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Side effetcs of steroids given for LEUKO CYTOCLASTIC VASCULITIS.

Resolved Question:

Dear Doctor,

One of my family members, female, 30 years old patientis diagnosed with LEUKO CYTOCLASTIC VASCULITIS (LCV). Photos showing the starting stage and advanced stage of the infection on her left leg are attached for your kind perusal. She is being treated with steroids. We would like to know the severity of the disease. It is informed by the treating rheumatologist that this disease cannot be cured permanently.

Kindly advise us on the


1. severity of the disease,

2. Can this disease be permanently Cured.

3. As the patient is on steroids, what are side effects

4. Can this disease have effect on internal organs

5. Impact on Pregnancy and the child thereafter

Regards

Please provide us with detail advice on the above set of questions

Regards


Category: Rheumatologist

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Category: Internal Medicine Specialist
Dr. Bimlesh Dhar Pandey is online now

Expert:  Dr. Bimlesh Dhar Pandey replied 4 Days.

Hello.
Thank you for posting your query at DoctorSpring.com
I understand your concern.
Did this lesion started as painful reddish lesion before it ulcerated. How long has this lesion been there? How many lesions are there.
What about fever, joint pain, pain abdomen,other blood investigations? Please attach all reports done.
I will able to reply once you give me information.
Regards.


Patient replied :

Dear Doctor,
As requested by you for further reports, I have attached the discharge summary report of my family member where she was treated as "in patient" for close to a month for a reddish Lesion that was detected on 2nd April 2012.
This report will give you a good picture of the patients condition.
Request you to please advise us on the following:
1. severity of the disease,
2. Can this disease be permanently Cured.
3. As the patient is on steroids, what are side effects
4. Can this disease have effect on internal organs
5. Impact on Pregnancy and the child thereafter
Regards


Expert:  Dr. Bimlesh Dhar Pandey replied 3 Days.

Hello,
Thank you for your follow-up.
Excellent your treatment is in correct direction Dr Padmanabh Shenoy is expert in his specialty.I am totally convinced about the way the diagnosis and treatment was carried out.
Vasculitis will always require steroids the way you have been prescribed. It is necessary and is not evil as depicted. it is life saving in your case. You are PR3 positive, this is a marker of small vessel vasculitis in your case by effective treatment you have been saved by expression of this disease in true sense.
The side effects are negligible compared to the effects.
You can contemplate pregnancy once your disease has settled and under strict supervision of rheumatologist.
1. Severity of the disease, this will be assessed by rheumatologist treating you, not at 1 frame of time but by constant evaluating you over months to years. However, your reports do not reflect and other organ affection, which is good news.
2. Can this disease be permanently Cured? This can be answered after some time. This is the most difficult question to answer as its decided by multiple factors like strict adherence to treatment, the treatment response. If there are no relapse or flare of disease over months, once the drugs are tapered - that will guide the outcome.

3. As the patient is on steroids, what are side effects?
Please Google or Wikipedia for the whole list but understand one thing. We have to choose between life and death. Common side ffects, weight gain, osteoporosis, hypertension and more heart attacks and diabetes

4. Can this disease have effect on internal organs
it may not affect as you donot have till date major organ involvement (internal organ is not correct terminology in vasculitis) i have given you hint that you have PR3 positivity this marker is seen with a serious disease called wegner's disease. i will call you lucky despite that you have a disease as you do not have internal/major organ involvement till now.if you take you medicines you are less likely to get major organ involvement. in medicine the questions answer will always be tricky and not straight yes or no.
when do you plan pregnancy? in near future you should not. if you attain sustainable remission for 2 years old patientand you are very small doses of drugs, you can contemplate pregnancy. outcome taking account 32 years old patientafter 2 years old patientand disease low then, would be fine.
Hope this helps, would be glad to discuss further.

Regards.


Patient replied :

Dear Doctor,
We may permitted to seek further clarifications for the following
1. In the event of patient conceiving inspite of all the precautions what would be the consequences such as
a. if the disease reoccur during pregnancy can she be treated with Steroids?
b. Is there a chance of infant getting deformities such as physical/mental etc
c. Is the disease fatal at any stage?
2. Is the disease vasculities heriditary?
Kindly arrange to clarify to enlighten we layman so as to enable us to assist the patient to lessen her pain.


Expert:  Dr. Bimlesh Dhar Pandey replied 2 Days.

Hello.
Thank you for the follow up.
I will start with this question Is the disease vasculities heriditary? No (simple logic the patient's father or mother did not have this disease, in there past) these disease are immunological disease not a hereditary disease
Is the disease fatal at any stage. it used to be very dangerous disease in past not anymore due to better understanding and better treatment. However stopping the treatment or poor adherence to treatment can make it a difficult disease.
child having any mental abnormality remote possibility of child having mental or physical problem theoretical yes and practical yes but the treatment offered is very good. Mycophenolate and steroid.
In case of pregnancy i will continue steroids and stop mmf/cellcept for first 3 months and restart cellcept or mmf however i will advise pregnancy once disease is well controlled and on low dose of steroids. We can start steroids in pregnancy but by the way why do you want to stop steroids at all its the single most important medicine. Plan pregnancy on low dose steroids rather jacking up the dose once disease is out of control during pregnancy.
Disease will flare during pregnancy if steroids are discontinued.
Hope this is helpful,
Regards.


Patient replied :

Hello.
Thank you for the follow up.
I will start with this question Is the disease vasculities heriditary? No (simple logic the patient's father or mother did not have this disease, in there past) these disease are immunological disease not a hereditary disease
Is the disease fatal at any stage. it used to be very dangerous disease in past not anymore due to better understanding and better treatment. However stopping the treatment or poor adherence to treatment can make it a difficult disease.
Child having any mental abnormality remote possibility of child having mental or physical problem theoretical yes and practical yes but the treatment offered is very good which is Mycophenolate and steroid.
In case of pregnancy i will continue steroids and stop mmf/cellcept for first 3 months and restart cellcept or mmf however i will advise pregnancy once disease is well controlled and on low dose of steroids. We can start steroids in pregnancy but by the way why do you want to stop steroids at all its the single most important medicine. Plan pregnancy on low dose steroids rather jacking up the dose once disease is out of control during pregnancy.
Disease will flare during pregnancy if steroids are discontinued.
Hope this is helpful,
Regards.



Dr. Bimlesh Dhar Pandey
Category: Internal Medicine Specialist
Experience: 
Senior Residency: Rhematology, All India Institute of Medical Schiences, New Delhi, 2009
Post Graduate, Junior Residency: MD (Internal Medicine), Rajendra Institute of Medical Sciences, Jharkhand, 2006
Residency: Physiology, Institute of Medical Science, Banaras Hindu University, Varanasi, 2003
Internship: Government Medical College, Trichur, 2001
Medical School: MBBS, Calicut University, 2001
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