Efficacy of steroid pulse, plasmapheresis, and mizoribine in a patient with focal segmental glomerulosclerosis.
There have been few reports on successful treatment for focal segmental glomerulosclerosis (FSGS) complicated by leukoencephalopathy. We report the efficacy of the steroid pulse and mizoribine (MZB) combined with plasmapheresis (PP) for a case of FSGS with leukoencephalopathy induced by cyclosporine (CyA). The patient was a 4-year-old boy with FSGS who presented with steroid-resistant nephrotic syndrome (NS) and was treated with CyA. On the 7th day after starting CyA, he complained of one visual disorder, and hypertension and tonic convulsions were observed. Electroencephalography (EEG) revealed generalized slow waves, and magnetic resonance imaging (MRI) disclosed high signal intensity in the white matter. A diagnosis of leukoencephalopathy induced by CyA was made on the basis of these findings with the improvement in clinical manifestations upon discontinuation of CyA. We treated the patient with steroid pulse therapy and MZB combined with PP, and the proteinuria gradually decreased and only microscopic hematuria remained. We report that steroid pulse and MZB combined with PP may be an effective treatment in a patient with FSGS complicated by CyA-induced leukoencephalopathy.
Imaizumi
Tomoko
T
Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima, 960-1295, Japan. tomo@fmu.ac.jp
Kawasaki
Yukihiko
Y
Matsuura
Hiromi
H
Matsumoto
Ayumi
A
Takano
Kei
K
Suyama
Kazuhide
K
Hashimoto
Koichi
K
Suzuki
Hitoshi
H
Hosoya
Mitsuaki
M
D001927:Brain Diseases / Q000139:chemically induced / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000473:pathology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D010956:Plasmapheresis; D020551:Pulse Therapy, Drug; D011859:Radiography; D012263:Ribonucleosides / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D012263:Ribonucleosides; C010052:mizoribine; D016572:Cyclosporine