 21595885 PMCID: PMC3127744 DOI: 10.1186/1750-1172-6-26] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 05/19/2011] [Indexed: 12/27/2022] Open
Abstract
The term congenital neutropenia encompasses a family of neutropenic disorders, both permanent and intermittent, severe (<0.5 G/l) or mild (between 0.5-1.5 G/l), which may also affect other organ systems such as the pancreas, central nervous system, heart, muscle and skin. Neutropenia can lead to life-threatening pyogenic infections, acute gingivostomatitis and chronic parodontal disease, and each successive infection may leave permanent sequelae. The risk of infection is roughly inversely proportional to the circulating polymorphonuclear neutrophil count and is particularly high at counts below 0.2 G/l.When neutropenia is detected, an attempt should be made to establish the etiology, distinguishing between acquired forms (the most frequent, including post viral neutropenia and auto immune neutropenia) and congenital forms that may either be isolated or part of a complex genetic disease.Except for ethnic neutropenia, which is a frequent but mild congenital form, probably with polygenic inheritance, all other forms of congenital neutropenia are extremely rare and have monogenic inheritance, which may be X-linked or autosomal, recessive or dominant.About half the forms of congenital neutropenia with no extra-hematopoietic manifestations and normal adaptive immunity are due to neutrophil elastase (ELANE) mutations. Some patients have severe permanent neutropenia and frequent infections early in life, while others have mild intermittent neutropenia.Congenital neutropenia may also be associated with a wide range of organ dysfunctions, as for example in Shwachman-Diamond syndrome (associated with pancreatic insufficiency) and glycogen storage disease type Ib (associated with a glycogen storage syndrome). So far, the molecular bases of 12 neutropenic disorders have been identified.Treatment of severe chronic neutropenia should focus on prevention of infections. It includes antimicrobial prophylaxis, generally with trimethoprim-sulfamethoxazole, and also granulocyte-colony-stimulating factor (G-CSF). G-CSF has considerably improved these patients' outlook. It is usually well tolerated, but potential adverse effects include thrombocytopenia, glomerulonephritis, vasculitis and osteoporosis. Long-term treatment with G-CSF, especially at high doses, augments the spontaneous risk of leukemia in patients with congenital neutropenia.
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D'Souza A, Jaiyesimi I, Trainor L, Venuturumili P. Granulocyte colony-stimulating factor administration: adverse events. Transfus Med Rev 2008; 22:280-90. [PMID: 18848155 DOI: 10.1016/j.tmrv.2008.05.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recombinant human granulocyte colony-stimulating factor (G-CSF) has been in clinical use for approximately 2 decades. In healthy donors, it has been used to mobilize peripheral blood progenitor cells for hematopoietic stem cell transplantation and granulocytes for apheresis collection. In patients, it has been used to decrease the duration of neutropenia after chemotherapy and to offset the neutropenia due to myelodysplasia, acquired immunodeficiency syndrome, and genetic disorders of granulocyte production. As the number of uses of G-CSF in clinical practice grows, more side effects of this generally safe pharmaceutical agent are being recognized. Our objective in this article is to provide an in-depth review of the reported adverse events associated with the use of G-CSF.
