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NCBI: db=pubmed; Term=vasculitis AND ((English[lang] OR French[lang]) AND adult[MeSH] AND "last 90 days"[PDat])
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Bevacizumab-induced immunoglobulin A vasculitis with nephritis: A case report.

ven, 29/11/2019 - 09:49
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Bevacizumab-induced immunoglobulin A vasculitis with nephritis: A case report.

Medicine (Baltimore). 2019 Nov;98(45):e17870

Authors: Endo Y, Negishi K, Hirayama K, Suzuki H, Shimizu A

Abstract
RATIONALE: Bevacizumab-an inhibitor of vascular endothelial growth factor-is effective against various advanced cancers. However, it is associated with the development of hypertension and high-grade proteinuria during thrombotic microangiopathy of the kidney. In addition, there are several reports of immunoglobulin A deposition in the glomeruli, but the etiology is unclear.
PATIENT CONCERNS: A 67-year-old Japanese man with metastatic rectal cancer underwent low anterior rectal resection, followed by treatment with bevacizumab and SOX (S-1 plus oxaliplatin). Six months later, the patient developed hematuria, nephrotic syndrome, and purpura.
DIAGNOSES: Renal biopsy revealed endocapillary proliferative glomerulonephritis. Immunofluorescence analyses showed granular mesangial deposition of galactose-deficient immunoglobulin A1. Skin biopsy revealed leukocytoclastic vasculitis.
INTERVENTIONS: We ceased bevacizumab treatment, while continuing the remaining chemotherapy regimen, as we suspected bevacizumab-induced nephropathy.
OUTCOMES: Proteinuria and purpura improved immediately after cessation of bevacizumab. We identified this as a case of bevacizumab-induced immunoglobulin A vasculitis with nephritis.
LESSONS: To our knowledge, this is the first case of bevacizumab-related immunoglobulin A vasculitis with nephritis, as evidenced by galactose-deficient immunoglobulin A1. When a patient's urine tests are abnormal during bevacizumab treatment, clinicians should consider not only thrombotic microangiopathy but also vasculitis.

PMID: 31702653 [PubMed - indexed for MEDLINE]

Co-occurrence of PLA2R-positive membranous nephropathy without crescents, and PR3-positive eosinophilic granulomatosis with polyangiitis
.

ven, 29/11/2019 - 09:49
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Co-occurrence of PLA2R-positive membranous nephropathy without crescents, and PR3-positive eosinophilic granulomatosis with polyangiitis
.

Clin Nephrol. 2019 Oct;92(4):208-215

Authors: Zhu Y, Chang Q, Cao X, Zheng S, Li P, Luan J, Zhou H

Abstract
Primary membranous nephropathy (PMN) is a common cause of adult nephrotic syndrome, most commonly associated with autoantibodies against M-type phospholipase A2 receptor (PLA2R). Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss syndrome, is a rare disorder characterized by asthma, eosinophilia, and multiorgan vasculitis. Here, we report the case of an adult who presented with typical nephrotic syndrome. Renal biopsy revealed PLA2R-positive PMN without crescents. He had a history of asthma, eczema, and eosinophilia, and testing revealed positive serological proteinase 3 (PR3) and antineutrophil cytoplasmic antibody (ANCA). Further skin and bone marrow biopsy revealed histologic eosinophilic infiltration, and a diagnosis of EGPA was made. The renal biopsy revealed a few eosinophils in glomerular capillary lumen and tubulointerstitial. Treatment with a glucocorticoid and cyclophosphamide was initiated. At 32 months after completing therapy, the patient was in complete clinical remission, and the PR3-ANCA result was negative.

PMID: 31347497 [PubMed - indexed for MEDLINE]

Trial of Apremilast for Oral Ulcers in Behçet's Syndrome.

mar, 26/11/2019 - 06:55
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Trial of Apremilast for Oral Ulcers in Behçet's Syndrome.

