BIOCORE JOURNALS

Refractory Schnitzler syndrome presenting with subcutaneous lesions and response to rituximab therapy 

Yulia Tunitsky-Lifshitz, MD, Ramit Maoz-Segal, MD , Tima Davidson, MD, Yulia Vol-chek, MD, Nancy Agmon-Levin, MD

Background: Schnitzler syndrome (SchS) is a rare auto-inflammatory disease characterized by urticarial exanthema, fever, bone and muscle pain and monoclonal gammopathy. Currently there is a lack of data regarding diagnostic imaging (e.g., PET-CT) and treatments of this rare disease, particularly in refractory cases. Herein, we describe unique findings on PET-CT and successful therapeutic interventions with immunoglobulins and B cell depletion for refractory SchS.

Case presentation: A 57 years old female was referred to our center for evaluation of monthly episodes of atypical urticarial rash accompanied by fever, malaise and joint pain. Laboratory findings revealed elevated inflammatory markers, liver function tests and leukocytes during the episodes as well as a monoclonal peak of IgG kappa. Skin biopsy was consistent with neutrophilic dermatosis and no evidence of malignancy. On PET-CT subtle ill-defined infiltration of subcutaneous fat were observed in several sites, compatible with skin lesions presented on physical examination. The disease was steroid responsive in the beginning but upon progression it became high dose steroid dependent. Biological targeted therapies IL-1 and IL-6 inhibitors failed to relieve the symptoms. Hence plasmapheresis and anti-CD20 monoclonal antibody were used, leading to clinical resolution.

Conclusions: In this case study of Schnitzler syndrome PET-CT detected subcutaneous fat inflammatory lesions. Additionally, treatment with B-cell depletion therapies enabled controlling of very aggressive disease that was resistant to all other line of therapies. The role of imaging as well as B-cell depletion therapy for s subset of patients with resistant SchS require further studies.

An Open labelled RCT to Evaluate the Efficacy and Safety of Siddha Supplement (MAM Granules) along with Standard Allopathy Treatment in the management of RT PCR Positive Pre Symptomatic COVID 19 patients –A Structured Summary of A Study Protocol

Anurag Srivastava, Manickavasagam Rengaraju, Saurabh Srivastava,Vimal Narayanan, Rashmi Upadhayay, Vivek Gupta and Shalini smanla

Background: COVID19 is emerging as a major health care challenge of this Century globally. Till date, there is no proven direct medication is declared to combat the COVID 19.Individual Ingredients of the MAM Granules are already having effective anti-viral activities in recent Pre-clinical studies. The outcome of these studies will really useful to explore the suitable Supplementary Siddha drug in the Management of COVID 19.
Methods:
Objectives: The primary objectives are to evaluate the efficacy of MAM Siddha Granules as a supplement along with standard Allopathy Supplement (Vit C and Zinc) to compared with standard Allopathy Supplement (Vit C and Zinc) in the management of Pre - Symptomatic COVID 19 patients and also determine the efficacy of Standard of care along with MAM Granules in reducing the onset of clinical symptoms in asymptomatic patients, Reduction in the duration of SARS CoV-2 viral infections and reduction of Viral load from the baseline. The secondary objectives are to evaluate the efficacy on immunity by selected immunological markers and safety of the trial medicines and their effects in reduce the risks of the disease. In addition, to document the profile of Pre-Symptomatic COVID 19 patients based on Siddha system Principles.
Trial Design: An open Labelled, Double arm, Single Centre, Exploratory and comparative Randomized Controlled Trial.
Participants: Patients tested RT PCR Positive COVID- 19 at COVID Care Centre at Govt. Institute of Medical Sciences. Noida, India will be recruited.
Primary outcomes: Negative conversion of SARS CoV - 2 by 7/14 days Reduction in Viral load at the end of treatment period .Reduction in incidence of clinical symptoms like fever, cough and breathlessness Effect of Supplement in Immunology and inflammatory markers (IL6,) at the end of treatment .
Secondary outcomes: Reduction in incidence of complications (ARDS, other Respiratory Illness).Mean changes in Laboratory markers (Hematological & Bio – Chemical Markers).
Trial Registration: This trial was registered with (Clinical Trial Registry of India) CTRI (Registration number - CTRI/2021/02/031420 on 19.02.2021.