Fulminant hepatitis and elevated levels of sIL-2R in thyroid storm

Summary We report the case of a 48-year-old man with thyroid storm associated with fulminant hepatitis and elevated levels of soluble interleukin-2 receptor (sIL-2R). Fatigue, low-grade fever, shortness of breath, and weight loss developed over several months. The patient was admitted to the hospital because of tachycardia-induced heart failure and liver dysfunction. Graves’ disease with heart failure was diagnosed. He was treated with methimazole, inorganic iodide, and a β-blocker. On the day after admission, he became unconscious with a high fever and was transferred to the intensive care unit. Cardiogenic shock with atrial flutter was treated with intra-aortic balloon pumping and cardioversion. Hyperthyroidism decreased over 10 days, but hepatic failure developed. He was diagnosed with thyroid storm accompanied by fulminant hepatitis. Laboratory investigations revealed elevated levels of sIL-2R (9770 U/mL). The fulminant hepatitis was refractory to plasma exchange and plasma filtration with dialysis, and no donors for liver transplantation were available. He died of hemoperitoneum and gastrointestinal hemorrhage due to fulminant hepatitis 62 days after admission. Elevated circulating levels of sIL-2R might be a marker of poor prognosis in thyroid storm with fulminant hepatitis. Learning points: The prognosis of thyroid storm when fulminant hepatitis occurs is poor. Liver transplantation is the preferred treatment for fulminant hepatitis induced by thyroid storm refractory to plasma exchange. Elevated levels of soluble interleukin-2 receptor might be a marker of poor prognosis in patients with thyroid storm.

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Interim Serum Soluble Interleukin-2 Receptor Levels Are Strongly Associated with Prognosis in Newly Diagnosis DLBCL Patients

Blood ◽

10.1182/blood-2019-122375 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4118-4118

Author(s):

Haruya Okamoto ◽

Akihiro Miyashita ◽

Hiroaki Nagata ◽

Yasuhiko Tsutsumi ◽

Yuri Kamitsuji ◽

...

Keyword(s):

Poor Prognosis ◽

Interleukin 2 ◽

B Cell Lymphoma ◽

Clinical Variable ◽

Rank Test ◽

Prognostic Impact ◽

Interleukin 2 Receptor ◽

Log Rank Test ◽

Soluble Interleukin 2 Receptor

<Background> Serum soluble interleukin-2 receptor (sIL2R) levels are often measured to evaluate the state of lymphoma. The serum sIL2R level at diagnosis has been reported to be correlated with the prognosis of diffuse large B cell lymphoma (DLBCL) patients treated with the R-CHOP regimen. However, it is unclear whether interim sIL2R levels are associated with prognosis in DLBCL. Here, we analyzed the prognostic impact of interim serum sIL2R levels in DLBCL. <Patients and Methods> We retrospectively examined data for DLBCL patients who started receiving chemotherapy at the Japanese Red Cross Society Kyoto Daini Hospital between January 2012 and December 2018. All of the patients received R-CHOP-like regimens (rituximab plus pirarubicin or adriamycin, cyclophosphamide, vincristine, and prednisolone). The interim sIL2R level (I-IL2R) was defined as the value measured after the third chemotherapy cycle. I-IL2R levels of >700 U/ml were regarded as positive. The primary endpoints of this study were progression-free survival (PFS) and overall survival (OS). The unadjusted probabilities of PFS and OS were estimated using the Kaplan-Meier method. The log-rank test and multivariate Cox regression analysis were used to assess the prognostic value of each clinical variable. <Results> In total, 102 patients were enrolled. The patients' median age was 73.5 years (range, 35-88), 58 patients (56.9%) were male, and 52 (51.0%) had poor revised International Prognostic Index scores. The median follow-up time was 25.2 months (range, 3.7-88.6). Twenty-three patients (22.5%) were I-IL2R-positive (>700 U/ml). Univariate analysis revealed that I-IL2R-positivity was associated with a poor prognosis. The 3-y PFS rates of the I-IL2R-negative (<700 U/ml) and I- IL2R-positive (>700 U/ml) patients were 60.4% (95% confidence interval [95%CI], 46.2-71.9) and 37.5% (95%CI, 15.7-59.4; p<0.001, log-rank test), respectively, and their 3-y OS rates were 82.2% (95%CI, 69.7-89.9) and 37.4% (95%CI, 13.8-61.4; p<0.001, log-rank test), respectively. Multivariate analysis confirmed that the I-IL2R level is independently associated with prognosis. <Conclusion> The I-IL2R level of >700 U/ml patients had poor prognosis. The I-IL2R level can be used to predict the outcomes of DLBCL patients. IL2R levels should be measured during chemotherapy, and I-IL2R-positive patients could be targeted with high-dose or novel therapies. As this study was based on a retrospective analysis and involved a small cohort and a limited follow-up period, further studies are needed to confirm the prognostic impact of I-IL2R. Figure Disclosures No relevant conflicts of interest to declare.

