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Fulltext Xanthomatous Hypophysitis Presenting in an Adolescent Girl: A Long-Term Follow-Up of a Rare Case and Review of the Literature

Wong JSL, Nasruddin AB, Selveindran NM, Latif KA, Kassim F, Nair SB, et al.

AACE Clin Case Rep, 2021 02 01;7(3):220-225.
PMID: 34095493 DOI: 10.1016/j.aace.2021.01.008

Objective: Primary hypophysitis refers to the isolated inflammation of the pituitary gland not associated with other secondary causes. Among its histopathologic subtypes, xanthomatous is the rarest.
Methods: We describe a 22-year-old woman with xanthomatous hypophysitis (XH), its clinical progression over 8 years as well as the treatment effects of prednisolone and azathioprine. Our patient was first referred for severe short stature and delayed puberty at the age of 14 years.
Results: Investigations revealed multiple pituitary deficiencies. Magnetic resonance imaging showed a pituitary mass whereby a partial resection was performed. A full resection was not feasible due to the location of the mass. The histopathologic analysis of the tissue was consistent with XH. The results of secondary workout for neoplasm, infection, autoimmune, and inflammatory disorders were negative. After surgery, a progressive enlargement of the mass was observed. Two courses of prednisolone were administered with a significant reduction in the mass size. Azathioprine was added due to the unsustained effects of prednisolone when tapered off and the concern of steroid toxicity with continued use. No further increase in the mass size was noted after 6 months on azathioprine.
Conclusion: Glucocorticoid and immunotherapy are treatment options for XH; however, more cases are needed to better understand its pathogenesis and clinical progression.

Matched MeSH terms: Prednisolone
Use of prednisolone to aid propagation of Toxoplasma gondii in mice

Puvanesuaran VR, Nowroji K, Sreenivasan S, Noordin R, Balakrishnan V

Eur Rev Med Pharmacol Sci, 2012 Aug;16(8):1028-32.
PMID: 22913152

AIM: To determine the usefulness of prednisolone in increasing the number of Toxoplasma (T.) gondii tachyzoites and bradyzoites in mice.
MATERIALS AND METHODS: The mice were water-fasted prior to being immunosuppressed with oral inoculation of prednisolone. Tachyzoites of 7T gondii RH strain were inoculated into mice and the number of the parasites in the intraperitoneal fluids was then determined at 96 hs post-infection. In addition, tachyzoites of T. gondii ME49 strains were orally introduced into mice and the number of brain cysts formed was observed by microscopic observation at 45 days post-infection.
RESULTS: T. gondii propagation was found to be significantly improved by introduction of the prednisolone (p = 0.0004); and the number of parasite showed positive correlation with the increment in dosage of prednisolone (r = 0.9051).
CONCLUSIONS: The use of prednisolone greatly improved the number of parasite formed in mice: both tachyzoite and cyst forms.

Matched MeSH terms: Prednisolone/pharmacology*
Fulltext Usage of traditional medicines among elderly and the prevalence of prednisolone contamination

Ismail Z, Mohamed R, Mohd Hassan MH, Wan Su K

Malays J Med Sci, 2005 Jul;12(2):50-5.
PMID: 22605958

The elderly consume many medications including traditional medicines. In 1986, it was found that 29% of elderly took traditional medicines although in 1996, the National Health Morbidity survey reported a 2.3% prevalence. However, studies from other countries showed much higher percentages. The Ministry of Health in Malaysia is concerned that some of these preparations maybe contaminated with steroids, antihistamines, hormones and other poisons. The aims of the study were to determine a). the health seeking behaviour of elderly Malays living in rural areas, b). the utilization of both modern and traditional medicines and c). the steroid content of the traditional medicines used. Methodology included interviews using structured questionnaires of elderly Malays living in rural areas of Kelantan, aged above 60 years. Samples of traditional medications collected were sent to the Pharmacology Department, School of Medical Sciences, Universiti Sains Malaysia, for steroid content analysis using Thin Layer Chromatography. A total of 599 elderly respondents were interviewed comprising 62.4% females and 37.6% males. The 60-69 years cohort group made up 48.7%, followed by 70-79 years at 36.1% and the remainder 15.2% were more than 80 years. There were 82% of elderly taking medicines. The trends of utilization of modern and traditional medicine in the last two weeks among elderly were 59.3% and 40.9% respectively. The utilization of traditional medicine by rural elderly Malays was therefore much higher than that reported in the previous study and nearly similar to that of France and Australian studies. There were 102 samples of traditional medications collected and analysed for steroid content. Results showed that 27.5% were positive for prednisolone, 34.3% positive for unknown steroids (a total of 61.8%) and 38.2% were negative for both steroids. The present study therefore once again confirmed the high usage of traditional medicines where some of which are contaminated with steroids.

