• Annals of Clinical Neurophysiology
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• 제22권1호
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• pp.41-45
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• 2020

Acute sarcoid myositis is rarely complicated by sarcoidosis, and steroid therapy is considered the standard treatment. We experienced a patient with acute sarcoid myositis who did not respond to aggressive high-dose corticosteroid therapy, but showed a dramatic improvement after the addition of weekly low-dose oral methotrexate (MTX). This intervention allowed the resumption of normal daily activities after 6 months. Our case strongly suggests that MTX should be considered in patients with acute sarcoid myositis that is resistant to corticosteroid therapy.

• Journal of Oral Medicine and Pain
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• 제43권1호
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• pp.16-20
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• 2018

Graft-versus-host disease (GVHD) is frequent complications of hematopoietic stem cell transplantation. In the chronic GVHD (cGVHD), the oral cavity is the most commonly affected region. The clinical manifestations include erythema, ulceration, lichenoid-hyperkeratotic change in oral mucosa, dry mouth, and limitation of mouth opening. The initial treatment strategy of oral cGVHD patients is topical corticosteroid therapy in various formulation. However, corticosteroid resistance appears in some patients. We report a case of a 25-year-old male patient with oral cGVHD, who has resistance to topical corticosteroid medication, treated with 0.03% tacrolimus ointment and low-dose doxycycline. The patient showed subjective and objective improvement without side effect.

• Tuberculosis and Respiratory Diseases
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• 제85권1호
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• pp.18-24
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• 2022

Background: Neutrophilic asthma (NeuA) is usually resistant to corticosteroids. Tiotropium bromide (TIO) is a bronchodilator that is used as an add-on therapy to inhaled corticosteroid and long-acting β2 agonist in asthma treatment. However, the role of TIO in NeuA is not fully known. Thus, the aim of this study was to evaluate the effect of TIO on NeuA compared to that of corticosteroids. Methods: C57BL/6 female mice were sensitized with ovalbumin and lipopolysaccharide to induce neutrophilic inflammation. Dexamethasone (DEX) was administered on days 14, 17, 20, and 23. TIO was inhaled on days 21, 21, and 23. On day 24, mice were sacrificed. Airway hyper-responsiveness, levels of cytokines in bronchoalveolar lavage (BAL) and lung homogenates, and lung tissue histopathology were compared between the two groups. Results: Neutrophil counts, T helper 2 cells (T_H2)/T_H17 cytokines, and pro-inflammatory cytokine in BAL fluids were elevated in the NeuA group. TIO group showed lower total cells, neutrophil counts, and eosinophil counts in BAL fluids than the DEX group (p<0.001, p<0.05, and p<0.001, respectively). Airway resistance was attenuated in the TIO group but elevated in the NeuA group (p<0.001). Total protein, interleukin (IL)-5, and IL-17A levels in BAL fluids were lower in the TIO group than in the NeuA group (all p<0.05). Conclusion: TIO showed more potent effects than DEX in improving airway inflammation and attenuating airway resistance in NeuA.

• IMMUNE NETWORK
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• 제19권1호
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• pp.5.1-5.12
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• 2019

Autophagy is a homeostatic mechanism that discards not only invading pathogens but also damaged organelles and denatured proteins via lysosomal degradation. Increasing evidence suggests a role for autophagy in inflammatory diseases, including infectious diseases, Crohn's disease, cystic fibrosis, and pulmonary hypertension. These studies suggest that modulating autophagy could be a novel therapeutic option for inflammatory diseases. Eosinophils are a major type of inflammatory cell that aggravates airway inflammatory diseases, particularly corticosteroid-resistant inflammation. The eosinophil count is a useful tool for assessing which patients may benefit from inhaled corticosteroid therapy. Recent studies demonstrate that autophagy plays a role in eosinophilic airway inflammatory diseases by promoting airway remodeling and loss of function. Genetic variant in the autophagy gene ATG5 is associated with asthma pathogenesis, and autophagy regulates apoptotic pathways in epithelial cells in individuals with chronic obstructive pulmonary disease. Moreover, autophagy dysfunction leads to severe inflammation, especially eosinophilic inflammation, in chronic rhinosinusitis. However, the mechanism underlying autophagy-mediated regulation of eosinophilic airway inflammation remains unclear. The aim of this review is to provide a general overview of the role of autophagy in eosinophilic airway inflammation. We also suggest that autophagy may be a new therapeutic target for airway inflammation, including that mediated by eosinophils.