N Engl J Med. 2019 11 14;381(20):1918-1928

Authors: Hatemi G, Mahr A, Ishigatsubo Y, Song YW, Takeno M, Kim D, Melikoğlu M, Cheng S, McCue S, Paris M, Chen M, Yazici Y

Abstract
BACKGROUND: The small-molecule phosphodiesterase 4 inhibitor apremilast modulates cytokines that are up-regulated in Behçet's syndrome. In a phase 2 trial involving patients with Behçet's syndrome, apremilast reduced the incidence and severity of oral ulcers. Data on the efficacy and safety of apremilast in patients with Behçet's syndrome who had active oral ulcers and had not previously received biologic agents are limited.
METHODS: In a phase 3 trial, we randomly assigned, in a 1:1 ratio, patients who had Behçet's syndrome with active oral ulcers but no major organ involvement to receive either apremilast at a dose of 30 mg or placebo, administered orally, twice daily for 12 weeks, followed by a 52-week extension phase. The primary end point was the area under the curve (AUC) for the total number of oral ulcers during the 12-week placebo-controlled period (with lower values indicating fewer ulcers). There were 13 secondary end points, including complete response of oral ulcers, change from baseline in pain associated with oral ulcers, disease activity, and change from baseline in the Behçet's Disease Quality of Life score (range, 0 to 30, with higher scores indicating greater impairment in quality of life). Safety was also assessed.
RESULTS: A total of 207 patients underwent randomization (104 patients to the apremilast group and 103 to the placebo group). The AUC for the number of oral ulcers was 129.5 for apremilast, as compared with 222.1 for placebo (least-squares mean difference, -92.6; 95% confidence interval [CI], -130.6 to -54.6; P<0.001). The change from baseline in the Behçet's Disease Quality of Life score was -4.3 points in the apremilast group, as compared with -1.2 points in the placebo group (least-squares mean difference, -3.1 points; 95% CI, -4.9 to -1.3). Adverse events with apremilast included diarrhea, nausea, and headache.
CONCLUSIONS: In patients with oral ulcers associated with Behçet's syndrome, apremilast resulted in a greater reduction in the number of oral ulcers than placebo but was associated with adverse events, including diarrhea, nausea, and headache. (Funded by Celgene; ClinicalTrials.gov number, NCT02307513.).

PMID: 31722152 [PubMed - indexed for MEDLINE]

[New concepts in giant cell arteritis].

sam, 23/11/2019 - 03:54
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[New concepts in giant cell arteritis].

Presse Med. 2019 Sep;48(9):917-918

Authors: Samson M, Bonnotte B

PMID: 31564552 [PubMed - indexed for MEDLINE]

Rituximab-induced vasculitis: Does the immune complex of rituximab play a key role in developing paradoxical adverse events?

sam, 16/11/2019 - 23:14
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Rituximab-induced vasculitis: Does the immune complex of rituximab play a key role in developing paradoxical adverse events?

J Dermatol. 2019 09;46(9):e311-e312

Authors: Abe K, Itoh M, Asahina A

PMID: 30969435 [PubMed - indexed for MEDLINE]

Successful control of severe eosinophilic granulomatosis with polyangiitis in a pregnancy and perinatal period: A use of mepolizumab.

sam, 16/11/2019 - 23:14
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Successful control of severe eosinophilic granulomatosis with polyangiitis in a pregnancy and perinatal period: A use of mepolizumab.

J Dermatol. 2019 09;46(9):e309-e311

Authors: Kasuya A, Kitano S, Hoshino T, Ishibe JI, Imura K, Goto H, Miyazawa H, Fujiyama T, Takeo N, Tokura Y

PMID: 30932239 [PubMed - indexed for MEDLINE]

Cutaneous sarcoidosis with livedo-like manifestation.

mer, 13/11/2019 - 20:04
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Cutaneous sarcoidosis with livedo-like manifestation.

An Bras Dermatol. 2019;94(4):493-494

Authors: Bittencourt MJS, Anjos ABD, Brito FCOCA, Unger DAA

PMID: 31644635 [PubMed - indexed for MEDLINE]

Analysis of the B cell receptor repertoire in six immune-mediated diseases.

mer, 13/11/2019 - 20:04
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Analysis of the B cell receptor repertoire in six immune-mediated diseases.

