Cyclophosphamide/prednisolone

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Fungal pneumonia and lack of efficacy: case report A 72-year-old man developed fungal pneumonia during immunosuppressants therapy with prednisolone and cyclophosphamide. Additionally, he exhibited lack of efficacy during treatment with prednisolone and cyclophosphamide for acquired haemophilia-A. The man had been receiving unspecified dipeptidyl peptidase-4 inhibitor for type 2 diabetes mellitus. He subsequently developed dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid, for which he started receiving prednisolone 0.5 mg/kg. Three months later and while receiving prednisolone at 19 mg/day dose, he developed purpura on his forearms bilaterally. Subsequently, based on prolonged activated partial thromboplastin time, decrease in factor VIII activity and the presence of factor VIII inhibitor, he was diagnosed with acquired haemophilia-A [aetiology not stated]. He started receiving immunosuppressants therapy with prednisolone 1 mg/kg and cyclophosphamide 300 mg/week [routes not stated]. However, this treatment did not reduce the inhibitor level. His condition subsequently got complicated with pneumonia caused by an unspecified fungal infection (fungal pneumonia) [durations of treatments to reaction onset not stated]. The man started receiving rituximab. Within four weeks, the factor VIII inhibitor level decreased, and he could decrease the prednisolone dose rapidly. He eventually achieved a coagulative complete remission of haemophilia-A with improvement in fungal pneumonia and in bullous pemphigoid. Matsumoto T, et al. [Acquired hemophilia A complicated by dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid]. Rinsho Ketsueki 61: 451-454, No. 5, 2020. 803498050 Available from: URL: http://doi.org/10.11406/rinketsu.61.451 [Japanese; summarised from an English abstract]

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Reactions 29 Aug 2020 No. 1819

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