This case report describes a 91-year-old bedridden man with a complex medical history who presented with fever and low oxygen saturation, suspected to be aspiration pneumonia. Further investigation revealed nephrotic syndrome, microscopic hematuria, and joint pain. The diagnosis of polymyalgia rheumatica (PMR) was considered due to the presence of characteristic symptoms and elevated inflammatory markers despite the inability to perform a kidney biopsy. The patient was treated with low-dose prednisolone (PSL), leading to significant improvement in joint pain, renal function, and overall condition. This case highlights the importance of considering PMR in elderly patients with unexplained nephrotic syndrome and systemic inflammation. Early diagnosis and corticosteroid treatment can improve clinical outcomes and enhance activities of daily living. This report underscores the need for awareness of PMR as a potential cause of nephrotic syndrome in the elderly and the effectiveness of PSL in managing such cases.

UNASSIGNED: The metabolism- and transporter-based drug-drug interactions (DDIs) between mycophenolate mofetil (MMF) and co-administered medications may be key factors for the high individual variability in MMF exposure. This study systematically assessed the influence of co-medications on the mycophenolic acid (MPA) pharmacokinetic (PK) process in vitro, particularly to provide mechanistic evidence of the metabolic interaction among steroids, cyclosporine (CsA), and MMF.
UNASSIGNED: Based on a previous study, we hypothesized that there are three main DDI pathways affecting MMF PK in vivo. A human hepatocyte induction study, transporter substrate/inhibition study using human embryonic kidney 293 cells, and multidrug resistance-associated protein 2 (MRP2) substrate/inhibition study using vesicle membrane were conducted to assess the mechanistic evidence of the metabolic interaction in triple therapies. The potential DDI risks associated with seven medications commonly co-administered with MMF in clinical practice were further evaluated.
UNASSIGNED: The in vitro results suggested that prednisolone, the active metabolite of prednisone, induces the enzymatic activity of uridine 5\'-diphospho-glucuronosyltransferase (UGT), particularly the UGT1A9 and UGT2B7 isoforms, resulting in increased metabolism of MPA to MPA glucuronide (MPAG). This induction potential was not observed in CsA-treated human hepatocytes. CsA inhibits organic anion-transporting polypeptide (OATP) 1B1- and OATP1B3-mediated MPAG. Prednisolone and CsA showed no inhibitory effect on MRP2-mediated MPAG efflux. Salvia miltiorrhiza significantly inhibited organic anion-transporting polypeptide and OAT 3 activities, suggesting that it affects the hepatic uptake and renal excretion of MPAG, causing increased MPAG exposure in vivo.
UNASSIGNED: These identified factors may contribute to the high inter-individual variability in MMF exposure and facilitate further development of mechanistic MMF PK models and individualized therapies.

Oral liquid prednisolone medications have poor acceptance among paediatric patients due to ineffective masking of the bitterness taste of prednisolone. This study aimed to develop a child-friendly prednisolone tablet using a patented chewable chocolate-based delivery system (CDS) previously applied successfully to mask the bitterness tastes of midazolam and tramadol. Prednisolone sodium phosphate (PSP) and prednisolone base (PB) CDS tablets were prepared, and the manufacturing process was optimised using a design of experiments (DoE) approach. Stability was assessed by quantifying residual drug content via a validated HPLC assay. A pilot randomised crossover taste study involving 25 young adult volunteers evaluated taste-masking effectiveness against Redipred™, a commercial oral PSP liquid medicine. The results showed that the PSP CDS tablet was chemically stable following storage for three months at ambient temperature, while the PB CDS tablet was unstable. The optimised PSP CDS tablet, manufactured at 50 °C with a stirring time of 26 h, was found to release over 80% of its drug load within 20 min in 0.1 M HCl and had a significantly better mean taste score compared to Redipred™ (7.08 ± 2.40 vs. 5.60 ± 2.33, p = 0.03). Fifty six percent of the participants preferred the PSP CDS tablet. In conclusion, compared to Redipred™, the CDS technology provided a more effective taste masking of PSP, potentially offering a child-friendly prednisolone formulation with improved compliance, dosing accuracy, and storage stability.

A woman in her 20s presented with 6 weeks of fever, persistent vomiting and 28% loss of body weight. Symptoms were refractory to treatment with antiemetics and broad spectrum antibiotics.Further investigation via oesophageogastroduedenoscopy revealed a large gastric ulcer and pyloric stricture, causing gastric outlet obstruction (GOO). Biopsies of the stomach and duodenum showed plasma cell infiltration with a large proportion being IgG4 positive.Treatment with methylprednisolone, and later prednisolone, quickly improved inflammatory markers and symptoms. Balloon dilatation of the pyloric stricture also improved vomiting, allowing eventual re-establishment of oral nutrition. The patient made a full recovery with maintenance treatment on mycophenolate mofetil.IgG4-related disease (IgG4-RD) is a multisystem disorder with unpredictable presentation. The case highlights diagnostic challenges in IgG4-RD and identifies it as a rare differential in upper gastrointestinal symptoms. To our knowledge this is the first published case of IgG4-RD in the duodenum causing GOO.