Nature. 2019 10;574(7776):122-126

Authors: Bashford-Rogers RJM, Bergamaschi L, McKinney EF, Pombal DC, Mescia F, Lee JC, Thomas DC, Flint SM, Kellam P, Jayne DRW, Lyons PA, Smith KGC

Abstract
B cells are important in the pathogenesis of many, and perhaps all, immune-mediated diseases. Each B cell expresses a single B cell receptor (BCR)1, and the diverse range of BCRs expressed by the total B cell population of an individual is termed the 'BCR repertoire'. Our understanding of the BCR repertoire in the context of immune-mediated diseases is incomplete, and defining this could provide new insights into pathogenesis and therapy. Here, we compared the BCR repertoire in systemic lupus erythematosus, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, Crohn's disease, Behçet's disease, eosinophilic granulomatosis with polyangiitis, and immunoglobulin A (IgA) vasculitis by analysing BCR clonality, use of immunoglobulin heavy-chain variable region (IGHV) genes and-in particular-isotype use. An increase in clonality in systemic lupus erythematosus and Crohn's disease that was dominated by the IgA isotype, together with skewed use of the IGHV genes in these and other diseases, suggested a microbial contribution to pathogenesis. Different immunosuppressive treatments had specific and distinct effects on the repertoire; B cells that persisted after treatment with rituximab were predominately isotype-switched and clonally expanded, whereas the inverse was true for B cells that persisted after treatment with mycophenolate mofetil. Our comparative analysis of the BCR repertoire in immune-mediated disease reveals a complex B cell architecture, providing a platform for understanding pathological mechanisms and designing treatment strategies.

PMID: 31554970 [PubMed - indexed for MEDLINE]

Ulcerative intestinal tuberculosis case as a complication of treatment by infliximab for intestinal Behçet's disease: A case report.

dim, 10/11/2019 - 18:42
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Ulcerative intestinal tuberculosis case as a complication of treatment by infliximab for intestinal Behçet's disease: A case report.

Medicine (Baltimore). 2019 Oct;98(43):e17652

Authors: Shen Y, Ma HF, Yang YL, Guan JL

Abstract
RATIONALE: Intestinal Behçet's disease (BD) is characterized by intestinal ulcerations and gastrointestinal symptoms. Ulcerative intestinal tuberculosis (TB) is usually with dyspepsia, abdominal pain, vomiting, and weight loss. The 2 diseases exhibit similar clinical manifestations, but the most critical aspects of their clinical courses and required treatments are not at all similar.
PATIENT CONCERNS: We present a case in which a patient with intestinal Behçet's disease developed a de novo ulcerative intestinal TB infection after the start of anti-tumor necrosis factor-α treatment. This was despite histopathologic examination without caseous necrosis granuloma and negative for acid-fast staining and latent TB screen.
DIAGNOSES: Intestinal Behçet's disease and intestinal TB.
INTERVENTIONS: The patient was treated with quadruple antituberculous chemotherapy, comprising rifapentine, isoniazid, ethambutol, and pyrazinamide.
OUTCOMES: At follow-up about 3 months, the therapy of oral antituberculous drugs and thalidomide was continued and the patient's condition had stabilized.
LESSONS: This case illustrates the importance of closely monitoring patients who are on infliximab for possible onset of TB, even without abdominal symptoms, and with negative screening results for latent TB.

PMID: 31651888 [PubMed - indexed for MEDLINE]

Brain pseudotumour secondary to Behçet's disease.

dim, 10/11/2019 - 18:42
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Brain pseudotumour secondary to Behçet's disease.

Ann R Coll Surg Engl. 2019 Nov;101(8):e164-e168

Authors: Mousa AE, Okasha M, Isaacs JD, Price DA, Bhatnagar P, Joshi A, Surash S

Abstract
Neuro-Behçet's disease (NBD) is a serious manifestation of Behçet's disease (BD) and can affect either the central or peripheral nervous systems, or both. It occurs in 10-50% of patients with BD. We report on a patient with an unusual intraparenchymal lesion, initially thought to be a brain tumour. Histological examination revealed vasculitis consistent with BD. Clinicians should include NBD as a differential diagnosis when considering an isolated inflammatory intracranial lesion.

PMID: 31537109 [PubMed - indexed for MEDLINE]

TIM-3 genetic variants and risk of Behçet disease in the Iranian population.

ven, 01/11/2019 - 13:10
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TIM-3 genetic variants and risk of Behçet disease in the Iranian population.

