2022 Volume 54 Issue 1 Pages 34-38
Objective: Low-dose ACTH therapy is recommended for epileptic spasms (ES) to reduce side effects ; however, infections are still a serious side effect of ACTH therapy. We studied the clinical characteristics of infectious complication during ACTH therapy. Methods: Patients with ES who had infectious complication during ACTH therapy in Division of Neurology, Saitama Children’s Medical Center, between November 2007 and October 2019 were selected. We retrospectively reviewed the medical records and investigated the frequency and clinical characteristics of the infectious complications. Results: ACTH therapies were performed in 85 patients, of which nine (10.6%) had infectious complication. Two patients experienced two different infections during ACTH therapy (11 episodes of infection in total). The median age at initiation of ACTH therapy was 8 months (ranging from 5-28 months), and six patients were males. The detected infectious agents were : adenovirus in 2 episodes, norovirus, RS virus, cytomegalovirus reactivation, Enterococcus faecalis, and Candida albicans in 1 episode each. Infectious agents were not identified in the remaining 4 episodes. ACTH therapy was discontinued in two patients. One of these patients showed somnolence and transient tachycardia after increasing the dose of ACTH ; however, the therapy was continued because of the underestimation of patient severity due to afebrile condition and lack of inflammatory findings in the blood test. The treatment was discontinued on the 16th day of ACTH therapy, because of the diagnosis of septic urinary tract infection due to Enterococcus faecalis. Conclusions: Even in low-dose ACTH therapy, infectious disease is not a rare side effect. Physicians should consider the effect of ACTH on clinical infectious symptoms and laboratory findings, which cause underestimation of the severity.