Although several studies have shown that glucocorticoids exert diuretic effects in animals and humans, the underlying mechanism responsible for the acute diuretic effect remains obscure. Here we examined the mechanism in terms of gene-expression. We observed that glucocorticoids, including dexamethasone (Dex) and prednisolone (PSL), acutely induced diuresis in rats in a dose-dependent manner. Free water clearance values were negative after Dex or PSL treatment, similar to those observed after treatment with osmotic diuretics (furosemide and acetazolamide). Dex significantly increased the urinary excretion of sodium, potassium, chloride, glucose, and inorganic phosphorus. Renal microarray analysis revealed that Dex significantly altered the renal expression of genes related to transmembrane transport activity. The mRNA levels of sodium/phosphate (NaPi-2a/Slc34a1, NaPi-2b/Slc34a2, and NaPi-2c/Slc34a3) and sodium/glucose cotransporters (Sglt2/Slc5a2) were significantly reduced in the Dex-treated kidney, being negatively correlated with the urinary excretion of their corresponding solutes. Dex did not affect renal expression of the natriuretic peptide receptor 1 (Npr1) gene, or the expression, localization, and phosphorylation of aquaporin-2 (AQP2), a water channel protein. These findings suggest that the acute diuretic effects of glucocorticoids might be mediated by reduced expression of sodium-dependent cotransporter genes.

In this case report we describe a pregnant woman with newly developed auditory hallucinations, initially seen by a psychiatrist of the psychiatric emergency service. The day after assessment , the patient developed epileptic seizures and was referred to the hospital. After additional blood and liquor tests and an MRI scan, an autoimmune encephalitis was diagnosed. She was treated with prednisolone and immunoglobulins. She made a full recovery and gave birth to a healthy son at term. In this article we describe the diagnostic considerations, the course and treatment, the importance of being alert to a somatic cause of psychiatric symptoms and of multidisciplinary collaboration.

A woman in her 20s presented with haematemesis, post-prandial abdominal pain, weight loss and anaemia. Imaging revealed a non-enhancing mass in the retroperitoneal space along the mesenteric plane, encasing the porto-mesenteric vasculature. Endoscopy showed oesophageal varices. She was diagnosed with sclerosing mesenteritis, causing extrinsic compression of the portal vein and superior mesenteric artery. She underwent endoscopic variceal ligation and received prednisolone and tamoxifen. After 3 months, her post-prandial pain improved, and she did not have further bleeding episodes.

An 86-year-old woman with leg edema and dyspnea on exertion was admitted to our hospital. Chest computed tomography (CT) revealed a mass in the anterior mediastinum with pericardial invasion. Histological examination with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) led to the diagnosis of Masaoka stage IVa type B2 thymoma. For palliation, radiotherapy (32 Gy/16 fractions) and prednisolone (30 mg/day) were administered and tapered. After treatment, both the pericardial effusion and tumour size decreased. Combination therapy with steroids and radiotherapy may be effective for treating thymomas.

The severe acute respiratory syndrome coronavirus 2 vaccine has contributed to infection control and the prevention of complications due to coronavirus disease 2019 (COVID-19). Conversely, the COVID-19 vaccine has been associated with adverse effects due to liver injury caused by autoimmunity or drugs. To date, Japanese journals have only published five reports of autoimmune liver damage associated with the COVID-19 vaccination. Although the pathogenic mechanism has not yet been fully elucidated, corticosteroids or azathioprine have shown effectiveness in certain patients. However, there have been cases of liver injury resulting in deaths. Here, we encountered three patients who developed autoimmune hepatitis (AIH) within 10 days following vaccination. All three patients were treated with prednisolone (PSL) and achieved remission. However, the serum alanine aminotransferase levels in all cases were observed to either increase or cease to improve during the therapeutic course before PSL administration. It is therefore imperative to closely monitor liver injury after the COVID-19 vaccination. In cases where AIH is suspected and a recurrence of liver dysfunction occurs, PSL may be administered. Future considerations should not only encompass the underlying mechanism by which autoimmunity contributes to the development of liver injury following COVID-19 vaccination but also the optimal treatment period for PSL and the long-term prognosis of AIH after COVID-19 vaccination.

Corneal deposits associated with topical medications, particularly fluoroquinolones, are a recognized complication in ophthalmic practice. We present a case of a 66-year-old female with pseudophakic bullous keratopathy who developed corneal crystalline deposits following prolonged use of gatifloxacin and prednisolone eye drops post-penetrating keratoplasty. The patient presented with diminished vision and significant corneal opacity in the affected eye. Anterior segment examination and OCT imaging confirmed deposits extending from the epithelium to the anterior stroma. Management included corneal scrapping and transition to topical tobramycin and propylene glycol eye drops, resulting in the resolution of deposits and improvement in vision. This case underscores the importance of vigilant monitoring and judicious use of topical medications to mitigate adverse effects in high-risk ophthalmic patients undergoing corneal procedures.