An Bras Dermatol. 2019;94(4):429-433

Authors: Ataei M, Behfarjam F, Jadali Z

Abstract
BACKGROUND: Behçet disease is a prototypical systemic autoimmune disease, caused by a complex interplay between environmental and genetic factors. The transmembrane immunoglobulin and mucin domain-3 (TIM-3) is a distinct member of the TIM family that is preferentially expressed on Th1 cells and plays a role in Th1-mediated autoimmune or inflammatory diseases, such as Behçet disease.
OBJECTIVE: The aim of this study was to test the potential association between TIM-3 gene polymorphisms and Behçet disease.
METHODS: Two single-nucleotide polymorphisms of TIM-3 (rs9313439 and rs10515746) were genotyped in 212 patients with Behçet disease and 200 healthy controls. Typing of the polymorphisms was performed using multiplex PCR amplification.
RESULTS: There were no significant differences in allele and genotype frequencies between the Behçet disease patients and controls who were successfully genotyped. Similar results were also found after stratification by gender, age, or clinical features.
STUDY LIMITATIONS: Lack of studies on various racial or ethnic groups and small sample size.
CONCLUSION: This study failed to demonstrate any association between the tested TIM-3 polymorphisms and Behçet disease.

PMID: 31644615 [PubMed - indexed for MEDLINE]

Cognitive deficits in vasculitis of the nervous system: a cross-sectional study.

sam, 26/10/2019 - 10:17
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Cognitive deficits in vasculitis of the nervous system: a cross-sectional study.

Postgrad Med. 2019 Sep;131(7):546-549

Authors: Mullin E, Aristotelidou V, Blackburn D, Jenkins T, Hadjivassiliou M

Abstract
Objectives: To identify the cognitive and functional deficits in a well-characterized group of patients with vasculitis of the nervous system. Methods: Sixty-seven patients diagnosed with Central Nervous System (CNS) or Peripheral nervous System (PNS) vasculitis over a 14-year period were retrospectively identified. Data on clinical presentation, laboratory, radiographic and tissue biopsy investigations, and treatment were collated. Cognitive, functional and quality of life evaluation assessments were performed in 31 patients who agreed to participate and included Addenbrooke's Cognitive Examination-revised (ACE-R), Nottingham Extended Activities of Daily Living (NEADL) and EQ-5D-3L quality of life questionnaires. Results: CNS vasculitis patients exhibited cognitive impairment, with a mean ACE-R score of 74/100 (standard deviation (SD) 16). NEADL and EQ-5D-3L scores were in the impaired range at 41/66 (SD 21) and 57/81 (SD 22), respectively. Patients with just PNS vasculitis exhibited fewer cognitive deficits with ACE-R and NEADL scores of 87 (SD 8) and 46 (SD 16) respectively. EQ-5D-3L score was in the impaired range of 65 (SD 22). Conclusions: Vasculitis of the nervous system and, in particular, CNS vasculitis causes cognitive impairment and deficits in functional ability. Such patients should be targeted for cognitive rehabilitation.

PMID: 31483199 [PubMed - indexed for MEDLINE]

Characteristics and prognosis of IgG4-related periaortitis/periarteritis: A systematic literature review.

sam, 26/10/2019 - 10:17
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Characteristics and prognosis of IgG4-related periaortitis/periarteritis: A systematic literature review.

Autoimmun Rev. 2019 Sep;18(9):102354

Authors: Akiyama M, Kaneko Y, Takeuchi T

Abstract
OBJECTIVE: Immunoglobulin G4 (IgG4)-related disease is a systemic chronic fibroinflammatory disease that can affect almost every organ of the body. IgG4-related periaortitis/periarteritis is a newly recognized subset of IgG4-related disease, and its characteristics and prognosis remain unclear. We investigated the clinical characteristics and prognosis of IgG4-related periaortitis/periarteritis.
METHODS: We performed a systematic literature review of IgG4-related periaortitis/periarteritis. Additionally, we have summarized the characteristics and prognosis of IgG4-related coronary arteritis.
RESULTS: We investigated 248 patients with IgG4-related periaortitis/periarteritis. All studies reported the condition in elderly patients, and male predominance was observed. The infra-renal abdominal aorta and iliac arteries were the most commonly affected sites. Most reports showed the serum C-reactive protein elevation in this disease entity, in contrast to non-vascular IgG4-related disease. Based on radiological findings observed in 27 patients with IgG4-related coronary arteritis, vasculitic lesions were classified into 3 types: stenotic (67% of patients), aneurysmal (42%), and diffuse wall thickening type (92%). Serum IgG4 level, but not C-reactive protein level, was associated with the number of affected organs in IgG4-related coronary arteritis. Corticosteroid treatment with or without cardiac surgery or percutaneous coronary intervention was effective in most patients with IgG4-related coronary arteritis; however, 33% of patients showed an unfavorable clinical course including disease progression, relapse, or death. Pre-treatment stenosis and/or aneurysms were associated with progression of stenosis or aneurysm after corticosteroid treatment.
CONCLUSION: Most clinical characteristics were similar between the IgG4-related periaortitis/periarteritis and the non-vascular IgG4-related disease groups; however, serum C-reactive protein level elevation was observed only in the former. Although corticosteroid treatment was effective, this disease can be life-threatening secondary to myocardial infarction, aortic dissection, and aneurysmal rupture. Pre-treatment evaluation of stenosis or aneurysms is important for predicting progression of stenosis or aneurysm after corticosteroid treatment.