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Association of soluble interleukin‐2 receptor α and tumour necrosis factor receptor 1 with heart failure: The Multi‐Ethnic Study of Atherosclerosis

ESC Heart Failure ◽

10.1002/ehf2.12623 ◽

2020 ◽

Vol 7 (2) ◽

pp. 639-644

Author(s):

Hooman Bakhshi ◽

Vinithra Varadarajan ◽

Bharath Ambale‐Venkatesh ◽

Zahra Meyghani ◽

Mohammad R. Ostovaneh ◽

...

Keyword(s):

Heart Failure ◽

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Interleukin 2 ◽

Tumour Necrosis Factor Receptor ◽

Ethnic Study ◽

Interleukin 2 Receptor ◽

Soluble Interleukin 2 Receptor ◽

Necrosis Factor

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A case of thyroid storm with a markedly elevated level of circulating soluble interleukin-2 receptor complicated by multiple organ failure and disseminated intravascular coagulation syndrome

Endocrine Journal ◽

10.1507/endocrj.ej14-0073 ◽

2014 ◽

Vol 61 (7) ◽

pp. 691-696 ◽

Cited By ~ 3

Author(s):

Yoko Shimoda ◽

Tetsurou Satoh ◽

Hiroki Takahashi ◽

Akiko Katano-Toki ◽

Atsushi Ozawa ◽

...

Keyword(s):

Multiple Organ Failure ◽

Organ Failure ◽

Disseminated Intravascular Coagulation ◽

Elevated Level ◽

Interleukin 2 ◽

Multiple Organ ◽

Thyroid Storm ◽

Intravascular Coagulation ◽

Interleukin 2 Receptor ◽

Soluble Interleukin 2 Receptor

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Thyroid storm with delayed hyperbilirubinemia and severe heart failure: indication and contraindication of plasma exchange

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0036 ◽

2020 ◽

Vol 2020 ◽

Author(s):

Tomomi Nakao ◽

Ken Takeshima ◽

Hiroyuki Ariyasu ◽

Chiaki Kurimoto ◽

Shinsuke Uraki ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Plasma Exchange ◽

Hepatic Failure ◽

Severe Heart Failure ◽

Acute Hepatic Failure ◽

Therapeutic Plasma Exchange ◽

Thyroid Storm ◽

Serum Total Bilirubin ◽

List Type

Summary Thyroid storm (TS) is a life-threatening condition that may suffer thyrotoxic patients. Therapeutic plasma exchange (TPE) is a rescue approach for TS with acute hepatic failure, but it should be initiated with careful considerations. We present a 55-year-old male patient with untreated Graves’ disease who developed TS. Severe hyperthyroidism and refractory atrial fibrillation with congestive heart failure aggregated to multiple organ failure. The patient was recovered by intensive multimodal therapy, but we had difficulty in introducing TPE treatment considering the risk of exacerbation of congestive heart failure due to plasma volume overload. In addition, serum total bilirubin level was not elevated in the early phase to the level of indication for TPE. The clinical course of this patient instructed delayed elevation of bilirubin until the level of indication for TPE in some patients and also demonstrated the risk of exacerbation of congestive heart failure by TPE. Learning points: Our patient with thyroid storm could be diagnosed and treated promptly using Japan Thyroid Association guidelines for thyroid storm. Delayed elevation of serum bilirubin levels could make the decision of introducing therapeutic plasma exchange difficult in cases of thyroid storm with acute hepatic failure. The risk of worsening congestive heart failure should be considered carefully when performing therapeutic plasma exchange.

