Buradasınız

Adölesan Bir Kız Hastada Mikofenolat İlişkili Alopesi Mikofenolat ve Alopesi

Mycophenolate-Associated Alopecia in an Adolescent Girl Mycophenolate and Alopecia

Journal Name:

Publication Year:

DOI: 
10.5262/tndt.2014.1001.12

Keywords (Original Language):

Abstract (2. Language): 
PURPOSE: To report a patient treated with enteric-coated mycophenolate sodium (EC-MPS), in whom infrequent side effects developed. CASE REPORT: A 14-year-old girl presented with hair loss after starting EC-MPS. She had her fi rst nephrotic syndrome attack when she was 7 years old. During the next six years, she had six attacks and two biopsies without fi ndings of segmental sclerosis. She received steroids and 55 months of CsA. She was evaluated as steroid and CsA dependent when she had a relapse a month after cessation of treatment. The last biopsy showed CsA toxicity. EC-MPS was institituted (1080 mg/d). Alopecia developed at the second month. The dose was decreased by two third and hair loss stopped within a month. Her menstrual cycles also ceased after EC-MPS treatment and resumed two months after dose reduction. She remained in remission during the following 8 months and had a new relapse thereafter, which responded to a short term of high dose steroid treatment. She is still on the 20th month of EC-MPS and had no relapse. CONCLUSION:This is the fi rst adolescent with alopecia and menstrual irregularity during EC-MPS treatment, which may be effective even at a two third of the suggested dose.
Abstract (Original Language): 
AMAÇ: Enterik kaplı mikofenolat sodyum (EC-MPS) ile tedavi edilen ve nadir görülen yan etkilerin geliştiği bir olguyu bildirmek. OLGU SUNUMU: On dört yaşında kız hasta EC-MPS tedavisi sonrası gelişen saç kaybı ile başvurdu. Hastanın ilk nefrotik sendrom atağını 7 yaşında iken geçirdiği, takip eden 6 yıl boyunca 6 atak daha geçirdiği, bu sürede yapılan iki renal biyopside segmental skleroz bulgularına rastlanmadığı, steroid tedavisi ve 55 ay süren siklosporin A (CsA) tedavisi aldığı kaydedildi. Tedavi kesiminden bir ay sonra relaps olması üzerine steroid ve CsA bağımlı olarak değerlendirilen olgunun tekrarlanan biyopsisinde CsA toksisitesi izlendi. Bunun üzerine başlanan EC-MPS (1080 mg/gün) tedavisinin ikinci ayında alopesi gelişti. Doz üçte iki oranında azaltılınca saç dökülmesi bir ay içinde durdu. Ayrıca, EC-MPS tedavisinden sonra duraklamış olan adet döngüsü dozun azaltılmasından iki ay sonra tekrar başladı. Takip eden 8 ay boyunca remisyonda kalan olgunun tekrarlayan atağı kısa süreli yüksek doz steroid tedavisine yanıt verdi. Halen EC-MPS tedavisinin 20. ayında olan olgu sorunsuz izlenmektedir. SONUÇ: Olgumuz, EC-MPS tedavisi sırasında alopesi ve adet düzensizliği bildirilen ilk adölesan olgudur. EC-MPS, önerilen dozun üçte ikisinde bile etkili olabilmektedir.

REFERENCES

References: 