PMID: 31323364 [PubMed - indexed for MEDLINE]

Assessment of Disease Activity in Takayasu Arteritis: Potential Role of Contrast-Enhanced Ultrasound.

sam, 26/10/2019 - 10:17
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Assessment of Disease Activity in Takayasu Arteritis: Potential Role of Contrast-Enhanced Ultrasound.

Ultraschall Med. 2019 Oct;40(5):638-645

Authors: Lottspeich C, Dechant C, Köhler A, Tischler M, Treitl KM, Treitl M, Schulze-Koops H, Hoffmann U, Czihal M

Abstract
PURPOSE:  To assess the diagnostic value of intima media thickness measurements and contrast-enhanced ultrasound (CEUS) of the supraaortic arteries in the assessment of disease activity in Takayasu arteritis (TA).
MATERIALS AND METHODS:  Patients with TA and involvement of the carotid and/or subclavian/axillary arteries underwent CEUS imaging in addition to B-mode and color duplex ultrasound. The maximum IMT (mIMT) was measured and high-resolution CEUS of the most prominently thickened vessel segment was performed. Two blinded readers reviewed the CEUS movies, with semiquantitative assessment of microbubble enhancement of the arterial wall (grade 0: no or minimal; grade 1: moderate; grade 2: pronounced). Clinical symptoms, acute phase reactants, and established indices of clinical disease activity (NIH criteria, ITAS score) were recorded.
RESULTS:  40 examinations in 17 patients were analyzed. According to clinical judgement, 27 and 13 cases were classified as clinically inactive and active, respectively. An mIMT-cutoff of > 2.7 mm identified active disease with a sensitivity and specificity of 69.2 % and 88.9 %, respectively (area under the curve 0.83). The interobserver agreement of CEUS analysis was substantial (Cohen's kappa 0.76). By consensus reading, 17, 15, and 8 cases were classified as uptake grade 0, grade 1 and grade 2, respectively. Grade 0 uptake was exclusively present in 17 clinically inactive patients. Grade 1 uptake was seen in 10 patients with clinically inactive disease and 5 patients with clinically active disease. Grade 2 uptake was exclusively present in 8 patients with active disease.
CONCLUSION:  Both sonographic IMT measurements and high-resolution CEUS are promising in the ad-hoc assessment of disease activity in patients with TA.

PMID: 30674040 [PubMed - indexed for MEDLINE]

Upper gastrointestinal hemorrhage and thoracic aortic aneurysm rupture as presenting signs of Behçet disease: A case report.

dim, 20/10/2019 - 07:54
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Upper gastrointestinal hemorrhage and thoracic aortic aneurysm rupture as presenting signs of Behçet disease: A case report.

Medicine (Baltimore). 2019 Oct;98(41):e17455

Authors: Yu LF, Guo LW, He JP, Yang B, Chen CH, Jin J

Abstract
INTRODUCTION: Behçet disease (BD) is an autoimmune disorder characterized by oral aphthosis, genital aphthosis, ocular lesions, and arthritis. However, other fatal complications are often misdiagnosed, which implies that the early diagnosis of the disease is important for a good prognosis.
PATIENT CONCERNS: A 51-year-old man complained of hematemesis for 5 hours and syncope once.
DIAGNOSIS: BD as demonstrated by esophageal ulcer and aortic aneurysm rupture.
INTERVENTIONS: Surgeries were conducted to repair the thoracic aortic aneurysm, proton-pump inhibitor was used to reduce acid secretion, antibiotics were applied for anti-infective therapy, and immunosuppressor was administered to control the injuries of BD.
OUTCOMES: The patient was discharged and his medication dosage was reduced gradually until the minimum maintenance dose. In the follow-ups, the gastric ulcer and vascular aneurysm were not found.
CONCLUSION: We presented a rare case of BD with the concurrence of huge esophageal ulcer and thoracic aortic aneurysms rupture, which helped us to diagnose BD at the early stage, while confronting atypical manifestations.