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High serum levels of soluble interleukin-2 receptor in acute myeloid leukemia: Correlation with poor prognosis and CD4 expression on blast cells

Cancer Epidemiology ◽

10.1016/j.canep.2012.03.011 ◽

2012 ◽

Vol 36 (5) ◽

pp. e306-e309 ◽

Cited By ~ 8

Author(s):

Kazunori Nakase ◽

Kenkichi Kita ◽

Taiichi Kyo ◽

Kota Tsuji ◽

Naoyuki Katayama

Keyword(s):

Acute Myeloid Leukemia ◽

Myeloid Leukemia ◽

Poor Prognosis ◽

Interleukin 2 ◽

Serum Levels ◽

High Serum ◽

Interleukin 2 Receptor ◽

Blast Cells ◽

Soluble Interleukin 2 Receptor ◽

Acute Myeloid

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Elevated soluble interleukin-2 receptor in childhood hemophagocytic histiocytic syndromes

Blood ◽

10.1182/blood.v73.8.2128.bloodjournal7382128 ◽

1989 ◽

Vol 73 (8) ◽

pp. 2128-2132 ◽

Cited By ~ 1

Author(s):

DM Komp ◽

J McNamara ◽

P Buckley

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Hairy Cell Leukemia ◽

Poor Prognosis ◽

Lymphoblastic Leukemia ◽

Interleukin 2 ◽

Hairy Cell ◽

Cell Leukemia ◽

Adult T Cell Leukemia ◽

Interleukin 2 Receptor ◽

Soluble Interleukin 2 Receptor

The serum of children with untreated hemophagocytic syndromes contains elevated levels (23,600 to 75,200 U/mL) of soluble interleukin-2 receptor (SIL2R) that returns toward normal with clinical improvement. These levels are in excess of levels previously reported for benign conditions. They are as high as levels reported for HTLV-1-associated adult T-cell leukemia (HATL) and hairy cell leukemia (HCL) in adults and some children with poor-prognosis non-T, non-B, acute lymphoblastic leukemia (ALL). Serum SIL-2R is a marker of disease activity that has the potential to identify infants at risk for the inherited form of the disease before the disease is clinically expressed.

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Elevated soluble interleukin-2 receptor in childhood hemophagocytic histiocytic syndromes

Blood ◽

10.1182/blood.v73.8.2128.2128 ◽

1989 ◽

Vol 73 (8) ◽

pp. 2128-2132 ◽

Cited By ~ 143

Author(s):

DM Komp ◽

J McNamara ◽

P Buckley

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Hairy Cell Leukemia ◽

Poor Prognosis ◽

Lymphoblastic Leukemia ◽

Interleukin 2 ◽

Hairy Cell ◽

Cell Leukemia ◽

Adult T Cell Leukemia ◽

Interleukin 2 Receptor ◽

Soluble Interleukin 2 Receptor

Abstract The serum of children with untreated hemophagocytic syndromes contains elevated levels (23,600 to 75,200 U/mL) of soluble interleukin-2 receptor (SIL2R) that returns toward normal with clinical improvement. These levels are in excess of levels previously reported for benign conditions. They are as high as levels reported for HTLV-1-associated adult T-cell leukemia (HATL) and hairy cell leukemia (HCL) in adults and some children with poor-prognosis non-T, non-B, acute lymphoblastic leukemia (ALL). Serum SIL-2R is a marker of disease activity that has the potential to identify infants at risk for the inherited form of the disease before the disease is clinically expressed.

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