1/3. Corticosteroid therapy for refractory infections in chronic granulomatous disease: case reports and review of the literature.BACKGROUND: Chronic granulomatous disease (CGD) is a primary phagocyte immunodeficiency. It is often accompanied by an exuberant and aberrant inflammatory response, with granulomata and obstruction of the gastrointestinal and genitourinary tracts and inflammatory bowel disease. Although corticosteroids are successful in managing the obstructive and inflammatory disorders of CGD, they are not ordinarily used for the management of infection because of the possibility of further compromising the patient's immune system. OBJECTIVES: To discuss the pros and cons of the use of corticosteroids for the treatment of infections in CGD. methods: We describe 2 patients with CGD and refractory infections who were successfully treated with systemic corticosteroids in addition to antimicrobial agents. We also review the medical literature in which corticosteroids have been used for CGD infection. RESULTS: Our cases add to 3 other reports in which antibiotics and corticosteroids were used successfully in patients with CGD. However, in the presence of a potential pathogen, notably, aspergilla, corticosteroids may mask or favor dissemination of the fungus, especially in adults. CONCLUSIONS: Corticosteroids may play an important adjunctive role in CGD refractory infections.- - - - - - - - - - ranking = 1keywords = granulomatous disease (Clic here for more details about this article) |
2/3. Steroid therapy for bronchopneumonia in chronic granulomatous disease.In general, immunosuppressive agents such as corticosteroids are considered to be a contraindication for immunocompromised hosts with an active infection. Recently, however, a few cases have been reported where the obstructive lesions caused by the excessive inflammation in chronic granulomatous disease were successfully resolved with corticosteroids, resulting in a remission of the infection. As we have also experienced a case in which oral corticosteroid used in combination with antibiotics had a beneficial effect on an intractable respiratory tract infection which occurred in a patient with chronic granulomatous disease, we present the case report. Although it may be very difficult to determine the candidates, we consider that in selected cases a corticosteroid therapy with concomitant use of antibiotics will be a choice for the treatment of intractable infections in chronic granulomatous disease.- - - - - - - - - - ranking = 1.4keywords = granulomatous disease (Clic here for more details about this article) |
3/3. Disseminated mycobacterium flavescens in a probable case of chronic granulomatous disease.We report the case of a diabetic Chinese male with no previous history of recurrent infections. His course was at first notable for relapsing salmonella blockley infections, following which he developed repeated soft-tissue infections and cryptococcus neoformans pneumonia. He was diagnosed as having chronic granulomatous disease and was treated with gamma interferon. During the latter stages of his illness he developed mycobacterium flavescens infection in soft tissues, joints, bones and lung. This is the first report of disseminated M. flavescens infection.- - - - - - - - - - ranking = 1keywords = granulomatous disease (Clic here for more details about this article) |