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Affiliation(s)
- Anita D'Souza
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Ames PRJ, Rainey MG. Consecutive pseudogout attacks after repetitive granulocyte colony-stimulating factor administration for neutropenia. Mod Rheumatol 2007; 17:445-6. [PMID: 17929142 DOI: 10.1007/s10165-007-0601-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 05/07/2007] [Indexed: 11/24/2022]
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Taggarshe D, Ng CH, Molokwu C, Singh S. Acute pseudogout following contrast angiography. Clin Rheumatol 2006; 25:115-6. [PMID: 15902520 DOI: 10.1007/s10067-005-1114-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 01/06/2005] [Accepted: 01/06/2005] [Indexed: 11/25/2022]
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Price TH. The current prospects for neutrophil transfusions for the treatment of granulocytopenic infected patients. Transfus Med Rev 2000; 14:2-11. [PMID: 10669936 DOI: 10.1016/s0887-7963(00)80111-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Infection continues to be a major cause of morbidity and mortality in patients undergoing aggressive chemotherapy and hematopoietic stem cell transplantation. The provision of normal neutrophils to such patients is a logical therapeutic approach, the success of which will likely be dependent on the dose of neutrophils provided. Stimulation of normal leukapheresis donors with G-CSF or dexamethasone causes marked neutrophilia and results in the collection of greatly increased numbers of neutrophils. Transfusion recipients, on average, exhibit large posttransfusion neutrophil increments that are sustained for 24 hours. These cells are capable of migrating to extravascular sites. Although the preliminary clinical impressions are encouraging, the clinical efficacy of transfusing large numbers of neutrophils will have to be determined by randomized controlled clinical trials.
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Affiliation(s)
- T H Price
- Puget Sound Blood Center, Seattle, WA 98104-1256, USA
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Ali Y, Weinstein M, Jokl P. Acute pseudogout following intra-articular injection of high molecular weight hyaluronic acid. Am J Med 1999; 107:641-2. [PMID: 10625037 DOI: 10.1016/s0002-9343(99)00255-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Reginato AJ, Tamesis E, Netter P. Familial and clinical aspects of calcium pyrophosphate deposition disease. Curr Rheumatol Rep 1999; 1:112-20. [PMID: 11123024 DOI: 10.1007/s11926-999-0007-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The mechanisms involved in calcium pyrophosphate dehydrated deposition disease (CPPDD) are unknown and those families with the disease, described in different countries, provide a fertile file for genomic research. Genomic DNA studies in these kindred with secondary or primary form of CPPDD provide a shortcut for trying to investigate the biomolecular basis of the disease. Mutations in the COL2A1 gene have been identified in one family with spondyloepiphyseal dysplasia and secondary deposits of pyrophosphate and apatite crystalline deposits. In another kindred with CPPDD due to precocious osteoarthritis, the phenotype was linked to markers of chromosome 8p. In four other kindreds (British, Argentinean, French, and the United States), the phenotypes were linked to a precise region of chromosome 5p. Two possible genes located in this region that are expressed in the articular cartilage, but of unknown articular physiologic role are being investigated as possible CPPDD genes. From the clinical point of view, CPPDD spectrum of clinical and radiographic manifestations is enlarging, especially those related to spine involvement or pseudo tumoral forms. At the end, the present review of a current therapeutic approach for CPPDD is discussed.
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Affiliation(s)
- A J Reginato
- Department of Medicine, Robert Wood Johnson Medical School, Camden, NJ, USA
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Abstract
This review focuses on several recent clinically-related observations concerning Calcium Pyrophosphate Deposition Disease (CPPDD). Developments include new information on the epidemiology of idiopathic CPPDD in aging, on familial CPPDD, and on associated conditions that predispose to secondary CPPDD. Factors that may precipitate pseudogout, including the use of intra-articular hyaluronan and systemic G-CSF, are also discussed.
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Affiliation(s)
- R A Terkeltaub
- VA Medical Center, University of California San Diego Division of Rheumatology, 3350 La Jolla Village Drive, San Diego, CA 92161, USA
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Vassilopoulos D, Camisa C, Strauss RM. Selected drug complications and treatment conflicts in the presence of coexistent diseases. Rheum Dis Clin North Am 1999; 25:745-77, x. [PMID: 10467638 DOI: 10.1016/s0889-857x(05)70096-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The presence of different coexistent systemic diseases often times complicates the selection of the appropriate treatment of an underlying rheumatologic condition. In this article, some controversial treatment conflicts that are frequently encountered in the daily practice of rheumatology are clarified and guidelines for the best available therapeutic options are provided.
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Affiliation(s)
- D Vassilopoulos
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Ohio, USA
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