PMID: 31593102 [PubMed - indexed for MEDLINE]

Severe transient left ventricular dysfunction in a patient with Legionella pneumophila pneumonia.

dim, 20/10/2019 - 07:54
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Severe transient left ventricular dysfunction in a patient with Legionella pneumophila pneumonia.

Pol Merkur Lekarski. 2019 Jul 29;47(277):19-24

Authors: Elikowski W, Małek-Elikowska M, Greberska W, Fertała N, Zawodna M, Marchlewska J, Dudziak J

Abstract
Legionella pneumophila infection (legionellosis) usually presents as a multisystemic disease, predominantly affecting the lungs (Legionnaires' disease - LD). Immunodeficiency, chemotherapy or chronic steroids use increase the risk of developing LD. Extrapulmonary manifestations of LD include cardiac complications: myocarditis, pericarditis or endocarditis.
A CASE REPORT: The authors describe a case of a 51-year-old female with a history of cryoglobulinemic vasculitis, Sjögren syndrome and chronic lymphocytic leukemia who was admitted due to a high fever, fatigue, tachycardia, dyspnea and cough. Chest X-ray and CT showed bilateral pulmonary infiltrations and pleural effusion. LD was diagnosed on positive L. pneumophila urinary antigen test. Echocardiography revealed severe left ventricular (LV) dysfunction with substantially decreased ejection fraction and global longitudinal strain (GLS), with a pattern resembling reverse takotsubo syndrome (rTTS). The coronary arteries in non-invasive coronary angiography were normal. During therapy with levofloxacin and intravenous immunoglobulins as well as with carvedilol, ramipril and diuretics, gradual clinical improvement with complete normalization of LV function was observed within 5 weeks. Cardiac magnetic resonance (CMR) performed on day 35 revealed only small intramural foci of late gadolinium enhancement (LGE) with localization not corresponding to the most decreased regional longitudinal strain in the initial echocardiographic examination. The authors suggest that the mechanism of transient LV dysfunction in the case presented may have been of complex nature, including LD myocarditis and stress-induced cardiomyopathy (with the prevalence of the latter) which has not so far been reported in the literature.

PMID: 31385942 [PubMed - indexed for MEDLINE]

[Contribution of Doppler ultrasound for the diagnosis of giant cell arteritis].

dim, 20/10/2019 - 07:54
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[Contribution of Doppler ultrasound for the diagnosis of giant cell arteritis].

Presse Med. 2019 Sep;48(9):941-947

Authors: Rinagel M, Chatelus E, Arnaud L, Jousse-Joulin S

Abstract
Ultrasound is a useful imaging modality for the diagnosis of giant cell arteritis. Ultrasound of temporal arteries is recommended as the first imaging modality in patients with suspected predominantly cranial giant cell arteritis. The thickening of the arterial wall (halo sign) is the ultrasound finding most suggestive of giant cell arteritis. In patients in whom there is a high clinical suspicion of giant cell arteritis and a halo sign, the diagnosis of giant cell arteritis may be made without temporal artery biopsy.

PMID: 31327543 [PubMed - indexed for MEDLINE]

[Salmonella aortitis in an elderly patient : clinical case and review of the literature].

jeu, 17/10/2019 - 06:09
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[Salmonella aortitis in an elderly patient : clinical case and review of the literature].

Rev Med Suisse. 2019 Sep 04;15(661):1574-1577

Authors: Pantelakis L, Rarogova J, Troillet N, Abbet P

Abstract
Gastroenteritis due to non-typhoidal Salmonella (NTS) is usually considered as a benign infection. NTS can nevertheless cause severe diseases with high mortality. Invasive NTS infections may present as bacteremia without other manifestations, particularly in immunocompromised hosts. They may also correspond to extra-digestive infections in various body sites. Patients with cardiovascular diseases are at risk for endovascular infections, aortitis being the most frequent. These infections are difficult to diagnose and require surgery.