Matched MeSH terms: Prednisolone
Trigger finger, a report on a series of cases

An HK

Med J Malaysia, 1978 Sep;33(1):7-9.
PMID: 750899
Matched MeSH terms: Prednisolone/administration & dosage*
Triamcinolone v prednisolone

WELLS R

Med J Malaya, 1959 Mar;13(3):243-7.
PMID: 13666193
Matched MeSH terms: Prednisolone/therapeutic use*
Treatment of childhood acute lymphoblastic leukemia in Malaysia, 1976-1982

Lin HP, Sinnah D, Menaka N, Cherian R, Singh P

Med. Pediatr. Oncol., 1983;11(5):327-32.
PMID: 6579342

One hundred four children with acute lymphoblastic leukaemia were diagnosed at the University Hospital, Kuala Lumpur, Malaysia, between 1976 and 1982; 87 were evaluable with respect to treatment. They were divided into good prognosis (GP) and bad prognosis (BP) groups based on their initial total white cell count, their treatment differing only during the maintenance phase. Remission was achieved in 82 patients (94%) of whom ten (12%) subsequently died in remission from infection. Twenty-eight (34%) relapsed while on treatment and three while off therapy. Eleven patients ceased treatment after 3 yr of continuous complete remission (CCR). Three of these later relapsed, two within the first year. Survival in CCR was significantly better in the GP group up to 30 months, after which the difference diminished. There was no difference in survival between boys and girls. The overall disease-free survival at 3 yr and 5 yr was 40% and 25%, respectively, with a median follow-up period of 20 months (range 4-69 months). The reasons for the relatively low survival rates as compared with those in developed countries are discussed.

Matched MeSH terms: Prednisolone/administration & dosage
Transvitreal migration of a Toxocara larva resulting in a second chorioretinal granuloma

Sivaratnam D, Subrayan V, Ali NA

Jpn. J. Ophthalmol., 2008 Sep-Oct;52(5):416-417.
PMID: 18991049 DOI: 10.1007/s10384-008-0569-z
Matched MeSH terms: Prednisolone/therapeutic use
Fulltext Transcriptome analysis of Escherichia coli K1 after therapy with hesperidin conjugated with silver nanoparticles

Masri A, Khan NA, Zoqratt MZHM, Ayub Q, Anwar A, Rao K, et al.

BMC Microbiol, 2021 Feb 17;21(1):51.
PMID: 33596837 DOI: 10.1186/s12866-021-02097-2

BACKGROUNDS: Escherichia coli K1 causes neonatal meningitis. Transcriptome studies are indispensable to comprehend the pathology and biology of these bacteria. Recently, we showed that nanoparticles loaded with Hesperidin are potential novel antibacterial agents against E. coli K1. Here, bacteria were treated with and without Hesperidin conjugated with silver nanoparticles, and silver alone, and 50% minimum inhibitory concentration was determined. Differential gene expression analysis using RNA-seq, was performed using Degust software and a set of genes involved in cell stress response and metabolism were selected for the study.
RESULTS: 50% minimum inhibitory concentration with silver-conjugated Hesperidin was achieved with 0.5 μg/ml of Hesperidin conjugated with silver nanoparticles at 1 h. Differential genetic analysis revealed the expression of 122 genes (≥ 2-log FC, P

Matched MeSH terms: Prednisolone
Thyroid eye disease--medical or surgical therapy?

Khalid BA, Ng ML

Ann Acad Med Singap, 1991 Mar;20(2):273-6.
PMID: 1883189

Thyroid eye disease is autoimmune in nature and associated with Graves' Disease. Autoantibodies to the 64 kDa antigen in thyroid membranes cross-react to the 64 kDa proteins in human eye muscle membranes. Antibody dependent cell mediated cytotoxicity against eye muscle cells are also found in patients with thyroid eye disease. The purpose of this paper is to review the treatment available and to share the authors' experience using cyclosporin A. In the majority of cases, thyroid eye disease is mild, manifest only as bilateral or unilateral proptosis, with/without grittiness of the eyes. This is usually treated conservatively with eye drops. If proptosis is more severe and there is incomplete closure of eyelids, epiphora and conjunctival injection, then lateral tarrsorrhaphy is usually effective, combined with use of eye pads and eye drops. The problem of diplopia can be treated conservatively with special lenses, or with surgical correction of tethered muscles. However when proptosis is severe, with raised intraocular pressure, severe chemosis and danger of blindness, then the choice of therapy is controversial: rapid decompression by surgical means or use of high doses of prednisolone. Most prefer prednisolone therapy initially, surgical decompression if it fails. Various other methods have been tried, aimed at the immunological nature of the disease, namely plasmapheresis, radiotherapy and immunosuppressive drugs such as cyclosporin, with variable success. Our experience with cyclosporin had been mixed and inconclusive.

