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2020 ; 39
(8
): 2449-2452
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Experience with Cidofovir as an adjunctive therapy in a patient of
adenovirus-induced macrophage activation syndrome in systemic arthritis
#MMPMID32418043
Pal P
; Bose N
; Poddar A
; Chowdhury K
; Saha A
Clin Rheumatol
2020[Aug]; 39
(8
): 2449-2452
PMID32418043
show ga
A 5-year-old female child, with known systemic juvenile idiopathic arthritis
diagnosed at 18 months of age (on low dose
Prednisolone?+?Methotrexate?+?Leflunomide?+?Tocilizumab), presented with fever
for 1 day, vomiting, drowsiness followed by seizures. On admission to PICU, she
was drowsy, tachycardic, tachypneic, with rashes, and hepatosplenomegaly. Lab
findings showed thrombocytopenia, leucopenia, low ESR, normal CRP, elevated liver
enzymes, high ferritin, LDH, and triglycerides suggestive of macrophage
activation syndrome (MAS). Chest X-ray showed left basal pneumonia and DNA PCR of
throat swab revealed adenovirus. She was diagnosed as adenovirus-triggered MAS
and was initiated on pulse methylprednisolone (6 mg/kg). Because of suboptimal
response after 2 doses, manifested by increasing drowsiness, further fall in
platelets and rising ferritin, methylprednisolone dosage was increased to
30 mg/kg/day with the addition of oral cyclosporine (4 mg/kg/day). In view of
worsening of the chest X-ray and increasing oxygen requirement, Cidofovir
infusion (1 mg/kg thrice weekly) was also started simultaneously considering
increased activity of the adenoviral infection concurrent to immunosuppression.
Within 48 h, the child showed signs of recovery with improved consciousness,
lower oxygen requirements, and improving lab parameters. She was discharged after
3 weeks of IV Cidofovir, on oral prednisolone and cyclosporine. To the best of
our knowledge, this is the first reported use of Cidofovir in adenovirus-induced
MAS.
free
free
free