PMID: 31496191 [PubMed - indexed for MEDLINE]

Behcets Syndrome with a Rare Manifestation.

ven, 11/10/2019 - 03:51
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Behcets Syndrome with a Rare Manifestation.

J Assoc Physicians India. 2019 Aug;67(8):77-79

Authors: Taparia N, Dhadke V

Abstract
We report a case of a 25 year old patient with history of recurrent oral aphthous ulcers and genital ulcers and phylectenular conjunctivitis presenting to us with sudden onset of cough and difficulty in breathing diagnosed as Behcets disease with pulmonary embolism. A rapid and precise diagnosis and treatment of this patient led to good recovery of this patient. Pulmonary thromboembolism is a rare complication of Behcets disease.

PMID: 31562726 [PubMed - indexed for MEDLINE]

Clinical Profile, Risk Factors and Outcomes in Patients with Cerebral Venous Sinus Thrombosis: A Study from Western India.

ven, 11/10/2019 - 03:51
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Clinical Profile, Risk Factors and Outcomes in Patients with Cerebral Venous Sinus Thrombosis: A Study from Western India.

J Assoc Physicians India. 2019 Sep;67(9):49-53

Authors: Ramrakhiani N, Sharma DK, Dubey R, Gupta P, Sharma A, Sharma KK

Abstract
Aim: Study of cause and clinical profile of venous sinus thrombosis in Western India.
Settings and Design: A retrospective study was conducted to ascertain the clinical profile, etiology, and follow up of patients with venous sinus thrombosis.
Methods and Material: Hospital database of patients suffering from venous sinus thrombosis from two tertiary care hospitals in West India were studied. A telephonic follow up was taken for assessment of outcome. Inclusion criteria were a) Age more than 15 years of age b) clinically symptomatic patients c) Diagnosis confirmed by Magnetic resonance Venography (MRV) or CT Venography (CT Venography) Exclusion criteria: Patients with infarct in arterial territory, hypertensive hemorrhage, metabolic encephalopathy and eclampsia were excluded from the study.
Statistical analysis used: Descriptive statistic was performed as frequency, mean and standard deviation or percentages. Difference in continuous variables was evaluated by using independent t-test while chi-square test was performed in categorical variables. Statistical P<0.05 was considered statistically significant.
Results: We conducted a retrospective study of patients with venous sinus thrombosis in Rajasthan in western India. Out of 71 patients in our study group the mean age of presentation was 36.64 years. 42 patients were male (59.2%) and 29 were female (40.8%). Only 9 patients (12.6%) had pregnancy or puerperium related venous sinus thrombosis. The most common presenting feature was headache 47/71(66.2), followed by seizures 33 (46.5%), paresis 20/71 (28.16%) and coma 15/71(21.1%). MRI Brain recorded infarcts in 32/71 patients and predominant hemorrhage was recorded in 34/71. 4 cases were associated with malignancy (one CNS, one outside CNS and 2 hematological). Raised homocysteine level was found in 26/35 (74.3%) patients in whom they were measured. 9 patients had moderately elevated homocysteine levels (15-30), another 9 had intermediate values (31-64) and 5 patients had elevated homocysteine level >65. Hyperhomocysteinemia was the commonest causative factor and was far more common in men (21/25) than in women (5/10). (p value 0.019). 24 out of 71 patients were found to be anemic (33.8%). Anemia was far more common in women than in men. (p value .002). Protein C level was found abnormal in 5/27 patients, Protein S in 6/27 patients and Anti thrombin III in 1/23 patient studied respectively. History of oral contraceptive intake was recorded in only a minority of women with venous sinus thrombosis 7(24.1%) compared to the western data where most of the venous sinus thrombosis are related to the contraceptive pills.
Conclusion: The clinical presentation of venous sinus thrombosis in tertiary care centers is changing outside the traditional peurperium / pregnancy related venous sinus thrombosis. Common risk factors include hyperhomocysteinemia, anemia, coagulopathy, pregnancy related, vasculitis, malignancy and oral contraceptive usage. Male involvement was far more common than females and was usually associated with a higher level of homocysteine.

PMID: 31561690 [PubMed - indexed for MEDLINE]

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