Matched MeSH terms: Prednisolone/administration & dosage; Prednisolone/therapeutic use
Thymoma-associated myasthenia gravis and LGI1-encephalitis, with nephrotic syndrome post-thymectomy

Hor JY, Lim TT, Cheng MC, Chia YK, Wong CK, Lim SM, et al.

J Neuroimmunol, 2018 04 15;317:100-102.
PMID: 29395322 DOI: 10.1016/j.jneuroim.2018.01.011

Thymoma is associated with a wide spectrum of autoimmune paraneoplastic syndromes, though it is uncommon for multiple paraneoplastic syndromes to be present in a single individual. We report a rare case of an elderly gentleman who was found to have thymoma-associated myasthenia gravis and LGI1-encephalitis with myokymia, who presented with nephrotic syndrome (minimal change glomerulopathy) after thymectomy. The latter two paraneoplastic syndromes had manifested when prednisolone was tapered down to low dose. This case serves to remind neurologists that apart from paraneoplastic neurological manifestations, thymoma may also be associated with renal disease. Nephropathy in myasthenia patients with thymoma should be properly evaluated, as it is treatable with immunotherapy, and it may even occur post-thymectomy.

Matched MeSH terms: Prednisolone
The use of prednisolone during Ramadan fasting in patients with adrenal insufficiency

Hee NKY, Lim QH, Paramasivam S, Lim LL, Vethakkan S, Ganapathy SS, et al.

Clin Endocrinol (Oxf), 2024 Mar;100(3):221-229.
PMID: 38031259 DOI: 10.1111/cen.14999

OBJECTIVE: Once daily prednisolone taken at predawn has been proposed to be the glucocorticoid replacement of choice in patients with adrenal insufficiency (AI) who intend to fast for the month of Ramadan. However, the effects of prednisolone on metabolic parameters and quality of life during fasting for Ramadan are unknown.
DESIGN, PATIENTS AND MEASUREMENTS: Patients with AI on twice-daily hydrocortisone, who had low or moderate risk and intended to fast, were recruited. Patients were converted to prednisolone 5 mg once daily taken at sahur (predawn) and Ramadan education given. Weight, sleep duration, biochemical parameters and quality of life measures (SF-36 questionnaire) were analysed at the end of Ramadan and compared against baseline.
RESULTS: Twenty patients (13 men) were recruited, with a mean age of 59.9 ± 15.0 years. All patients were on hydrocortisone 15 mg daily (in divided doses) as pre-Ramadan glucocorticoid replacement. Half had type 2 diabetes with low IDF-DAR risk. Eighty-five percent of patients completed the full 29 days of fasting with no complications. There was a significant reduction in weight (-1.1 ± 1.6 kg, p = .005), with no significant change in blood pressure or sleep duration. There was a significant increase in urea (0.80 ± 1.1 mmol/L, p = .005) and haematocrit, (0.011 ± 0.019 L/L, p = .019) and decrease in serum sodium (-1.6 ± 3.0 mmol/L, p = .028), with no change in serum creatinine or liver function. Quality of life measures were preserved in all domains with significant improvement in role limitation due to physical health (15.3 ± 21.6, p = .005) and bodily pain (8.8 ± 16.3, p = .031).
CONCLUSIONS: This study has demonstrated that converting patients with AI who are fasting for Ramadan from twice-daily hydrocortisone to prednisolone 5 mg daily at sahur was safe, with no major short-term adverse effects. Despite the higher equivalent glucocorticoid doses, patients experienced weight loss and no clinically significant change in blood pressure, sleep, biochemical parameters or quality of life. This study paves the way to trial even lower doses of prednisolone once daily in patients fasting for Ramadan with AI.

Matched MeSH terms: Prednisolone/therapeutic use
The etiology and pathology of eosinophilic lung (tropical eosinophilia)

Danaraj TJ, Pacheco G, Shanmugaratnam K, Beaver PC

Am J Trop Med Hyg, 1966 Mar;15.(2):183-9.
PMID: 5910525

The finding of microfilariae in lung tissue from patients with eosinophilic lung is reported and the histopathological appearances are described.