• Journal of Oral Medicine and Pain
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• 제37권3호
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• pp.155-159
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• 2012

구강편평태선은 면역매개성 반응으로 유발되는 만성염증질환으로 정의할 수 있으며 그 정확한 원인은 아직 밝혀지지 않은 상태이다. 일반적으로 스테로이드를 이용한 국소적 또는 전신적 치료를 시행하고 있으나 스테로이드 치료에 반응이 없는 환자의 경우에는 치료가 힘들다. Sulfasalzine은 염증성 장질환을 치료하기 위한 약물로 선택되고 있고 류마티스성 관절염에서도 치료제로 사용하고 있다. 염증성 장질환과 구강편평태선에서 발병기전을 살펴보면 공통적인 부분이 많이 발견된다. 전신적으로 투여시 나타나는 부작용을 최소화하고 접근의 편이성을 위하여 Sulfasalzine을 구강편평태선에 국소 도포의 형태로 시도하였으며, 본 연구에서는 성공적으로 치료한 2 치험례를 소개하였다. 첫번째 증례에서는 8주간의 도포(30mg/5ml, 하루3번) 후 증상이 완화되었으며, 두번째 증례에서는 15주간의 도포 후 증상이 완화되었다. 두 증례 모두 스테로이드에 치료반응이 없었던 환자였으며 sulfasalazine 도포 후 현재까지 증상이 완화된 상태로 지내고 있다. 따라서 Sulfasalazine은 구강편평태선환자에서 치료약물로 선택될 수 있다는 결론을 얻었다.

• Clinical and Experimental Pediatrics
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• 제60권6호
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• pp.167-174
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• 2017

Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006-2007, 2011, and 2015-2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80%-90%. Macrolide-resistant Mycoplasma pneumoniae (MRMP) harbors a point mutation in domain V of 23S rRNA with substitutions mainly detected at positions 2063 and 2064 of the sequence. The excessive use of macrolides may contribute to these mutations. MRMP can lead to clinically refractory pneumonia, showing no clinical or radiological response to macrolides, and can progress to severe and complicated pneumonia. Refractory MPP is characterized by an excessive immune response against the pathogen as well as direct injury caused by an increasing bacterial load. A change of antibiotics is recommended to reduce the bacterial load. Tetracyclines or quinolones can be alternatives for treating MRMP. Otherwise, corticosteroid or intravenous immunoglobulin can be added to the treatment regimen as immunomodulators to downregulate an excessive host immune reaction and alleviate immune-mediated pulmonary injury. However, the exact starting time point, dose, or duration of immunomodulators has not been established. This review focuses on the mechanism of resistance acquisition and treatment options for MRMP pneumonia.

• Tuberculosis and Respiratory Diseases
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• 제42권6호
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• pp.801-812
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• 1995

CR asthma is associated with disease chronicity, a positive family history of asthma and in vitro and in vivo defects in mononuclear cell function. The HPA axis in CR asthmatics is suppressed normally by dexamethasone and the pharmacokinetic profile of an oral dose of prednisolone is similar to that found in CS subjects. In addition, competitive binding studies have shown that the ligand binding and nuclear translocation functions of the GR are similar in the two groups. Studies using gel retardation assay have indicated a defect in DNA binding in CR subjects. Chemical mutational analysis of the GR has shown that is not due to a defect in its structure at the cDNA level. Scatchard analysis of the GR/DNA and GR/ligand interactions suggests that there may be transcriptional interference of the GR with other transcriptionally active molecules leading to defective gene transcription.

• Journal of Yeungnam Medical Science
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• 제35권2호
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• pp.222-226
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• 2018

Recurrent pericarditis is rare in children and is considered idiopathic in most cases. Its course is chronic, and preventing recurrences is important for the patient's quality of life. Although a treatment strategy in pediatric recurrent pericarditis has not yet been established, non-steroidal anti-inflammatory drugs (NSAIDs) are the most common treatment for management of this condition, followed by corticosteroids, colchicine, immunosuppressive agents, immunoglobulins, and interleukin-$1{\beta}$ receptor antagonists (e.g. anakinra). Herein, we report a case of recurrent pericarditis with pericardial effusion in a 5-year-old child who presented with fever and epigastric pain. He responded poorly to NSAIDs and corticosteroid therapy, but was successfully treated with colchicine.

• Tuberculosis and Respiratory Diseases
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• 제40권2호
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• pp.197-202
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• 1993

저자들은 37세의 여자에서 스테로이드치료에 저항을 보이다가 prednisolone과 cyclophosphamide 병합투여로 치료반응을 보인 간질성폐질환을 동반한 다발성근염 1예를 경험하였기에 이를 문헌 고찰과 함께 보고하는 바이다.

• 대한의생명과학회지
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• 제20권3호
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• pp.111-116
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• 2014

Human neutrophils play an essential role in the innate immune response and are involved in the pathogenesis of the severe and corticosteroid-resistant asthma. Asthma is characterized by an infiltration of inflammatory cells into the lung and by a cytokine release. The aim of this study is to investigate the effects of a bronchoalveolar lavage fluid (BALF) on the chemotaxis and apoptosis of neutrophils which were isolated from healthy subjects. The BALF of subjects with asthma induces the blood neutrophil chemotaxis in the opposite of that in normal subjects. The IL-8, IL-6, and monocyte chemoattractant protein-1 (MCP-1) levels in BALF were higher in subjects with asthma than in normal subjects. The BALF of normal and asthmatic subjects has no effect on neutrophil apoptosis of BALF. MCP-1 delays the constitutive apoptosis of normal blood neutrophils, but has no effect in normal BALF neutrophils. These results may indicate that inflammatory factors secreted by the lung tissue of patients with asthma trigger the neutrophil chemotaxis and also induce the neutrophil dysregulation.