OKT3 encephalopathy

Coleman, Anton E.; Norman, Douglas J.

doi:10.1002/ana.410280618

Cited by 25 publications

(10 citation statements)

References 11 publications

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“…109 These cytokines include tumor necrosis factor, interleukin 2, and interleukin 6. 114 Moreover, administration of OKT3 antibodies increases systemic cytokine levels, which may contribute to the inflammatory response.…”

Section: Okt3 Antibody-induced Meningitismentioning

confidence: 99%

“…24,37 In 2 additional patients with antibioticrelated meningitis, MRI showed bilateral supratentorial white matter T 2 -signal abnormalities without gadolinium enhancement with complete resolution in several months. 58 Neuroimaging was performed in 8 patients with OKT3-associated DIAM and was abnormal in 3: a patient showed cerebral edema on brain CT scan 109 and MRI disclosed high intensities on T 2 -weightedsequencesin2additionalpa-tientsthatdisappearedin10days. 113,114 The outcome was always excellent provided that the offending drug was withdrawn, with complete recovery in all cases.…”

Section: 97mentioning

confidence: 99%

“…65 #Includes the following: 1 left abducens palsy and 1 bilateral abducens palsy, 106,107 1 patient with brainstem reflexes abolition and bilateral Babinski sign, 109 1 patient with hemiparesis, 114 1 patient with ataxia, nystagmus, and decreased visual acuity, 113 and 2 patients with hallucinations. †In 2 cases, there were eosinophils representing 60% and 13% of the total cell count, respectively.…”

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confidence: 99%

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The Challenge of Drug-Induced Aseptic Meningitis

Morís¹,

1999

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Several drugs can induce the development of aseptic meningitis. Drug-induced aseptic meningitis (DIAM) can mimic an infectious process as well as meningitides that are secondary to systemic disorders for which these drugs are used. Thus, DIAM constitutes a diagnostic and patient management challenge. Cases of DIAM were reviewed through a MEDLINE literature search (up to June 1998) to identify possible clinical and laboratory characteristics that would be helpful in distinguishing DIAM from other forms of meningitis or in identifying a specific drug as the culprit of DIAM. Our review showed that nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, intravenous immunoglobulins, and OKT3 antibodies (monoclonal antibodies against the T3 receptor) are the most frequent cause of DIAM. Resolution occurs several days after drug discontinuation and the clinical and cerebrospinal fluid profile (neutrophilic pleocytosis) do not allow DIAM to be distinguished from infectious meningitis. Nor are there any specific characteristics associated with a specific drug. Systemic lupus erythematosus seems to predispose to NSAID-related meningitis. We conclude that a thorough history on prior drug intake must be conducted in every case of meningitis, with special focus on those aforementioned drugs. If there is a suspicion of DIAM, a third-generation cephalosporin seems a reasonable treatment option until cerebrospinal fluid cultures are available.

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Section: Okt3 Antibody-induced Meningitismentioning

confidence: 99%

Section: 97mentioning

confidence: 99%

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The Challenge of Drug-Induced Aseptic Meningitis

Morís¹,

1999

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“…Those that are available generally refer to developmental delay (Geary and Haka-Ikse, 1989), or to iatrogenic symptoms associated with the transplant surgery, such as seizures (Appleton et al, 1989;McEnery et aL, 1989), or with medication regimens (Coleman and Norman, 1990;Hart and Kreutzer, 1988).…”

Section: Neuropsychiatric and Cognitive Deficits After Kidney Transplantmentioning

confidence: 99%

Cognitive deficits related to major organ failure: The potential role of neuropsychological testing

Farmer

1994

Neuropsychol Rev

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Until recently, little attention has been paid to the possibility of cognitive deficits in patients with disease or failure of major organs such as the liver, kidney, or heart. However, there is a growing awareness that major organ failure often has neuropsychological sequelae. These sequelae may at times be quite subtle and not detectable under gross examination. Nevertheless, even subtle deficits may have a major impact on adherence to medical regimens, psychosocial adjustment, and quality of life of patients. Neuropsychological assessment has a potentially valuable role to play both in research and in clinical work. It can be useful in adding to our knowledge of the cognitive effects of various types, severity and duration of major organ disease, as well as sequelae associated with treatment. It also is a potentially valuable clinical tool for identifying cognitive deficits that will affect the quality of life and probability of survival for organ failure patients.

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“…Although the cerebrospinal fluid is generally culture negative, pleocytosis and elevation in protein are often seen. A complex of other CNS-related toxicity including confusion, hallucinations, obtundation, seizures, coma, transplant blindness and hearing loss has been reported in renal transplant recipients who exhibit delayed graft function during treatment with muromonab CD3 (Coleman & Norman 1990).…”

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confidence: 99%

Prevention and Management of the Adverse Effects Associated with Immunosuppressive Therapy

et al. 1993

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Advances in immunosuppressive therapy have resulted in significantly improved patient and graft survival after solid organ transplantation. However, increased use has brought attention to specific toxicities associated with the use of these agents. Corticosteroid therapy can result in a wide array of short and long term toxicities. Management of these effects has focused on alternate day and dosage reduction protocols. Myelosuppression, hepatotoxicity, alopecia and gastrointestinal adverse effects are associated with azathioprine and generally respond to a reduction in dosage or withdrawal. Cyclophosphamide myelosuppression is managed in a similar manner. Use of cyclosporin, while the mainstay of immunosuppressive therapy, is often complicated by several well documented adverse effects. Short and long term nephrotoxicity is often managed through pharmacokinetic dosing strategies as well as pharmacological intervention with calcium channel blockers, prostaglandin analogues, pentoxifylline and thromboxane antagonists. Cyclosporin-induced hypertension, hyperlipidaemia, hyperkalaemia and hyperuricaemia are generally responsive to appropriate dietary restrictions and pharmacological therapies. The adverse effects associated with polyclonal antilymphocyte agents (fever, chills, rash, arthralgias) occur in response to the administration of foreign protein substances but can be prevented by pretreatment with corticosteroids, diphenhydramine and paracetamol (acetaminophen). The administration of muromonab CD3 (OKT3) stimulates the release of cytokines resulting in potentially severe complications seen during the first 1 or 2 doses. Pretreatment with diphenhydramine, low dose corticosteroids and paracetamol as well as proper fluid management has reduced the incidence of this syndrome. However, agents such as high dose corticosteroids, indomethacin, pentoxifylline and anti-tumour necrosis factor monoclonal antibodies may further decrease the severity of cytokine-induced toxicity. Antimurine antibodies may also develop during muromonab CD3 therapy, potentially limiting the efficacy of this agent. However, continued concomitant immunosuppressive therapy has significantly reduced antibody formation. In summary, as newer agents are developed with narrow therapeutic windows, it will be critical to identify specific drug toxicity and to develop preventative and management therapeutic strategies.

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OKT3 encephalopathy

Abstract: OKT3 therapy for induction immunosuppression in a patient who underwent renal transplantation produced obtundation and quadriparesis associated with computed tomographic scan evidence of brain edema. These findings resolved over 3 days with supportive therapy and OKT3 withdrawal.

Cited by 25 publications

References 11 publications

The Challenge of Drug-Induced Aseptic Meningitis

The Challenge of Drug-Induced Aseptic Meningitis

Cognitive deficits related to major organ failure: The potential role of neuropsychological testing

Prevention and Management of the Adverse Effects Associated with Immunosuppressive Therapy

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