title: [Effective infliximab treatment for a recurrent type of acute intestinal graft-versus-host disease accompanied by steroid-induced depression].
abstract: A 22-year-old man with chronic active Epstein-Barr virus infection underwent allogeneic bone marrow transplantation (allo-BMT) from an HLA two allele-mismatched unrelated donor. Ten months after allo-BMT, he developed protein-losing enteropathy following a respiratory syncytial virus infection. A diagnosis of a recurrent type of acute graft-versus-host disease (GVHD) was made based on the histopathological findings, such as the infiltration of T lymphocytes into the superficial epithelium and crypts, and apoptotic bodies in crypts. Although methylprednisolone (mPSL: 10 mg/kg) administration for two consecutive days improved gastrointestinal symptoms, acute pancreatitis and severe depression developed in association with corticosteroid treatment. Reduction of mPSL and administration of infliximab (5 mg/kg/dose, 3 times) resulted in rapid improvement of depression and pancreatitis without aggravating intestinal GVHD. Recent studies have demonstrated that tumor-necrosis-factor (TNF)-α is associated with not only GVHD but also depression and acute pancreatitis. In the present case, anti-TNF-α treatment enabled us to reduce corticosteroid dose without aggravating GVHD, which suggests that this approach might be effective for the treatment of depression and acute pancreatitis.
authors.affiliation: Department of Pediatrics, Matsushita Memorial Hospital.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Tamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishida
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fujiki
authors.forename: Takao
authors.initials: T
authors.lastname: Yoshihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Kondo
authors.forename: Masami
authors.initials: M
authors.lastname: Inoue
authors.forename: Keisei
authors.initials: K
authors.lastname: Kawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawabata
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Imamura
mesh_terms: D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D003863:Depression / Q000139:chemically induced* / Q000188:drug therapy*; D020031:Epstein-Barr Virus Infections / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000188:drug therapy* / Q000209:etiology; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D000069285:Infliximab; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D058990:Molecular Targeted Therapy; D010195:Pancreatitis / Q000188:drug therapy / Q000209:etiology; D012008:Recurrence; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D008775:Methylprednisolone