Matched MeSH terms: Prednisolone/therapeutic use
Fulltext The epidemiology and treatment of infection due to Brugia malayi

Edeson JFB

Bull World Health Organ, 1962;27(4-5):529-41.
PMID: 20604131

The author reviews the distribution, epidemiology, and treatment of filarial infection due to Brugia malayi, with special reference to Malaya. B. malayi infection in man is confined to the Far East between longitudes 75 degrees E and 140 degrees E and is essentially rural. The chief vectors are Mansonia spp., Anopheles hyrcanus group, A. barbirostris group, and Aëdes togoi. The epidemiological picture is complicated by the fact that B. malayi and other closely related species have now been found in several species of animals. The existence of an animal reservoir of infection might have important implications for filariasis control. As to the treatment of B. malayi infection, diethylcarbamazine has been found to reduce the microfilaria count and to kill the adult worms; the severe febrile reactions of microfilaria carriers to the initial doses of this drug may be reduced by administration of the steroid prednisolone.

Matched MeSH terms: Prednisolone
Fulltext The atypical presentation of rheumatoid arthritis in an elderly woman: a case report

Devaraj NK

Ethiop J Health Sci, 2019 Jan;29(1):957-958.
PMID: 30700964 DOI: 10.4314/ejhs.v29i1.18

The diagnosis of rheumatologic problem can be difficult, especially if not all the diagnostic criteria or typical clinical features are seen. This includes conditions such as rheumatoid arthritis which needs early diagnosis to start disease modifying drugs (DMARDs) which can improve the prognosis and prevent further joint erosion and organ damage. This case report focused on a similar scenario in an elderly woman initially thought to have osteoarthritis but was diagnosed later with rheumatoid arthritis which brought much relief to her current predicament.

Matched MeSH terms: Prednisolone/therapeutic use
Systemic lupus erythematosus with membranous lupus nephropathy in Malaysian patients

Wang F, Looi LM

Q. J. Med., 1984;53(210):209-26.
PMID: 6463196 DOI: 10.1093/oxfordjournals.qjmed.a067794

Thirty-one patients with systemic lupus erythematosus had membranous lupus nephropathy (MLN). They were divided into two groups. Group I consisted of 13 patients who had pure MLN but the patients in Group 2 had segmental proliferation in up to 35 per cent of their glomeruli. The rest of the glomeruli had purely membranous change. The patients of Group 2 were no different from the other MLN patients in terms of age, sex and race. The extrarenal disease in both groups was extensive and severe. The renal disease was usually associated with the nephrotic syndrome or oedema but was asymptomatic throughout in one patient. Both renal and extrarenal features responded to treatment initially but relapses were frequent and often severe. Relapses often occurred as treatment was discontinued or medication reduced. Survival at six years in Group I was 62 per cent and in Group 2 was 50 per cent. Only one patient died with renal failure although five patients had impaired renal function at death. The chief causes of death were disease of the central nervous system and infection.

Matched MeSH terms: Prednisolone/therapeutic use
Systemic lupus erythematosus in a tertiary, east Malaysian hospital: Admission, readmission and death

Teh CL, Chan GYL, Lee J

Int J Rheum Dis, 2008;11(1):24-29.
DOI: 10.1111/j.1756-185X.2008.00325.x

Objective: There are limited data on hospitalization of systemic lupus erythematosus (SLE) patients in Asian countries. Our aim of this study is to describe the characteristics and poor prognostic factors in our patients. Method: We performed a retrospective study of SLE hospitalization during a 1-year period (2006) in our centre. Results: There were 125 episodes of hospitalization of 79 patients with SLE. This is the first report of SLE patients from the native population of east Malaysia. The cause of admission was flare of SLE (80.8%), infection (23.2%), renal biopsy (22.4%) and others (4%). There was only one admission for thromboembolism. Patients with both flare of SLE and infection have the longest median length of stay of 11 days (IQR 5,24) requiring more intensive care therapy (P < 0.01). Readmission occurred in 31.4% and was associated with admission for other reasons during the first admission. Flare of SLE was protective against readmission (P < 0.05, OR = 0.36). There were six deaths (4.8% of admissions). The deaths were due to infection in three patients, active SLE in two and acute myocardial infarction in one. The deaths have a higher cumulative prednisolone dose than the survivals (P < 0.01). In multivariate modelling, the only predictor of death was high Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (P < 0.05, OR = 9.61 per increase of 1 score). Conclusion: Active disease and infection remains the main cause of admission, readmission and death in SLE patients. © 2008 Asia Pacific League of Associations for Rheumatology.

