Person: KUTLU, NURETTİN ONUR
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- PublicationOpen AccessThe role of plasma exchange in acute liver failure of autoimmune etiology(2021-03-01T00:00:00Z) Gokce, Selim; Cermik, Banu Bal; KUTLU, NURETTİN ONUR; Ocak, Ilhan; KUTLU, NURETTİN ONURBackground: Autoimmune hepatitis (AIH) is characterized by increased immunoglobulin G (IgG) levels, the presence of autoantibodies, and various degrees of lymphocyte predominant inflammation and fibrosis histologically. Immunosuppressive therapy induces remission in approximately 80% of those affected. However, liver transplantation is indicated in patients with acute liver failure with encephalopathy at presentation. Liver supporting systems, including plasma exchange (PE) allow bridging patients to transplantation or spontaneous recovery in the setting of liver failure. The role of these systems has not been assessed in children with liver failure of autoimmune etiology. Case: Herein, we report three cases of AIH with fulminant presentation, with marked symptom resolution with PE as an adjunct therapeutic option to immunosuppressive treatment. Conclusion: In the setting of AIH, PE may have a special therapeutic role by removing autoantibodies and cytokines, therefore preventing further liver damage and decompensation, and allowing time for recovery.
- PublicationMetadata onlyA Rare Presentation of Neurobrucellosis in a 6-Year-Old Pediatric Patient with Sagittal Sinus Thrombosis(2020-10-01T00:00:00Z) TÜREL, Özden; KUTLU, NURETTİN ONUR; YEŞİLBAŞ, Osman; Yozgat, Can Yilmaz; DÜNDAR, TOLGA TURAN; BURSAL DURAMAZ, BURCU; UZUNER, SELÇUK; ABDİLLAHİ, FATOUMA KHALİF; TÜREL, ÖZDEN; UZUNER, SELÇUK; BURSAL DURAMAZ, BURCU; DÜNDAR, TOLGA TURAN; SEYİTHANOĞLU, MEHMET HAKAN; YEŞİLBAŞ, OSMAN; KUTLU, NURETTİN ONURBrucellosis is one of the most common zoonosis worldwide. It is still endemic in many regions of the world. A 6-year-old female was admitted to the emergency department (ED) due to a sudden change in consciousness, urinary incontinence, vomiting, and difficulty in walking. Neurological examination demonstrated abducens nerve paralysis, mild-to-moderate motor deficit in hemiparesis in the left arm. Brain magnetic resonance imaging showed a hemorrhagic focus at the right frontal lobe and thrombosis in the superior sagittal sinus of the brain. The diagnosis of neurobrucellosis was confirmed by identifying Brucella spp. in the blood culture on the day 6 of pediatric intensive care unit admission; thus, trimethoprim-sulfamethoxazole and rifampicin, and ceftriaxone were promptly initiated. Despite neuroprotective management and acetazolamide, the patient-s neurological problems and high intracranial pressure (ICP) persisted. An external ventricular drainage tube and a Codman ICP monitor were placed to be on the consent vigilance of the patient-s neurological condition. The patient-s ICP continued to increase despite the current treatment regimen; therefore, a decompressive bitemporal craniectomy was performed. The ICP level of the patient returned to its normal range immediately after the craniectomy. The patient did not have any notable neurologic sequelae at the first-year follow-up. Neurobrucellosis is a rare complication of systemic brucellosis and may present as meningitis, encephalitis, myelitis, radiculitis, and/or neuritis. Herein, we describe a six-year-old girl with brucellosis complicated with cerebral vein thrombosis. This case illustrates the need for close monitoring of patients with unexplained neurological signs or symptoms for brucellosis in endemic areas.