1. Li Z, Duan C, He J, Wu T, Xun M, Zhang Y, Yin Y: Mycophenolate
mofetil therapy for children with steroid-resistant nephrotic
syndrome. Pediatr Nephrol 2010; 25: 883-888
2. de Mello VR, Rodrigues MT, Mastrocinque TH, Martins SP,
de Andrade OV, Guidoni EB, Scheffer DK, Martini Filho D,
Toporovski J, Benini V: Mycophenolate mofetil in children with
steroid/cyclophosphamide-resistant nephrotic syndrome. Pediatr
Nephrol 2010; 25: 453-4603. Hogg RJ, Fitzgibbons L, Bruick J, Bunke M, Ault B, Baqi N,
Trachtman H, Swinford R: Mycophenolate mofetil in children
with frequently relapsing nephrotic syndrome: A report from the
Southwest Pediatric Nephrology Study Group. Clin J Am Soc
Nephrol 2006; 1: 1173-1178
4. Gellermann J, Querfeld U: Frequently relapsing nephrotic
syndrome: Treatment with mycophenolate mofetil. Pediatr Nephrol
2004; 19: 101-104
5. Fujinaga S, Ohtomo Y, Hirano D, Nishizaki N, Someya T, Ohtsuka
Y, Kaneko K, Shimizu T: Mycophenolate mofetil therapy for
childhood-onset steroid dependent nephrotic syndrome after longterm
cyclosporine: Extended experience in a single center. Clin
Nephrol 2009; 72: 268-273
6. Fujinaga S, Ohtomo Y, Umino D, Takemoto M, Shimizu T,
Yamashiro Y, Kaneko K: A prospective study on the use of
mycophenolate mofetil in children with cyclosporine-dependent
nephrotic syndrome. Pediatr Nephrol 2007; 22: 71-76
7. Barletta GM, Smoyer WE, Bunchman TE, Flynn JT, Kershaw DB:
Use of mycophenolate mofetil in steroid-dependent and-resistant
nephrotic syndrome. Pediatr Nephrol 2003; 18: 833-837
8. Kitiyakara C, Ophascharoensuk V, Changsirikulchai S, Ingsathit A,
Tankee P, Sangpanich A, Sumethkul V: Treatment of lupus nephritis
and primary glomerulonephritis with enteric-coated mycophenolate
sodium. Clin Nephrol 2008; 69: 90-101
9. Okada M, Sugimoto K, Yagi K, Yanagida H, Tabata N, Takemura
T: Mycophenolate mofetil therapy for children with intractable
nephrotic syndrome. Pediatr Int 2007; 49: 933-937
10. Chan TM, Li FK, Tang CS, Wong RW, Fang GX, Ji YL, Lau CS,
Wong AK, Tong MK, Chan KW, Lai KN: Effi cacy of mycophenolate
mofetil in patients with diffuse proliferative lupus nephritis. Hong
Kong-Guangzhou Nephrology Study Group. N Engl J Med 2000;
343: 1156-1162
11. Budde K, Glander P, Diekmann F, Waiser J, Fritsche L, Dragun
D, Neumayer HH: Review of the immunosuppressant entericcoated
mycophenolate sodium. Expert Opin Pharmacother 2004; 5:
1333-1345
12. Novak I, Frank R, Vento S, Vergara M, Gauthier B, Trachtman
H: Effi cacy of mycophenolate mofetil in pediatric patients with
steroid-dependent nephrotic syndrome. Pediatr Nephrol 2005; 20:
1265-126813. Gargah TT, Lakhoua MR: Mycophenolate mofetil in treatment of
childhood steroid-resistant nephrotic syndrome. J Nephrol 2011;
24: 203-207
14. Gellermann J, Ehrich JH, Querfeld U: Sequential maintenance
therapy with cyclosporin A and mycophenolate mofetil for sustained
remission of childhood steroid-resistant nephrotic syndrome.
Nephrol Dial Transplant 2012; 27(5): 1970-1978
15. Baudouin V, Alberti C, Lapeyraque AL, Bensman A, André JL,
Broux F, Cailliez M, Decramer S, Niaudet P, Deschênes G, Jacqz-
Aigrain E, Loirat C: Mycophenolate mofetil for steroid-dependent
nephrotic syndrome: A phase II Bayesian trial. Pediatr Nephrol
2012; 27(3): 389-396
16. Tse KC, Tang CS, Lio WI, Lam MF, Chan TM: Quality of life
comparison between corticosteroid-and-mycofenolate mofetil
and corticosteroid-and-oral cyclophosphamide in the treatment of
severe lupus nephritis. Lupus 2006; 15: 371-379
17. Touma Z, Gladman DD, Urowitz MB, Beyene J, Uleryk EM,
Shah PS: Mycophenolate mofetil for induction treatment of lupus
nephritis: A systematic review and metaanalysis. J Rheumatol 2011;
38: 69-78
18. Cho BK, Sah D, Chwalek J, Roseborough I, Ochoa B, Chiang C,
Price VH: Effi cacy and safety of mycophenolate mofetil for lichen
planopilaris. J Am Acad Dermatol 2010; 62: 393-397
19. Tursen U, Api H, Kaya T, Ikizoglu G: Treatment of lichen
planopilaris with mycophenolate mofetil. Dermatol Online J 2004;
10: 24
20. Köse O, Safali M, Bulent Tastan H, Gur AR: Mycophenolate
mofetil in extensive Alopecia areata: No effect in seven patients.
Dermatology 2004; 209: 69-70
21. Laskari K, Mavragani CP, Tzioufas AG, Moutsopoulos HM:
Mycophenolate mofetil as maintenance therapy for proliferative
lupus nephritis: A long-term observational prospective study.
Arthritis Res Ther 2010; 12: R208
22. Zierhut M, Stübiger N, Aboalchamat W, Landenberger H,
Bialasiewicz AA, Engelmann K: Immunosuppressive therapy
with mycophenolate mofetil (CellCept) in treatment of uveitis.
Ophthalmologe 2001; 98: 647-651

Thank you for copying data from http://www.arastirmax.com