Matched MeSH terms: Methylprednisolone; Prednisolone
Systemic lupus erythematosus in a malay boy

Wan Mohamad WM, Mohd Ashari NS, Wan AbHamid WZ

International Medical Journal (Tokyo), 2017;24(3):295-296.

Objective: We presented a case report, systemic lupus erythematosus (SLE) in a Malay boy. Interestingly, this case occurs in a boy, which is not so common because autoimmune disease usually occurs in female. Design: Case report. Methods: We highlighted a case of a boy with SLE who presented with clinical symptoms suggestive of SLE and fulfilled the criteria for SLE diagnosis. Results: The patient was successfully managed with antihypertensive, intravenous cyclophosphamide and oral prednisolone and respond well to the therapy. Conclusion: Systemic lupus erythematosus is a chronic autoimmune disease which rarely occurs in male. However we reported one such case which fulfilled the criteria for SLE. © 2017 Japan Health Sciences University & Japan International Cultural Exchange Foundation.

Matched MeSH terms: Prednisolone
Fulltext Sweet-like syndrome in a patient with acute myeloid leukaemia

Norhaya MR, Cheong SK, Hamidah NH, Ainoon O

Singapore Med J, 1996 Jun;37(3):320-2.
PMID: 8942241

A 45-year-old Malay lady developed brisk vesicular, plaque-like reaction to a Mantoux test concomitant with a diagnosis of acute myeloid leukaemia (AML). The lesion resolved one month after chemotherapy. Similar lesions developed later after she was bitten by mosquitoes on the forearms. She also had the lesions over her cheek. A skin biopsy showed infiltration of the dermis with neutrophils and some monocytoid cells. The lesion resolved one week after prednisolone therapy.

Matched MeSH terms: Prednisolone/therapeutic use
Suspected new wave of muscular sarcocystosis in travellers returning from Tioman Island, Malaysia, May 2014

Tappe D, Stich A, Langeheinecke A, von Sonnenburg F, Muntau B, Schäfer J, et al.

Euro Surveill, 2014 May 29;19(21).
PMID: 24906376

In May 2014, six patients presented in Germany with a Sarcocystis-associated febrile myositis syndrome after returning from Tioman Island, Malaysia. During two earlier waves of infections, in 2011 and 2012, about 100 travellers returning to various European countries from the island were affected. While the first two waves were associated with travel to Tioman Island mostly during the summer months, this current series of infections is associated with travel in early spring, possibly indicating an upcoming new epidemic.

Matched MeSH terms: Prednisolone/therapeutic use
Fulltext Subcutaneous panniculitic T-cell lymphoma-review of five cases

Ng TG, Ayadurai K, Gangaram HB, Hussein SH

Med J Malaysia, 2006 Dec;61(5):586-91.
PMID: 17623960 MyJurnal

Subcutaneous panniculitic T-cell lymphoma (SPTL) is a rare variant of cutaneous T-cell lymphoma where lymphoma cells infiltrate preferentially into subcutaneous tissue. Five cases of SPTL were seen during the period from 2001-2004 at the Department of Dermatology, Hospital Kuala Lumpur. All five presented with multiple subcutaneous nodules on the face, trunk and limbs of one week to six months duration with associated fever and loss of weight. Physical examination showed multiple tender, erythematous indurated plaques and subcutaneous nodules on their face, trunk and limbs. One patient also presented with unhealing ulcerated nodules. Two patients had hepatosplenomegaly and one hepatomegaly. Two patients had pancytopaenia while the other three had leucopaenia. One patient had deranged liver function. Out of the five patients, three had bone marrow examination with haemophaegocytosis in two and one hypocellular marrow. Skin biopsy of all patients showed infiltration with atypical lymphoid cells in the upper dermis and subcutaneous fat. These neoplastic cells showed positivity for CD3 and CD30 in three patients with CD8, TIA-1 and LCA (Leucocyte common antigen) being positive in one patient. One patient treated with prednisolone and subcutaneous Roferon 3Mu three times a week since 2001 was in remission. Two patients who were planned for chemotherapy had deteriorated rapidly and succumbed to septicaemia from pancytopaenia. Subcutaneous panniculitic T-cell lymphoma has been reported to show two distinct clinical presentations. The first is characterized by an indolent course with good prognosis and the second with rapid clinical deterioration, haemophaegocytosis and death. Both presentations were seen in our five patients seem to demonstrate these two subtypes of SPTL.

Matched MeSH terms: Prednisolone/therapeutic use

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